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)