Hospital Financial Assistance in Texas: How to Get Charity Care

Many Texans who are struggling with a hospital bill never find out that they may qualify to have it reduced or even erased entirely. Nonprofit hospitals across the country, including many of the largest systems in Texas, are required to run financial assistance programs, often called charity care. These programs can cover patients with no insurance, and sometimes patients who have insurance but can't afford their share.

This guide explains what these programs are, who may qualify, and exactly how to apply.

Why Nonprofit Hospitals Offer Financial Assistance

Nonprofit hospitals receive significant tax exemptions. In exchange, federal tax rules under Section 501(r) of the Internal Revenue Code require them to:

• Adopt a written Financial Assistance Policy (FAP) that explains who qualifies and how to apply

• Publicize the policy widely, including on their website, in the emergency room and admissions areas, and in a plain-language summary

• Limit what they charge eligible patients for emergency and other medically necessary care to no more than the amounts generally billed to insured patients

• Make reasonable efforts to find out whether a patient qualifies before taking serious collection actions, such as reporting a debt to credit bureaus or filing a lawsuit

Texas also requires nonprofit hospitals to provide charity care and community benefits as a condition of their tax-exempt status under state law. For-profit hospitals aren't bound by the federal 501(r) rules, but many still offer discounts or assistance, so it is always worth asking.

Who May Qualify

Every hospital sets its own eligibility rules, which is why it's important to read the policy for your specific hospital. Most programs are based on household income compared with the Federal Poverty Guidelines, and on household size.

• Free care: Many hospitals provide free care to patients with household incomes up to around 200% of the federal poverty level. Some set the line higher.

• Discounted care: Patients with higher incomes, often up to 300% or 400% of the poverty level, may qualify for a reduced bill.

• Medical hardship: Some policies also help patients whose medical bills are very large compared with their income, even if their income would otherwise be too high.

Having insurance doesn't automatically disqualify you. Many policies help with deductibles, coinsurance, and other balances left after insurance pays.

How to Find Your Hospital's Policy

• Search the hospital's website: Look for "financial assistance," "charity care," or "patient financial services." The full policy, summary, and application are usually downloadable.

• Ask the billing office: Call the number on your bill and ask, "Do you have a financial assistance policy, and can you send me the application?"

• Check your bill: Nonprofit hospitals must include a notice about financial assistance on billing statements.

How to Apply, Step by Step

• Get the application: Request it by phone, download it, or pick it up at the hospital.

• Gather documents: Typically proof of income (recent pay stubs, a tax return, or Social Security or unemployment letters), proof of household size, and sometimes bank statements or a letter explaining your situation if you have no income.

• Fill it out completely: Incomplete applications are the most common reason for delays. If a question doesn't apply to you, write "N/A" rather than leaving it blank.

• Submit and keep copies: Send the application by a trackable method or hand-deliver it and ask for a dated receipt.

• Ask for a collections hold: Tell the billing office in writing that you have applied and ask them to pause collection activity while your application is reviewed.

• Follow up: If you don't hear back within a few weeks, call and ask about the status.

Timing Matters, but It Is Rarely Too Late

Under the federal rules, nonprofit hospitals must accept financial assistance applications for at least 240 days from the first billing statement after you're discharged. They also generally can't begin serious collection actions until at least 120 days after that first statement, and they must notify you beforehand. If a bill has already gone to collections, you can still ask about financial assistance. If you qualify, the hospital may be required to reverse certain collection actions.

Other Texas Resources to Ask About

• Medicaid: Hospital financial counselors can check whether you qualify for Medicaid, which in some cases can cover recent past bills.

• County indigent health care: Many Texas counties run indigent health care programs, and large counties often operate hospital districts with their own financial assistance programs for residents.

• Payment plans: If you don't qualify for assistance, ask for an interest-free payment plan that fits your budget before agreeing to any medical credit card or loan.

Before You Pay Anything, Get the Itemized Bill

Whether or not you qualify for assistance, request a complete itemized bill and check it for errors. Duplicate charges and incorrect codes are common. Texas law also requires providers to send patients an itemized bill before sending a debt to collections. Our guide to demanding an itemized bill explains what to look for.

The Bottom Line

If a hospital bill is more than you can manage, ask about financial assistance before you pay, before you sign up for a payment plan, and even after the bill has gone to collections. It costs nothing to apply, and for many Texas families it can reduce or eliminate what they owe.