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This policy describes how Hopscotch Primary Care determines and applies fee discounts for patients who qualify based on income and family size, and our commitment that no patient is ever denied care due to inability to pay.
Policy effective: January 1, 2026 | Reviewed annually
"All patients seeking health care services at Hopscotch Primary Care are assured they will be served regardless of their ability to pay. No one is refused service because of lack of financial means to pay."
— Hopscotch Primary Care Sliding Fee Discount Program Policy
This program is designed to provide free or discounted care to those who have no means, or limited means, to pay for their medical services, regardless of insurance coverage status.
Hopscotch Primary Care offers a Sliding Fee Discount Program to all who are unable to pay for their services. Program eligibility is based solely on family size and income, and Hopscotch does not discriminate on the basis of an individual's race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. The Federal Poverty Guidelines are used in creating and annually updating the sliding fee schedule (SFS) to determine eligibility.
Hopscotch Primary Care notifies patients of the Sliding Fee Discount Program by:
Requests for discounted services may be made by patients, family members, staff, or others who are aware of financial hardship. The Sliding Fee Discount Program is only made available for clinic visits. Information and forms can be obtained from the front desk or a clinic care team member.
The Program is administered by Hopscotch Primary Care, with the Revenue Cycle Management team assisting to ensure Athena is updated accordingly. Staff will provide information about the policy and procedure and will aid patients in completing the application if needed. Dignity and confidentiality are respected for all who seek and/or are provided health care services.
Discounts are based on income and family/household size only.
To complete the application, the patient must first speak with the clinic's CHW and/or PRM to discuss insurance coverage options and possible enrollment in alternative programs. The patient/responsible party must then complete the Sliding Fee Discount Program application in its entirety; staff can assist with this if needed. By signing the application, applicants confirm their income to Hopscotch Primary Care as disclosed on the form.
Applicants may provide one of the following as proof of income: prior year W-2, two most recent pay stubs, a letter from employer, or Form 4506-T if a W-2 was not filed. Self-employed individuals are required to submit detail of the most recent three months of income and expenses for the business. Adequate information must be made available to determine eligibility for the Program.
The sliding fee schedule is updated during the first quarter of every calendar year using the latest Federal Poverty Guidelines. See the current Sliding Fee Schedule for income thresholds by family size.
Patients will not be denied services due to an inability to pay. The nominal fee is not a threshold for receiving care and is not a minimum fee or co-payment.
The Sliding Fee Discount Program determination is provided to the applicant in writing and includes the percentage of the discount, or, if applicable, the reason for denial. If an application is approved for less than a 100% discount, or is denied, Hopscotch Primary Care will work with the patient and/or responsible party to arrange payment.
An approved application covers outstanding patient balances for six months prior to the application date, as well as any balances incurred within 12 months after the approval date, unless the patient's financial situation changes significantly. The applicant must reapply after 12 months have expired, or anytime there has been a significant change in family income.
In certain situations, patients may not be able to pay the nominal or discounted fee. Waiving of charges must be approved by Hopscotch Primary Care's designated official, and any waiving of charges is documented in the patient's file along with an explanation.
If a patient verbally expresses an unwillingness to pay, or vacates the premises without paying for services, the patient will be contacted in writing regarding their payment obligations. If the patient is not on the sliding fee schedule, a copy of the Sliding Fee Discount Program application will be sent with the notice.
If the patient does not make an effort to pay, or fails to respond within 60 days, this constitutes refusal to pay. At that point, Hopscotch Primary Care can explore options including, but not limited to, offering the patient a payment plan, waiving of charges, or referring the patient to collections.
Information related to Sliding Fee Discount Program decisions is maintained in a centralized confidential file and scanned into the patient medical record, to preserve the dignity of those receiving free or discounted care.
The sliding fee schedule is updated yearly based on the current Federal Poverty Guidelines. Hopscotch Primary Care also reviews possible changes to its policy and procedures, and examines institutional practices that may serve as barriers preventing eligible patients from accessing our community care provisions.
Related documentation: the 2026 Sliding Fee Schedule, the Patient Application for the Sliding Fee Discount Program, and the SFDP Clinic Workflow.
Questions about this policy or the application process should be directed to the front desk staff at any Hopscotch clinic.
Related resources: Sliding Fee Schedule
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