Community health centers (FQHCs): what they are and what they cost
An FQHC, or federally qualified health center, is a community clinic that meets federal rules and sees people with or without insurance. It charges on a sliding scale based on income. With income at or below the 2026 poverty guideline (aspe.hhs.gov), $15,960 a year for one person in most states, you get a full discount. A small fee may apply.
What is an FQHC?
FQHC stands for federally qualified health center. It is the legal name for a community health center that meets federal rules. These clinics see people with or without insurance. What you pay is based on your income and the size of your family.
Under federal law, these are the main kinds of FQHCs (42 U.S.C. 1396d(l)(2)(B) (law.cornell.edu)):
- Health centers with HRSA grants. HRSA is the Health Resources and Services Administration, a federal health agency. The grants come from Section 330 of the Public Health Service Act. Clinics that get this grant money through a contract with a grantee also count.
- Look-alikes. These clinics meet all the same program rules, but they get no HRSA grant money (HRSA, look-alikes (bphc.hrsa.gov)).
- Some tribal and urban Indian clinics. Certain outpatient programs run by tribes or urban Indian groups also count.
HRSA says it funds about 1,400 health centers. Together they run more than 16,000 sites in every state, DC and the U.S. territories (HRSA, About the Health Center Program (bphc.hrsa.gov)). In 2025, health centers served more than 32.7 million people (HRSA, 2025 impact (bphc.hrsa.gov)).
Every HRSA health center must have a board where most members are patients. It must also serve everyone, even people who cannot pay (HRSA, What is a health center? (bphc.hrsa.gov)).
What you pay, cheapest first
Health centers charge on a sliding scale based on income; some visits cost little or nothing. A sliding scale means the price goes down as your income goes down. It covers each service in the center's HRSA program that has its own fee, such as a medical or dental visit. The rules below come from HRSA's sliding fee chapter (bphc.hrsa.gov).
Full discount
- Who qualifies
- Households with income at or below 100% of the federal poverty guideline.
- What it costs
- Little or nothing. The center may charge a small flat fee. That fee must be less than what people in the next income group pay.
- How to get it
- Ask for the sliding fee form when you sign up. Bring proof of income.
Medicaid or CHIP
- Who qualifies
- Medicaid and CHIP are free or very low cost for people who qualify. Rules depend on your state, income and household size.
- What it costs
- Your state sets any copays. Health centers must take Medicaid and CHIP.
- How to get it
- Apply on your state's official site or through HealthCare.gov. You can apply any time of year. Many health centers have staff who can help you apply.
Partial discount
- Who qualifies
- Households with income above 100% and up to 200% of the guideline.
- What it costs
- A reduced fee. The less you earn, the lower it is. Each center sets its own price steps and must have at least three.
- How to get it
- The same sliding fee form places you in a price step.
Regular fee
- Who qualifies
- Households with income above 200% of the guideline.
- What it costs
- The center's regular price. The sliding fee stops at 200%. But every center must have a written policy on when it will lower or waive fees for people who can't pay.
- How to get it
- Ask for the price before your visit. Ask if the center offers a payment plan. If you can't pay, ask for the policy on lowering fees (HRSA, billing rules (bphc.hrsa.gov)).
Medicines, glasses and dentures can cost extra. If the center charges for them, it must tell you the price before you get them (HRSA, billing rules (bphc.hrsa.gov)).
Who qualifies for the sliding fee: 2026 dollar limits
The discount depends only on your income and family size. The yardstick is the federal poverty guideline, a yearly income amount that HHS sets. People often call it the federal poverty level, or FPL. Health centers must use the newest guidelines. These are the 2026 limits for households of one to four:
| Household size | Full discount (at or below 100% of poverty) | Sliding discount (up to 200% of poverty) |
|---|---|---|
| 1 | $15,960 | $31,920 |
| 2 | $21,640 | $43,280 |
| 3 | $27,320 | $54,640 |
| 4 | $33,000 | $66,000 |
- Full discount (at or below 100% of poverty): Full discount; the center may charge a small nominal fee.
- Sliding discount (up to 200% of poverty): Discount based on income and family size; no discount is required above 200%.
Alaska and Hawaii use higher guidelines. For one person in 2026, the 100% amount is $19,950 in Alaska and $18,360 in Hawaii (HHS, 2026 poverty guidelines (aspe.hhs.gov)).
Most patients fall in this range. In 2025, about 9 in 10 health center patients whose income was known were at or below 200% of the guideline (HRSA UDS 2025, national (data.hrsa.gov)).
Two worked examples
A single adult in Ohio earns $15,000 a year. The 2026 guideline for one person is $15,960. This person is under that line, so they get the full discount. They may still pay the small flat fee. At this income, they should also see if they qualify for Medicaid. The center can often help them apply.
A parent and one child in Texas live on $30,000 a year. The guideline for two people is $21,640. So they are at about 139% of the guideline ($30,000 divided by $21,640). That is between 100% and 200%, so they get a partial discount. HRSA's rules give an example with four steps: 101-125%, 126-150%, 151-175% and 176-200%. On a schedule like that, this family lands in the second step. Each center sets its own steps and prices, so ask to see its schedule. The child may also qualify for Medicaid or CHIP, even if the parent does not, so ask the center to check.
If you have insurance
A deductible is what you pay for care each year before your plan starts to pay. A copay is a set amount you pay for a visit. A high deductible or copay can still make a visit costly. HRSA's rules say that if your income qualifies for the sliding fee, the center should charge you no more than its sliding fee, unless your insurance contract does not allow it. In HRSA's own example, a patient at 150% of the guideline pays $40 instead of a $60 copay (HRSA, sliding fee chapter (bphc.hrsa.gov)).
Immigration status
The sliding fee looks only at income and family size. In July 2025, HHS issued a notice that listed the Health Center Program as a "federal public benefit." Under a 1996 law, some immigrants can't get those benefits (90 FR 31232 (govinfo.gov)). On September 21, 2026, a federal court in Rhode Island declared that notice unlawful and set it aside (New York v. U.S. Department of Justice (ag.ny.gov)). The court said HHS may still write new rules through public notice and comment, so this could change. If this matters to you, call the health center and ask what it needs from you at check-in.
What health centers offer
By law, every HRSA health center must offer a core set of primary care services (42 U.S.C. 254b (law.cornell.edu)). A center can give some of them through a partner clinic.
- Checkups and sick visits for adults and children, plus women's health and prenatal care.
- Shots, cancer screenings, lab tests and family planning.
- Preventive dental care, and eye, ear and dental checks for children.
- Referrals for specialty care, mental health and substance use care.
- Help signing up for programs such as Medicaid and CHIP.
Many health centers also have a pharmacy with lower drug prices, and many can help with rides (HRSA (bphc.hrsa.gov)). Centers that serve many people who speak limited English must offer interpreters (HRSA, required services (bphc.hrsa.gov)).
In 2025, 21.3% of health center patients got dental care and 9.4% got mental health care (HRSA UDS 2025, national (data.hrsa.gov)). Services differ from center to center, so call and ask.
How to find a health center and get the discount
- Search HRSA's Find a Health Center tool (findahealthcenter.hrsa.gov) by city, state or ZIP code. You can set the search area from 5 to 250 miles.
- Call the closest one or two centers. Ask if they take new patients and what the sliding fee form needs.
- Bring the papers on the list below to your first visit.
- Fill out the sliding fee form. Ask which price step you are in and get it in writing.
- If your income or family size changes, tell the center. Your price step may change too.
What to bring
- A photo ID, if you have one. If you don't, ask what the center accepts.
- Proof of income for your household, such as recent pay stubs, a benefits letter or last year's tax return.
- The number of people in your household.
- Any insurance card, including a Medicaid or CHIP card.
- A list of the medicines you take.
No pay stubs? Some centers let you sign a statement of your income. Ask before your visit.
What to say when you call
"Hello, I'd like to become a new patient. Are you taking new patients now? I'd like to apply for your sliding fee discount. What proof of income should I bring? Do you offer dental care at this location?"
What to expect at your first visit
- Sign-up forms. You fill out new-patient forms and the sliding fee form. Staff look only at your household income and size to set your price step (HRSA, sliding fee chapter (bphc.hrsa.gov)).
- If you don't share your income. The center may decide you can't get the sliding fee. Each center sets this rule.
- Help with coverage. If you might qualify for Medicaid or CHIP, staff may offer to help you apply. Helping patients sign up for programs is one of the services health centers must provide (42 U.S.C. 254b (law.cornell.edu)).
- An interpreter if you need one. Patients who speak limited English get interpreting, in person, by video or by phone (HRSA, required services (bphc.hrsa.gov)).
- An after-hours number. Every HRSA health center must have a way for patients to reach a trained person after hours, often by phone. Ask for the number before you leave (HRSA, after-hours care (bphc.hrsa.gov)).
- Referrals. If the center sends you to an outside specialist or lab, ask if your discount applies there. HRSA requires a discount only when the center has a formal contract or referral agreement with that provider.
- Updates later. The center will ask you to update your income and family size from time to time. Each center sets how often.
Health center data by state, 2025
This table shows how many people used HRSA-funded health centers in each state in 2025. It also shows the share of those patients with no insurance and the share who got dental care. Health centers report these numbers to HRSA each year in the Uniform Data System (UDS). The table counts HRSA grant recipients only, not look-alikes. We copied each row from HRSA's state report on October 19, 2026, and rounded the shares to one decimal. To see more about your state, pick it on HRSA's UDS data page (data.hrsa.gov).
| State | Health center organizations | Patients in 2025 | Share with no insurance | Share who got dental care |
|---|---|---|---|---|
| Alabama | 17 | 316,993 | 24.3% | 10.4% |
| Alaska | 27 | 113,867 | 17.8% | 27.6% |
| Arizona | 23 | 856,192 | 17.1% | 18.3% |
| Arkansas | 12 | 385,249 | 16.3% | 8.5% |
| California | 170 | 5,900,539 | 9.3% | 23.5% |
| Colorado | 19 | 638,538 | 21.7% | 27.2% |
| Connecticut | 16 | 447,075 | 15.2% | 18.7% |
| Delaware | 3 | 44,103 | 37.3% | 19.1% |
| District of Columbia | 8 | 179,535 | 19.1% | 23.6% |
| Florida | 47 | 1,673,307 | 26.2% | 27.0% |
| Georgia | 35 | 766,045 | 24.8% | 8.8% |
| Hawaii | 13 | 157,004 | 9.5% | 29.5% |
| Idaho | 14 | 247,642 | 20.5% | 24.0% |
| Illinois | 45 | 1,450,397 | 18.6% | 11.8% |
| Indiana | 26 | 714,585 | 13.8% | 12.9% |
| Iowa | 14 | 263,006 | 20.0% | 40.6% |
| Kansas | 19 | 316,544 | 25.9% | 27.1% |
| Kentucky | 25 | 675,713 | 12.4% | 12.4% |
| Louisiana | 35 | 501,384 | 15.8% | 15.6% |
| Maine | 18 | 205,142 | 8.2% | 18.8% |
| Maryland | 16 | 368,723 | 18.8% | 15.4% |
| Massachusetts | 37 | 884,863 | 14.7% | 20.2% |
| Michigan | 39 | 693,367 | 12.7% | 28.0% |
| Minnesota | 16 | 158,039 | 28.3% | 30.8% |
| Mississippi | 20 | 306,400 | 25.4% | 11.3% |
| Missouri | 27 | 681,965 | 15.5% | 41.7% |
| Montana | 13 | 124,474 | 19.4% | 25.5% |
| Nebraska | 7 | 121,579 | 30.0% | 25.5% |
| Nevada | 7 | 135,913 | 28.1% | 7.5% |
| New Hampshire | 9 | 93,585 | 13.4% | 10.8% |
| New Jersey | 23 | 643,753 | 26.4% | 20.9% |
| New Mexico | 16 | 294,409 | 24.6% | 26.8% |
| New York | 64 | 2,314,742 | 12.5% | 21.1% |
| North Carolina | 38 | 732,318 | 29.5% | 15.4% |
| North Dakota | 4 | 36,924 | 16.8% | 32.7% |
| Ohio | 51 | 933,422 | 12.9% | 25.2% |
| Oklahoma | 21 | 356,851 | 17.0% | 10.2% |
| Oregon | 30 | 440,152 | 8.3% | 31.1% |
| Pennsylvania | 40 | 869,212 | 16.2% | 26.7% |
| Rhode Island | 8 | 232,629 | 9.1% | 33.4% |
| South Carolina | 23 | 442,323 | 24.1% | 8.9% |
| South Dakota | 4 | 123,557 | 12.9% | 11.8% |
| Tennessee | 29 | 427,688 | 30.4% | 11.4% |
| Texas | 71 | 1,898,301 | 32.2% | 13.0% |
| Utah | 12 | 139,551 | 39.1% | 20.6% |
| Vermont | 11 | 207,752 | 10.5% | 23.4% |
| Virginia | 26 | 410,092 | 20.9% | 21.0% |
| Washington | 27 | 1,294,656 | 12.8% | 36.5% |
| West Virginia | 28 | 593,315 | 8.8% | 11.4% |
| Wisconsin | 16 | 299,686 | 16.7% | 56.2% |
| Wyoming | 5 | 33,872 | 18.3% | 5.2% |
| All health centers (includes U.S. territories) | 1,356 | 32,746,392 | 17.2% | 21.3% |
What the numbers mean: nationally, 17.2% of health center patients had no insurance in 2025. Utah (39.1%), Delaware (37.3%) and Texas (32.2%) had the highest shares. Maine, Oregon and West Virginia had the lowest, all under 9%. A high share means many patients there rely on the sliding fee, not insurance.
About 1 in 5 health center patients got dental care. The share ranged from 5.2% in Wyoming to 56.2% in Wisconsin. A low share does not mean there is no dentist near you. It means fewer patients in that state got dental care at a health center. These numbers describe whole states, not one clinic, so call the center you plan to use. The national row also counts Puerto Rico and the other territories (HRSA UDS 2025, national (data.hrsa.gov)).
School-based health centers
Some health centers run sites inside or next to schools. In 2025, about 1.2 million patients got care at a health center's school-based site (HRSA UDS 2025 (data.hrsa.gov)). Ask your child's school if it has one. If the site belongs to a health center, the center's sliding fee rules apply there too.
If this doesn't work
- Told you can't be seen because you can't pay? HRSA health centers may not deny care because a person is unable to pay (42 CFR 51c.303(u) (law.cornell.edu)). Ask to speak with the billing office. Ask for the sliding fee policy in writing, and for the center's policy on lowering or waiving fees for people who can't pay. A center may limit care only for people who refuse to pay, and it must have a board-approved policy for that (HRSA, billing rules (bphc.hrsa.gov)).
- No openings soon? Ask if the same health center has other sites. You can also look for a free clinic near you. Each free clinic sets its own rules, so call first.
- Got a hospital bill? Hospitals have separate rules. See our guide to hospital charity care.
- Need coverage? If your income is low, check how Medicaid works and apply on your state's official site. A premium is what you pay each month for a health plan. If you earn too much for Medicaid, the premium tax credit may lower the premium of a Marketplace plan, depending on your income. Check HealthCare.gov or your state's marketplace for when you can enroll.
- Other low-cost care: see how to get care without insurance, cheapest options first.
Find it near you (official and nonprofit finders)
- HRSA Find a Health Center (findahealthcenter.hrsa.gov)Search by address or ZIP code; results list federally funded health centers by distance.
- NAFC Find a Free Clinic (nafcclinics.org)Search by city or ZIP code; call the clinic before you go, because hours and rules vary.
- OPA Find a Family Planning Clinic (Title X) (opa-fpclinicdb.hhs.gov)Search by location for Title X family planning clinics.
Common questions
- What is the difference between an FQHC and a community health center?
- Most community health centers are FQHCs. "Community health center" is the everyday name. "Federally qualified health center" is the legal name used for Medicare and Medicaid payment. It mainly covers health centers with HRSA grants, look-alikes that meet the same rules without a grant, and some tribal and urban Indian clinics (42 U.S.C. 1396d (law.cornell.edu)).
- Do FQHCs take Medicaid?
- Yes. HRSA requires health centers to take part in Medicaid, CHIP and Medicare (HRSA billing rules (bphc.hrsa.gov)). In 2025, 47.9% of health center patients had Medicaid or CHIP (HRSA UDS 2025 (data.hrsa.gov)).
- Can I go to a community health center without insurance?
- Yes. Health centers see people with or without insurance and can't turn you away because you are unable to pay. In 2025, 17.2% of health center patients had no insurance (HRSA UDS 2025 (data.hrsa.gov)). Bring proof of income so the center can place you on its sliding fee.
- Is a community health center free?
- Not always. Health centers charge on a sliding scale based on income; some visits cost little or nothing. If your income is at or below the federal poverty guideline, you get a full discount, but the center may charge a small flat fee. Above 200% of the guideline, the sliding fee does not apply, but you can ask about the center's policy for lowering fees if you can't pay.
- Do FQHCs offer dental care?
- Preventive dental care is one of the services health centers must provide, either on site or through a partner (42 U.S.C. 254b (law.cornell.edu)). In 2025, 21.3% of health center patients got dental care. Not every site has a dentist, so call and ask before you go.
Sources
- HRSA, What is a Health Center? (last reviewed November 2025) (bphc.hrsa.gov), accessed October 19, 2026
- HRSA, About the Health Center Program (number of health centers and sites; look-alike benefits; last reviewed July 2026) (bphc.hrsa.gov), accessed October 19, 2026
- HRSA, Impact of the Health Center Program (2025 patients; last reviewed July 2026) (bphc.hrsa.gov), accessed October 19, 2026
- HRSA, What is a Health Center Program Look-Alike (LAL)? (bphc.hrsa.gov), accessed October 19, 2026
- HRSA Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program (bphc.hrsa.gov), accessed October 19, 2026
- HRSA Health Center Program Compliance Manual, Chapter 16: Billing and Collections (bphc.hrsa.gov), accessed October 19, 2026
- HRSA Health Center Program Compliance Manual, Chapter 4: Required and Additional Health Services (bphc.hrsa.gov), accessed October 19, 2026
- HRSA Health Center Program Compliance Manual, Chapter 7: Coverage for Medical Emergencies During and After Hours (bphc.hrsa.gov), accessed October 19, 2026
- HRSA, Uniform Data System (UDS) 2025, national data (data.hrsa.gov), accessed October 19, 2026
- 42 U.S.C. 254b, Health centers (Section 330 of the Public Health Service Act; Cornell LII) (law.cornell.edu), accessed October 19, 2026
- 42 U.S.C. 1396d(l)(2)(B), definition of federally qualified health center (Cornell LII) (law.cornell.edu), accessed October 19, 2026
- 42 CFR 51c.303, Project elements (sliding fee discounts; no denial for inability to pay; Cornell LII) (law.cornell.edu), accessed October 19, 2026
- HHS ASPE, 2026 Poverty Guidelines (aspe.hhs.gov), accessed October 19, 2026
- HRSA, Find a Health Center (findahealthcenter.hrsa.gov), accessed October 19, 2026
- HealthCare.gov, How to find low-cost health care in your community, accessed October 19, 2026
- HealthCare.gov, Medicaid & CHIP coverage, accessed October 19, 2026
- HHS, PRWORA: Interpretation of "Federal Public Benefit", 90 FR 31232 (July 14, 2025) (govinfo.gov), accessed October 19, 2026
- New York v. U.S. Department of Justice, No. 1:25-cv-00345 (D.R.I. Sept. 21, 2026), memorandum and order (posted by the New York Attorney General) (ag.ny.gov), accessed October 19, 2026
- HRSA, Health Center Program Uniform Data System (UDS), 2025 awardee data by state (data.hrsa.gov), accessed October 19, 2026