This case study describes how a sliding-fee scale is developed and utilized in a community health center practice setting, which must conform to certain federal statutes and regulations. The sliding-fee scale is a critical system for reaching patients who have financial barriers to accessing care. In developing a scale, a community health center must involve its governing board, consider financial impacts of various approaches and assure it complies with the federal rules that must be followed. A gap analysis comparing current practice with required regulations is the method illustrated in this case study to describe how a community health center can successfully develop its sliding-fee scale. Researching the best practices of other community health centers is also explained.