Written by a parent, not a doctor. Nothing here is medical advice.

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Arkansas Children's

Financial Assistance Program

What you get

Up to 100% off qualifying hospital balances after other payment sources. Smaller discounts also depend on household income. Open now.

Who starts it
You
How it’s sent
By post
Your time
About 30 minutes
Last checked
Aug 27, 2026

Before you start, check you fit

  • Medicaid and other available payers must be pursued first.
  • The discount applies only to eligible medically necessary or emergency services and included providers under the current policy.
  • An approval is time-limited under the policy and does not make excluded third-party charges eligible.

  1. What their form asksA preview, so you can gather things first. Fill it in on their site.

    Open the application PDF ↗ Checked Aug 27, 2026

    Send it by post to the address on the form.

    What the form asks for

    Patient and guarantor information
    Patient NameDOBPatient Insurance informationGuarantor Address / City / State / Zip
    Household members and income information
    Guarantor - NameGuarantor - DOBGuarantor - Relationship to PatientGuarantor - Monthly Gross Income from all sourcesOther - NameOther - DOBOther - Relationship to PatientOther - Monthly Gross Income from all sourcesChild 1 - NameChild 1 - DOBChild 1 - Relationship to PatientChild 1 - Monthly Gross Income from all sourcesChild 2 - NameChild 2 - DOBChild 2 - Relationship to PatientChild 2 - Monthly Gross Income from all sourcesChild 3 - NameChild 3 - DOBChild 3 - Relationship to PatientChild 3 - Monthly Gross Income from all sourcesChild 4 - NameChild 4 - DOBChild 4 - Relationship to PatientChild 4 - Monthly Gross Income from all sources
    Income verification
    Mark the type of income verification you are providingStatement, if you report $0 income, please attach a brief explanation of how you are financially maintaining
    Applicant attestation
    Applicant's signatureDate

    Have ready

    • Completed and applicant-signed Arkansas Children's financial-assistance application.
    • Copies of one month of the most current pay stubs; this is one published income-verification option.
    • Employer letter stating gross income for the past 30 days; this is one published income-verification option.
    • Prior-year income-tax return.
    • Written signed statement explaining how day-to-day basic living needs are met when the applicant reports no income and is ineligible for Medicaid, Medicare, or Marketplace subsidies.
    • For an applicant age 19 or older who lives with parents, a parent's federal income-tax return to verify whether the applicant was claimed as a dependent.

After you send

Admissions states that it notifies your child or guarantor approximately 30-45 days after receiving a complete application. If Arkansas Children's identifies missing required information, provide it to reopen completion of the application review. If you have not heard back by then, write and ask.

Full record, as published