How federally qualified and rural health clinics work
In most counties there is a medical clinic that adjusts your bill to your income, sees you whether or not you have insurance, and cannot refuse care because you are unable to pay. These are federally qualified health centers, usually called FQHCs, and they exist because the federal government funds them with that exact requirement attached. Rural communities have a related option called rural health clinics.
This page explains what FQHC and rural health clinic status actually means for you as a patient - what the clinics must offer, how the sliding fee scale is set, the special programs for the homeless, farmworkers and public housing residents, and where to find a clinic in your state.
What a federally qualified health center is
A federally qualified health center is a nonprofit clinic that receives money from the federal Health Center Program. The funding comes with rules written to protect patients. The clinic must charge based on a sliding fee scale tied to your income and household size, it cannot deny care because you are unable to pay, and it must serve everyone in its area - insured, uninsured, homeless, or new to the country. The clinics are run by community boards, and a majority of each board must be made up of patients who actually use the clinic.
Most FQHCs offer primary medical care, and many add dental care, mental health counseling, substance use treatment and an on-site pharmacy. To understand the difference from a charity-run clinic: a volunteer or church-run free clinic sets its own rules and may limit who it serves, while an FQHC is legally required to see you. The fastest way to find one is the federal search tool at https://findahealthcenter.hrsa.gov- enter your ZIP code and it lists every funded clinic with phone numbers.
You can also call the federal agency behind the program, the Health Resources and Services Administration, at 1-877-464-4772 on weekdays, or use the state listings further down this page. Some clinics are called "look-alikes" - they meet every program standard but do not receive the grant. The patient rules, including the sliding fee scale, work the same way at those locations.
How the sliding fee scale works
The section below explains the part most new patients ask about first: the bill. When you register, the clinic asks for proof of income, such as pay stubs or a benefits letter, and your household size. Your fee for each visit is then set from a written discount schedule. Patients with the lowest incomes pay a small flat amount or nothing at all, and the fee rises gradually for households earning more. Nobody is quoted full price first and discounted later - the scale is the price.
Insurance is accepted but never required. If you have Medicaid, Medicare or a private plan, the clinic bills it. If you have no coverage, staff at most centers will also help you apply for Medicaid, CHIP or a marketplace plan while you are there - the guide to free health insurance explains what each of those covers.
Rural health clinics are a different program
Rural health clinics, or RHCs, operate in areas the government has designated as rural and short on medical providers. They are often attached to a small hospital or run out of a doctor's office, and they are required to use nurse practitioners or physician assistants so that care is available even where doctors are scarce.
One difference matters to your wallet: rural health clinics are not required to offer a sliding fee discount the way FQHCs are. Many choose to, but you have to ask. If you are uninsured in a rural area, check for an FQHC first using the search tool above - many rural counties have one - and treat the local RHC as the next option, asking directly whether they discount care based on income.
Health centers for the homeless, farmworkers and other groups
Part of the same federal program funds clinics built around specific situations.
- Health Care for the Homeless clinics treat people living in shelters, in transitional housing or on the street, and no address or ID is required to be seen - many send medical teams out rather than waiting for patients to come in.
- Migrant health centers serve seasonal and migratory farmworkers and their families, with hours and locations planned around growing seasons. The public housing primary care program places clinics in or near public housing developments so residents can get checkups, medications and chronic disease care close to home.
- There are also Native Hawaiian health care systems serving Native Hawaiian communities.
Every one of these shows up in the same federal search tool, and all of them follow the same rule: care regardless of ability to pay.
Find a federally funded or community clinic in your state
The state pages below list community clinics across each state - federally funded health centers, charity and nonprofit clinics, and volunteer-run programs. For a national explanation of how community clinics work from the patient side, including what to bring and how intake works, this site also has a full guide to free and low-cost community clinics and a directory of clinics by city and county.
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Washington
West Virginia
Wisconsin
Disclaimer: This page is informational only and does not give medical advice. Services and fees vary by clinic, so confirm details with the location before you go.
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