Sliding Scale Form

Sliding Scale FAQ’s

Who is eligible for the sliding scale?

The Child & Family Therapy Center of Denver is pleased to offer clients sliding fee discounts for services on a “as-needed” basis as determined by a client’s family size and annual income.  The Child and Family Therapy Center of Denver is committed to providing equal opportunity for all clients without regard to race, color, religion, national origin, citizenship, sex, age, marital status, sexual orientation, gender identity, ability to pay, Medicaid/Medicare/CHP+ coverage status, genetic information, disability, political affiliation, personal appearance, family responsibilities, matriculation or any other characteristic protected under federal, state or local law.

How do I know if I am eligible?

In order to be eligible for the sliding scale, you must complete the sliding fee schedule (SFS) application below, or available in print or electronic copies, which you can request from any of our team members. Our Sliding Fee Discount Program follows the guidelines of the United States Department of Health and Human Services’ Health Resources and Services Administration. As a result, it is updated annually based on the Federal Poverty Guidelines as follows:

 

Federal Poverty Level 100% 150% 200% >200%
Family Size Discount 100% Discount 50% Discount 10% Discount 0%
1 $12,880 $19,320 $25,760 $25,761+
2 $17,420 $26,130 $34,840 $34,841+
3 $21,960 $32,940 $43,920 $43,921+
4 $26,500 $39,750 $53,000 $53,001+
5 $31,040 $46,560 $62,080 $62,081+
6 $35,580 $53,370 $71,160 $71,161+
7 $40,120 $60,180 $80,240 $80,241+
8 $44,660 $66,990 $89,320 $89,321+
Each Add'l $4,540 $6,810 $9,080 $9,080
How long can I receive a sliding scale rate?

Sliding scale rates are approved for a duration of 12 months at a time. If at any point during that time your income situation changes, please communicate this to your therapist. After your rate expires, you will default back to the full fee unless you re-apply for sliding scale and are approved.

What are the rates?

Our Sliding Fee Schedule for 2021 is presented in the below table:

 

Poverty Level 100% 110% 120% 130% 140% 150% 160% 170% 180% 190% 200% >200%
50 min session Discount 100% Discount 90% Discount 80% Discount 70% Discount 60% Discount 50% Discount 40% Discount 30% Discount 20% Discount 15% Discount 10% Discount 0%
Individual or Family Therapy $0 $13 $26 $39 $52 $65 $78 $91 $104 $111 $117 $130
Music Therapy or Massage Therapy $0 $8 $16 $24 $32 $40 $48 $56 $64 $68 $72 $80

Sliding Fee Application

Click or drag files to this area to upload. You can upload up to 5 files.
Applicants may provide one of the following: prior year W-2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed).
If you have any questions about the services provided by us then please do not hesitate to contact us!