Resources for Converge Title X Sub-Recipients
2022-2023 Scope of Work for Title X Sub-Recipients
2022-2023 Scope of Work for Title X Sub-Recipients (Download .pdf)
2022 Sliding Fee Scale for Title X Clinics
by Monthly Income
| Family Size | 0-100% FPL | 101-125% FPL | 126-150% FPL | 151-175% FPL | 176-200% FPL | 201-225% FPL | 226-250% FPL | 251% FPL and greater |
| No Charge | Patient pays 10% | Patient pays 25% | Patient pays 40% | Patient pays 55% | Patient pays 70% | Patient pays 85% | Full Pay | |
| 1 | 0-1133 | 1144-1416 | 1427-1699 | 1710-1982 | 1993-2265 | 2276-2548 | 2559-2831 | 2843 |
| 2 | 0-1526 | 1541-1907 | 1923-2289 | 2304-2670 | 2686-3052 | 3067-3433 | 3448-3815 | 3830 |
| 3 | 0-1919 | 1938-2399 | 2418-2879 | 2898-3359 | 3378-3838 | 3858-4318 | 4337-4798 | 4817 |
| 4 | 0-2313 | 2336-2891 | 2914-3469 | 3492-4047 | 4070-4625 | 4648-5203 | 5226-5781 | 5804 |
| 5 | 0-2706 | 2733-3382 | 3409-4059 | 4086-4735 | 4762-5412 | 5439-6088 | 6115-6765 | 6792 |
| 6 | 0-3099 | 3130-3874 | 3905-4649 | 4680-5424 | 5455-6198 | 6229-6973 | 7004-7748 | 7779 |
| 7 | 0-3493 | 3527-4366 | 4401-5239 | 5274-6112 | 6147-6985 | 7020-7858 | 7893-8731 | 8766 |
| 8 | 0-3886 | 3925-4857 | 4896-5829 | 5868-6800 | 6839-7772 | 7811-8743 | 8782-9715 | 9753 |
Each additional person, add $393.33/month.
Same scale must be applied to labs, medications, and supplies related to Title X services.
At or below 100% FPL, patient must not be charged for Title X services.
2022 Sliding Fee Scale for Title X Clinics (Download .xlsx)
Patient Bill of Rights
This document is for everyone within a Title X clinic—clinicians, staff, and patients—and creates a set of shared expectations for patients to know what kind of experience they’ll have in a Title X clinic.
Patient Bill of Rights in English (Download .docx)
Patient Bill of Rights in Spanish (Download .docx)
Title X Manuals
Administrative Manual (Download PDF)
This manual is designed by family planning subrecipients and Converge staff to help guide clinics through the
administrative regulations of the Title X Family Planning Program
Clinical Manual (Download PDF)
The Family Planning Clinical Manual must be reviewed and signed annually by Physicians, Nurse Practitioners,
Certified Nurse Midwives, Physician Assistants, Registered Nurses, Medical Assistants and Clinic Assistants providing
clinical services in the Title X Family Planning Programs.