Financial assistance

Financial assistance / charity care

Nonprofit hospitals must maintain a Financial Assistance Policy (IRS 501(r)), must publicize it, and can't charge FAP-eligible patients more than insurers generally pay (AGB). Many for-profit and all public hospitals have programs too, and several states mandate them for everyone. Legal detail: knowledge/rights-and-laws.md §2.

Steps

1. Is the hospital nonprofit? Check ProPublica Nonprofit Explorer (projects.propublica.org/nonprofits) for the hospital or its health system. Note state charity-care laws that apply regardless (rights-and-laws.md lists the strong-law states).

2. Get the actual FAP. Search <hospital name> financial assistance policy — 501(r) requires it to be posted, usually with an income eligibility table and application PDF. Download both into the case folder. Read the policy, not the summary: note the FPL thresholds for free vs. discounted care, whether insured patients are eligible (most policies: yes), the required documents, and the deadline.

3. Screen the user against the table using household size + income from intake. Compute their FPL percentage (current FPL figures: aspe.hhs.gov /poverty-guidelines). Report the likely outcome: 100% write-off, partial, or AGB cap.

4. Timing check: applications are generally open 240 days from the first post-discharge statement — after payments, after payment plans, even in collections (and an approval can claw back what was paid). Compute the deadline and put it in case.md.

5. Prepare the application: fill what you can, list exactly which documents the user must gather (pay stubs, tax return, bank statements). Draft the cover letter from templates/letters/charity-care-cover.md — it asserts the 501(r) frame, requests written acknowledgment of receipt, and asks that collections be held while the application is pending (which 501(r) effectively requires for the ECA clock).

6. Check for a hidden screening. Many hospitals run automated "presumptive eligibility" scoring using credit data and zip-code median income — and deny quietly without telling the patient. Ask in writing: "Has any financial assistance screening or eligibility determination already been performed on this account? If so, what income figure was used and from what source?" If the screening used estimated income (zip-code median is common and often wildly wrong), request a rescreening with actual income documentation. The full account-file request in templates/letters/records-request.md surfaces this too.

7. Bring the hospital's own numbers. Its Form 990 (free at ProPublica Nonprofit Explorer) shows executive compensation and charity-care spending side by side, and Schedule H details community benefit. A hospital reporting mostly bad debt (failed collections) rather than real charity care inside its "community benefit" total is under-enrolling eligible patients — reasonable to note, factually, in a written assistance request or an AG complaint. LEP patients: translated FAPs and applications are a Title VI/§1557 right (rights-and-laws.md §9).

8. If they stonewall ("only for uninsured," "you don't qualify" with no written basis): comebacks in knowledge/objections.md; escalation is a state AG complaint + IRS Form 13909 — mention only at the right rung.

Denied fairly? The case continues — assistance and negotiation aren't exclusive. Take the denial in writing and proceed to strategy.