Federal, exists in every state
Ask the hospital to reduce your bill
Your hospital’s financial assistance can reduce eligible bills, including some amounts left after insurance.
What it is
Your hospital’s financial assistance can reduce eligible bills, including some amounts left after insurance.
A large bill does not always mean you must pay the full balance. Your hospital has its own financial-assistance policy. A counselor can check ordinary discounts and any hardship route, including when income is above the usual line.
Hospital-specific rules
- Sanford Fargo and Sioux Falls: full assistance through 225% of poverty and partial assistance from 226% through 375%. Insured families can qualify. Income, assets, debt and hardship rules matter. Eligibility may extend up to six months from approval at Sanford’s discretion. The counselor confirms the current policy for your billing entity and service dates.
- Mayo Minnesota: full assistance through 200% of poverty and a 50% adjustment above 200% through 400%. Income, assets, coverage and network conditions apply, using the prior tax year’s poverty guideline. A separate catastrophic-hardship review may apply. Approval can run up to one year from the first day of the first-service month or the end of the next ACA open-enrollment month, whichever comes first; reapplication may be needed after 180 days.
- Children’s Minnesota: uninsured free care through 275% of poverty. Insured families through 350% can receive 30% off eligible deductible and coinsurance balances, excluding copays. Above 350%, balances greater than 10% of gross income have a separate discount route.
- Children’s Minnesota: uninsured patients above 275% through 350% of poverty have an amounts-generally-billed adjustment. A separate uninsured branch above 350% is tied to $125,000 annual income. Assistance can cover outstanding balances and one year following approval. The counselor confirms the applicable branch and current income worksheet.
What you get
- A reduction or write-off of eligible hospital bills when you qualify.
- A review of hardship options when ordinary income limits do not fit.
Federal protections at tax-exempt hospitals
- At a tax-exempt hospital, the federal application period lasts at least 240 days after the first post-discharge bill. Extraordinary collection actions generally cannot begin in the first 120 days.
- An approved timely application can require a refund of amounts paid above the assistance amount when the excess is $5 or more.
- The federal requirements depend on the hospital’s tax status. Its counselor can identify which entity billed you and the collection protections that apply.
- Sanford assistance covers eligible emergency and medically necessary Sanford hospital, clinic and employed-clinician bills. Independent bills, ordinary retail pharmacy and excluded equipment do not automatically qualify. A complete Sanford application pauses its collection activity pending a decision.
- Mayo assistance covers eligible Mayo medically necessary and employed-clinician bills. Non-Mayo bills and certain research accounts and post-transplant medicines are excluded. A hardship request does not automatically remove network restrictions.
- Children’s Minnesota assistance covers eligible Children’s-billed hospital, clinic and professional care. Unrelated professionals and nonmedical purchases are separate. Its insured 30% discount excludes copays.
- Federal nonprofit-hospital rules can pause extraordinary collection actions during a timely assistance review. Minnesota facilities also have Minnesota screening and collection protections. Neither an application nor an appeal automatically pauses every bill or court deadline.
If you decide to apply
- Ask your hospital’s financial counselor for the policy, application and list of covered doctors.
- Bring income records, insurance statements and the bills or account numbers.
- Ask which collection activity can pause during review and get the answer in writing.
Your hospital’s financial counselor; Sanford 877-629-2999, Mayo 844-217-9591, Children’s Minnesota 612-813-6432 · Official page ↗
The decision
- Ask for a written decision naming the discount, accounts and dates covered, and when a new application is needed.
Good to know
Doctors who bill separately may fall outside the hospital’s policy. Insurance does not automatically disqualify you. With Medicaid, the counselor can still check an assigned client share, earlier bills and uncovered services.
Policy details to confirm
- The counselor confirms the legal entity billing each account, its current policy and effective date, and its tax-exempt status. Sanford’s policy does not state an unambiguous effective date. Mayo’s form revision is September 2024; Children’s Minnesota’s policy version 23 is dated September 24, 2024. Those document dates do not guarantee which policy covers your bill. Income year, assets, network rules, hardship options and separately billed doctors need their own checks.
Official sources
“Could you help us apply for the hospital's financial assistance and check which bills it covers?”
Why I’m asking: I want the hospital to check our current income and patient bills before we agree to a payment plan.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask for the application, send proof of income, and do not pay or put a bill on a card while it is open.
Your social worker
The social worker connects you with the financial counselor. The counselor checks Medicaid and explains which providers the assistance covers.
The care team
Records and letters when the application asks for them.
- Who decides
- The hospital's financial-assistance office under its written policy
- Ask the billing office
- “I would like to apply under the hospital's financial assistance policy. What is the income ceiling, which providers are covered by it, and can you hold collections while it is reviewed?”
How to apply
First step: Call the hospital's financial counselor, say “financial assistance policy”, and ask for the application, the income table and the list of covered providers.
- Call the financial counselor and say “financial assistance policy”.
- Ask which providers are covered by it.
- Ask for a collection hold while it is reviewed.
Where it starts: Apply to the hospital; the financial counselor checks Medicaid at the same time
What to gather
- Proof of household income (pay stubs or last tax return)
- The insurance card and recent explanation-of-benefits statements
- The bills or account numbers
How long: A decision within weeks of a complete application. A nonprofit hospital may not sue, report the debt or garnish wages for at least 120 days after the first bill after discharge, and holds collections while it decides.
What a yes looks like
A letter naming the discount percent and the period it covers (often 12 months). If you paid before the decision, a refund of the difference follows. Re-apply when it lapses.
What a no looks like, and the next move
“Over the income limit”: ask about the high-medical-expense branch, a prompt-pay discount and an interest-free plan. Then go to bill negotiation.
Watch out
- Apply before paying if you can. If you already paid, apply anyway: within 240 days of the first bill after discharge, an approved application means the hospital refunds what you paid above the assistance amount ($5 or more).
- Doctors who bill separately (anesthesia, radiology, some oncologists) may not be under the hospital's policy. Ask which providers are covered.
- Insured families count too: some hospitals have a high-medical-expense branch that discounts at any income when bills pass a share of income.
Each hospital’s own policy
The federal rule sets the floor; each hospital’s policy sets the actual numbers. “Unknown” means the policy could not be read yet: call the number and ask.
| Hospital | Free care up to | Discounts up to | Insured families | Financial counselor |
|---|---|---|---|---|
| Sanford Children’s Hospital Fargo · policy | 225% FPL | 375% FPL | yes | 877-629-2999 |
| Sanford Children’s Hospital Sioux Falls · policy | 225% FPL | 375% FPL | yes | 877-629-2999 |
| Mayo Eugenio Litta Children’s Hospital · policy | 200% FPL | 400% FPL | yes | 844-217-9591 |
| Children’s Minnesota Hospital, Minneapolis · policy | 275% FPL | unknown | yes | 612-813-6432 |
The numbers and the rules
The arcane layer, kept on purpose. Checked September 8, 2026.
What it is worth
The hospital's own bill reduced or written off entirely under its published schedule. Collections held while the application is open.
- Discount or charity write-off — Discount or charity write-off
- $240 (at least; a policy can allow longer) — Days to apply after the first bill after discharge
- $120 (at least) — Days after that first bill before the hospital can sue, report the debt or garnish wages
- $5 (refunded when $5 or more) — Refund of what you paid above the assistance amount
Legal protection: A written policy and application, published · Limits on collection actions while the application is reviewed · At a nonprofit hospital, an application filed within 240 days of the first bill after discharge must be taken (federal rule) · No lawsuit, credit reporting, wage garnishment or sale of the debt for at least 120 days after that first bill · If you already paid and the application is approved, the hospital refunds what you paid above the assistance amount ($5 or more)
What it costs the family: Free application.
The eligibility facts, as published
- Tax exempt hospital for federal floor
- yes
- Policy specific
- yes
- Insured patients
- often eligible; some policies add a high-medical-expense branch at any income; a children's hospital policy often reaches families at 400% of the poverty line and above
- Federal 501r floor
- nonprofit (tax-exempt) hospitals: application period runs to at least the 240th day after the first post-discharge bill; no extraordinary collection actions for at least 120 days after that bill; refund of amounts paid above the assistance amount when $5 or more
Decisions this site cannot make: Hospital policy eligibility
Expect friction on: Separately billing physicians · Documentation · Application deadlines
The trap: Paying first and then not applying. If you already paid and the application is approved in time, the hospital must refund what you paid above the assistance amount ($5 or more). Doctors who bill separately may not be under the hospital's policy.
What changes by state: Some states set minimum hospital discounts, including California. Your hospital sets its own assistance limits and provides a financial counselor.
Where I read this
- Financial Assistance Policies for Tax-Exempt Hospitals — Internal Revenue Service, read August 27, 2026
- 26 CFR 1.501(r)-1: Definitions (financial assistance application period) — GovInfo (CFR 2025), read September 8, 2026
- 26 CFR 1.501(r)-6 and -7: Billing and collections; effective dates — GovInfo (CFR 2025), read September 8, 2026
- IRS: Billing and collections — section 501(r)(6) — Internal Revenue Service, read September 8, 2026