Federal, exists in every state
Help reducing your hospital bills (financial assistance)
Your hospital’s financial-assistance policy can reduce eligible bills, including some balances left after insurance.
What it is
Your hospital’s financial-assistance policy can reduce eligible bills, including some balances left after insurance.
Ohio children’s hospitals have their own financial-assistance policies. The income range and insurance rules differ by hospital, and some policies consider unusually large bills. HCAP is a separate floor for basic hospital care at or below the poverty line, with Medicaid and transplant exclusions.
Eligibility rules
- Each hospital sets its financial-assistance terms, subject to applicable law. Its application should explain which services, dates and separately billed clinicians are included.
- HCAP applies at participating hospitals to Ohio residents at or below 100% of the poverty line who are not Medicaid recipients. It excludes transplantation and associated services.
- An HCAP denial does not decide eligibility under the hospital’s broader policy. Insurance is billed first.
What you get
- A reduction or cancellation of eligible hospital charges.
- A written decision showing which accounts and dates the hospital covers.
If you decide to apply
- Ask your hospital’s financial counselor for both its financial-assistance policy and an HCAP review.
- Bring income records for the care dates, insurance statements and the bills you want reviewed.
- Ask which doctors bill separately and whether each bill is covered by the hospital’s decision.
After the review
- At a covered nonprofit hospital, a timely complete financial-assistance application requires extraordinary collection actions to pause during review. That does not stop every bill or a court deadline. Billing can confirm which accounts and collection activities are on hold in writing.
Good to know
Being above HCAP’s income line does not decide your hospital’s own policy. An insurance plan or a separate doctor’s bill can change the answer.
Official sources
- Ohio Administrative Code 5160-2-17 — Provision of basic, medically necessary hospital-level services
- Nationwide Children’s Hospital — Financial Assistance
- Cincinnati Children’s — Financial Assistance
- University Hospitals — Financial Assistance
- Cleveland Clinic — Financial Review Services
- Akron Children’s — How do I apply for financial assistance or free care?
- Dayton Children’s — After Your Visit / Financial Assistance
- IRS: nonprofit-hospital billing and collection requirements
“Could you check our hospital’s own assistance policy as well as HCAP, including the bills left after insurance and any doctors who bill separately?”
Why I’m asking: We want to know the correct balance and whether the hospital can reduce it.
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 |
|---|---|---|---|---|
| Nationwide Children's Hospital · policy | 200% FPL | 400% FPL | yes | 614-722-2070 |
| Cincinnati Children's Hospital Medical Center · policy | 200% FPL | 300% FPL | yes | 513-636-4427 |
| University Hospitals Rainbow Babies & Children's Hospital · policy | 250% FPL | 400% FPL | yes | 866-771-7266 |
| Cleveland Clinic Children's · policy | 250% FPL | 400% FPL | catastrophic_only | 216-442-1600 |
| Akron Children's Hospital · policy | 200% FPL | 400% FPL | yes | 330-543-2455 |
| Dayton Children's Hospital · policy | 100% FPL | 400% FPL | yes | 937-641-5727 |
| ProMedica Russell J. Ebeid Children's Hospital · policy | 200% FPL | unknown | yes | 844-373-0871 |
| Nationwide Children's Hospital - Toledo · policy | 200% FPL | 400% FPL | yes | 567-290-6543 |
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