Sliding scale therapy in Texas: what it means, who offers it, and how to ask

If you need help now: call 911 in an emergency. In a mental health or substance use crisis, call or text 988, any time; it's free. Your county's local mental health authority also runs a 24-hour crisis line. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open 24/7 for treatment referrals.

What sliding scale means

• The fee is set by income. The provider looks at your household income and how many people it supports, and puts you on a row of its fee schedule. Lower income, lower fee.
• Each provider has its own scale. Only some places have to follow a set formula (the next two sections). A private therapist can set any scale, or none.
• You may need to show proof. Pay stubs, a tax return or a benefits letter, and sometimes proof of address.
• It isn't insurance. It's a discount on the provider's own fee. If you have Medicaid or CHIP, use that first: covered therapy usually costs little or nothing (our guide to how much therapy costs in Texas explains).

Who offers sliding scale therapy in Texas

Where	Sliding scale?	How to find one
Community health centers (FQHCs)	Required, by federal rule, for every patient who qualifies. Many offer counseling; ask.	HRSA's Find a Health Center
Your local mental health authority	Required: fees follow HHSC's ability-to-pay schedule.	HHSC's local authority locator, or 2-1-1
Addiction treatment programs	Some, by choice. FindTreatment.gov records which ones say they have a sliding fee.	Cima Find Care's sliding-fee pages
University training clinics	Often low or income-based fees; graduate students see clients under licensed faculty supervision.	Our city guides list the ones we checked
Private therapists and group practices	Some, by choice, often for a limited number of clients.	Ask when you call. A therapist who claims their Cima Find Care listing can note a sliding scale on it.

Community health centers: the federal sliding fee rules

Health centers funded by the federal Health Resources and Services Administration (HRSA) see you whether or not you have insurance (HRSA). Chapter 9 of HRSA's Health Center Program Compliance Manual sets how their sliding fee discount works:

Your yearly household income	What the rule says
At or below 100% of the federal poverty guidelines	A full discount. The center may charge a small nominal fee instead, which HRSA says isn't a minimum fee or a co-pay.
Above 100%, up to 200%	A partial discount that shrinks as income rises, in at least three pay levels.
Above 200%	No sliding discount.

• Only income and family size count. Eligibility can't depend on anything else, and the same scale applies to everyone (HRSA's compliance FAQ).
• They have to tell you about it, for example at intake, on their website, and in the languages their patients speak.
• The schedule uses the current poverty guidelines, so the income limits move each year.
• Ask what's included. Ask whether the center offers counseling, whether you can be seen for counseling on its own, and how soon.

The 2026 income limits

These are HHS's 2026 poverty guidelines for Texas and the other 48 contiguous states (ASPE; Federal Register, January 15, 2026). The 200% column is twice the guideline, worked out by us. Ask each place what it counts as income.

People in household	100%: full discount at or below	200%: partial discount up to	200%, per month
1	$15,960	$31,920	$2,660
2	$21,640	$43,280	$3,607
3	$27,320	$54,640	$4,553
4	$33,000	$66,000	$5,500
5	$38,680	$77,360	$6,447
6	$44,360	$88,720	$7,393

For more than 6 people, add $5,680 a year for each extra person at 100% (and $11,360 at 200%). Monthly figures are rounded to the dollar.

An example, with a made-up person: Ana lives alone and earns $1,900 a month, or $22,800 a year. That's above $15,960 (100%) and below $31,920 (200%), so at a health center she gets a partial discount. Which row of the scale she lands on, and what she pays a visit, depends on that center's own schedule: ask them.

Your local mental health authority's ability-to-pay fee

Texas HHSC names a local mental health or behavioral health authority for every county: the public agency that provides or arranges mental health care for people who are uninsured, have little money, or have Medicaid or Medicare. What you pay there isn't up to each clinic:

• There's a state fee schedule. HHSC's Local Authority Monthly Ability-to-Pay Fee Schedule sets the most you can be charged in a month, by family size and yearly gross income. The 2026 schedule took effect February 12, 2026, and there's a Spanish version.
• The rules are in 26 TAC chapter 301, subchapter C (charges for community services): the ability-to-pay determination and the monthly fee schedule, which is built from the federal poverty guidelines (Texas Register transfer table, from the former 25 TAC chapter 412).
• Your fee is worked out at your first visit. Bring proof of income and household size. Some local authorities add their own charity care discounts; our city guides note the ones we checked.
• It's also your crisis line. Every local authority runs a 24-hour crisis line (HHSC).

Sliding-fee addiction treatment on Cima Find Care

For alcohol or drug treatment, SAMHSA's FindTreatment.gov records whether each program says it offers a "sliding fee scale (fee is based on income and other factors)". Cima Find Care counts those programs and lists them, with phone numbers, by level of care:

Level of care	Programs in Texas	Accept Medicaid	Accept Medicare	Accept private insurance	Sliding-scale fee
Detox	131	83	61	123	23
Residential	181	126	86	156	51
PHP (partial hospitalization)	114	63	43	114	17
IOP (intensive outpatient)	160	98	58	137	52
Outpatient	339	224	173	284	111
MAT (medication)	168	111	88	147	45

Counted from Cima Find Care's Texas records as of 2026-10-27: one program per organization, so an organization in several cities counts once (city by city, it counts in each), from SAMHSA's FindTreatment.gov and the programs' own websites. A program counts when any of its locations lists it.

• Statewide: all Texas addiction treatment with a sliding-scale fee, or by level: detox, residential rehab, partial hospitalization (PHP), intensive outpatient (IOP), outpatient and medication for addiction (MAT).
• By city: Houston, Dallas, San Antonio, Austin, Fort Worth and El Paso.
• No money at all? Texas pays for substance use treatment for adults whose income qualifies. The door is an OSAR (Outreach, Screening, Assessment and Referral) center: see free and state-funded rehab in Texas.

A sliding fee on a program's record is what the program told SAMHSA. Call and ask what you'd pay at your income before you go: how our listings work.

How to ask for a sliding scale: a script and what to bring

1. Ask early, on the first call. "Do you offer a sliding scale or reduced fee? What would I pay per session with a household of [number] and an income of about [amount] a year?"
2. Ask what the fee covers. "Is the first visit (the assessment) priced differently? Is there a fee for missed or late-cancelled sessions?"
3. Ask how it's decided. "What proof of income do you need? How often do you check it again? What if my income changes?"
4. Ask about the wait. "How soon can I be seen? Is there a waitlist, and what should I do while I wait?"
5. Get the price in writing. If you're paying yourself, you have a right to a written Good Faith Estimate of the charges under the federal No Surprises Act; for ongoing therapy one estimate can cover up to 12 months (CMS).

What to bring: a photo ID, proof of address, and proof of household income (recent pay stubs, last year's tax return, or a letter about benefits or unemployment). If you have no income, ask what they accept instead; many places have a form for that.

Low-cost places often have waitlists, so it's fine to call two or three at once. If things get worse while you wait, call or text 988.

Free and low-cost therapy by city

Our city guides name the local mental health authority, the community health centers with counseling, the university training clinics and the free support groups we checked, with phone numbers:

• Houston and Harris County
• Dallas
• San Antonio
• Austin
• Fort Worth
• El Paso

Somewhere else in Texas? Start with your local mental health authority and HRSA's health center finder, both above, or call 2-1-1.

Other ways to lower the cost

• Check Medicaid and CHIP first. Texas Medicaid covers children, pregnant women, some parents and caretakers with limited income, people with disabilities and people 65 and older, and CHIP has no co-pay for mental health office visits. See how to apply for Texas Medicaid or CHIP.
• Have insurance with a high deductible? A sliding scale may not apply when you use your insurance. Our guide to using insurance for therapy in Texas has the questions to ask your plan.
• Your employer's Employee Assistance Program (EAP), if your job has one, offers free, confidential counseling sessions. Ask HR how many.
• Group therapy may cost less than individual sessions. Ask whether a group fits what you need.
• Video visits. A provider licensed in Texas can see you by video anywhere in the state, which widens your choice of low-fee providers: search video visits in Texas.
• Crisis help is free. 988 and your local authority's crisis line cost nothing, any time. For a crisis that needs a hospital, see mental and psychiatric hospitals in Texas.