Insurance
Low income
Receiving Hill-Burton Free or Reduced Cost Care
Frequently Asked Questions
What services are covered under the Hill-Burton program?
Each facility chooses which services it will provide at no or
reduced cost. The covered services are specified in a notice
which is published by the facility and also in a notice provided
to all persons seeking services in the facility. Services fully
covered by a third-party insurance or a government program (e.g.,
Medicare and Medicaid) are not eligible for Hill-Burton coverage.
However, Hill-Burton may cover services not covered by the government
programs.
Private pharmacy and private physician fees are not covered
by this program. However, services provided by physicians
hired by the facility may be covered under the Hill-Burton
program if included in the published notice (Allocation Plan).
Can I receive Hill-Burton assistance to cover my Medicare
deductible and coinsurance amounts or Medicaid co-pay and
spenddown amounts?
Medicare deductible and coinsurance amounts are not eligible
under the program. However, Medicaid co-payment amounts are
eligible, except in a long-term care facility. In addition,
Medicaid spenddown amounts (the liability a patient must incur
before being eligible for Medicaid) are eligible in all Hill-Burton
facilities.
Where can I get Hill-Burton free or reduced cost care?
At a Hill-Burton facility. Check the Directory
listing. The facilities included are hospitals, nursing
homes, clinics, etc. Apply at the Admissions, Business or
Patient Accounts Office.
Who can receive free care?
Eligibility is based on a person's family size and income.
Income is calculated based on your actual income for the last
12 months or your last 3 month's income times 4, whichever
is less. You may qualify if your income falls within the poverty
guidelines, as published in the Federal Register every
year. You may also qualify for free or reduced cost care at
some facilities if your income is up to double (or triple
for nursing home services) the poverty
guidelines.
What does income include?
Gross income (before taxes), interest/dividends earned, and
child support payments are examples of income. Assets, food
stamps, gifts, loans or one-time insurance payments are examples
of items not included as income when considering eligibility.
For self-employed people, income is determined after deductions
for business expenses. For more specific information, see
the poverty guidelines (listed in the chart below).
When can I apply for Hill-Burton assistance?
You may apply for Hill-Burton assistance at any time, before
or after you receive care. You may even apply after a bill
has been sent to a collection agency. If a hospital obtains
a court judgment before you applied for Hill-Burton assistance,
the solution must be worked out within the judicial system.
However, if you applied for Hill-Burton before a judgment
was rendered and are found eligible, you will receive Hill-Burton
even if a judgment was rendered while you were waiting for
a response to your application.
Is United States citizenship required for Hill-Burton
eligibility?
No. However, in order for a person to have a Hill-Burton eligibility
determination made, he must have lived in the U. S. for at
least 3 months.
Can I apply for Hill-Burton assistance on behalf of an
uninsured relative or friend?
Yes. You can apply for Hill-Burton assistance on behalf of
any patient for whom you can provide the information required
to establish eligibility, i.e., you must be able to provide
information regarding the patient's family size and income.
Do I have to wait until I am sick before I can apply for
Hill-Burton assistance?
Hill-Burton is not health insurance. In order to apply for
Hill-Burton assistance you must have already received services
or know that you will require a specific service in the near
future.
What are some reasons I could be denied Hill-Burton care?
The facility may deny your request if:
-
for non-nursing homes, your income is more
than the current poverty guidelines, or more than twice
the guidelines if specified in the facility's allocation
plan. For nursing home services, your income is more than
the poverty guidelines, or double or triple the guidelines,
if specified in the facility's allocation plan
-
the facility has given out its required
amount of free care as specified in its allocation plan
-
the services you requested or received are
not covered in the facility's allocation plan
-
the services you requested or received are
to be paid by Medicare/Medicaid, insurance or other financial
assistance program
-
the facility asks you to first apply for
Medicaid/Medicare or a financial assistance program, and
you do not cooperate
-
you do not give the facility requested proof
of your income, such as a pay stub.
What can I do if I have a complaint against a Hill-Burton
facility?
If you feel you were unfairly denied free care or reduced
cost care, a complaint must be filed in writing to the Central
Office. You must include: 1) the name and address of the
person making the complaint; 2) the name and location of the
facility; and 3) a statement of the actions that the complainant
considers to violate the requirements of the Hill-Burton program.
What other service obligation does a Hill-Burton facility
have?
Under the community service assurance, Hill-Burton facilities
are responsible for providing emergency treatment and for
treating all persons residing in the service area, regardless
of race, color, national origin, creed or Medicare or Medicaid
status. This assurance is in effect for the life of the facility.
If you feel you were unfairly denied services or discriminated
against you should contact the Office
for Civil Rights (OCR) at 1-800-368-1019.
How do I apply for free care?
You should contact the Admissions, Business or Patient Accounts
Office at a Hill-Burton obligated facility to find out if
you qualify for assistance and whether or not a facility provides
the specific services needed.
How can I find out which facilities in my area are Hill-Burton
facilities?
Check our Directory
listing for your State. Be aware that although a facility
may be listed in the Directory, you still need to call the
facility to be certain that it still has funds available and
that the service you desire would be covered.
Hill-Burton Toll Free Hotline
The Hill-Burton program manages a toll-free Hotline, where
callers may request that information be mailed to them. Calls
are primarily received from individuals who have incurred
medical bills that they are unable to pay or who are currently
in need of medical services for which they are unable to pay.
In addition, the hotline receives calls from hospitals and
other health care providers, voluntary organizations, state
and local government agencies, the news media and others.
The Hotline responds to approximately 19,000 calls annually.
In response to inquiries, information mailed to callers includes:
Hill-Burton Free
Care Brochure (PDF) (it describes the program and how to apply
for services), the Poverty Guidelines (used to determine financial
eligibility), and a list of Hill-Burton obligated facilities
in the caller's geographical area.
The Hotline can be reached 24 hours-a-day, at 1-800-638-0742,
or 1-800-492-0359 for Maryland residents.
Revised Poverty Guidelines - effective April 13, 2004
Printer-friendly
PPN 04-02
Frequently Asked Questions (FAQs) Related to Poverty Guidelines
Persons in
Family Unit |
|
|
|
| 1 |
$ 9,570 |
$11,950 |
$11,010 |
| 2 |
12,830 |
16,030 |
14,760 |
| 3 |
16,090 |
20,110 |
18,510 |
| 4 |
19,350 |
24,190 |
22,260 |
| 5 |
22,610 |
28,270 |
26,010 |
| 6 |
25,870 |
32,350 |
29,760 |
| 7 |
29,130 |
36,430 |
33,510 |
| 8 |
32,390 |
40,510 |
37,260 |
For each additional
person, add |
3,260 |
4,080 |
3,750 |
| SOURCE: Federal Register, Vol. 70, No. 33,
February 18, 2005, pp. 8373-8375. |
NOTE: Charts
below showing percentage multiples are estimates - the rounding rules for
these calculations, as well as procedures for calculating monthly income,
are determined by the federal, state, and local program offices that use
the poverty guidelines for eligibility purposes.
Persons in
Family Unit |
100% |
120% |
135% |
150% |
185% |
200% |
| 1 |
$ 9,570 |
$11,484 |
$12,920 |
$14,355 |
$17,705 |
$19,140 |
| 2 |
12,830 |
15,396 |
17,321 |
19,245 |
23,736 |
25,660 |
| 3 |
16,090 |
19,308 |
21,722 |
24,135 |
29,767 |
32,180 |
| 4 |
19,350 |
23,220 |
26,123 |
29,025 |
35,798 |
38,700 |
| 5 |
22,610 |
27,132 |
30,524 |
33,915 |
41,829 |
45,220 |
| 6 |
25,870 |
31,044 |
34,925 |
38,805 |
47,860 |
51,740 |
| 7 |
29,130 |
34,956 |
39,326 |
43,695 |
53,891 |
58,260 |
| 8 |
32,390 |
38,868 |
43,727 |
48,585 |
59,922 |
64,780 |
For each additional
person, add |
3,260 |
3,912 |
4,401 |
4,890 |
6,031 |
6,520 |
Persons in
Family Unit |
100% |
120% |
135% |
150% |
185% |
200% |
| 1 |
$11,950 |
$14,340 |
$16,133 |
$17,925 |
$22,108 |
$23,900 |
| 2 |
16,030 |
19,236 |
21,641 |
24,045 |
29,656 |
32,060 |
| 3 |
20,110 |
24,132 |
27,149 |
30,165 |
37,204 |
40,220 |
| 4 |
24,190 |
29,028 |
32,657 |
36,285 |
44,752 |
48,380 |
| 5 |
28,270 |
33,924 |
38,165 |
42,405 |
52,300 |
56,540 |
| 6 |
32,350 |
38,820 |
43,673 |
48,525 |
59,848 |
64,700 |
| 7 |
36,430 |
43,716 |
49,181 |
54,645 |
67,396 |
72,860 |
| 8 |
40,510 |
48,612 |
54,689 |
60,765 |
74,944 |
81,020 |
For each additional
person, add |
4,080 |
3,912 |
4,401 |
4,890 |
6,031 |
6,520 |
Persons in
Family Unit |
100% |
120% |
135% |
150% |
185% |
200% |
| 1 |
$11,010 |
$13,212 |
$14,864 |
$16,515 |
$20,369 |
$22,020 |
| 2 |
14,760 |
17,712 |
19,926 |
22,140 |
27,306 |
29,520 |
| 3 |
18,510 |
22,212 |
24,989 |
27,765 |
34,244 |
37,020 |
| 4 |
22,260 |
26,712 |
30,051 |
33,390 |
41,181 |
44,520 |
| 5 |
26,010 |
31,212 |
35,114 |
39,015 |
48,189 |
52,020 |
| 6 |
29,760 |
35,712 |
40,176 |
44,640 |
55,056 |
59,520 |
| 7 |
33,510 |
40,212 |
45,239 |
50,265 |
61,994 |
67,020 |
| 8 |
37,260 |
44,712 |
50,301 |
55,890 |
68,931 |
74,520 |
For each additional
person, add |
3,750 |
4,500 |
5,063 |
5,625 |
6,938 |
7,500 |
Persons in
Family Unit |
100% |
120% |
135% |
150% |
185% |
200% |
| 1 |
$ 798 |
$ 957 |
$1,077 |
$1,197 |
$1,476 |
$1,595 |
| 2 |
1,070 |
1,283 |
1,444 |
1,604 |
1,978 |
2,139 |
| 3 |
1,341 |
1,609 |
1,811 |
2,012 |
2,481 |
2,682 |
| 4 |
1,613 |
1,935 |
2,177 |
2,419 |
2,984 |
3,225 |
| 5 |
1,885 |
2,261 |
2,544 |
2,827 |
3,486 |
3,769 |
| 6 |
2,156 |
2,587 |
2,911 |
3,234 |
3,989 |
4,312 |
| 7 |
2,428 |
2,913 |
3,278 |
3,642 |
4,491 |
4,855 |
| 8 |
2,700 |
3,239 |
3,644 |
4,049 |
4,994 |
5,399 |
For each additional
person, add |
218 |
326 |
367 |
408 |
503 |
544 |
Persons in
Family Unit |
100% |
120% |
135% |
150% |
185% |
200% |
| 1 |
$ 996 |
$1,195 |
$1,345 |
$1,494 |
$1,843 |
$1,992 |
| 2 |
1,336 |
1,603 |
1,804 |
2,004 |
2,472 |
2,672 |
| 3 |
1,676 |
2,011 |
2,263 |
2,514 |
3,101 |
3,352 |
| 4 |
2,016 |
2,419 |
2,722 |
3,024 |
3,730 |
4,032 |
| 5 |
2,356 |
2,827 |
3,181 |
3,534 |
4,359 |
4,712 |
| 6 |
2,696 |
3,235 |
3,640 |
4,044 |
4,988 |
5,392 |
| 7 |
3,036 |
3,643 |
4,099 |
4,554 |
5,617 |
6,072 |
| 8 |
3,376 |
4,051 |
4,558 |
5,064 |
6,246 |
6,752 |
For each additional
person, add |
340 |
408 |
459 |
510 |
629 |
680 |
Persons in
Family Unit |
100% |
120% |
135% |
150% |
185% |
200% |
| 1 |
$ 918 |
$1,101 |
$1,239 |
$1,377 |
$1,698 |
$1,835 |
| 2 |
1,230 |
1,476 |
1,661 |
1,845 |
2,276 |
2,460 |
| 3 |
1,543 |
1,851 |
2,083 |
2,314 |
2,854 |
3,085 |
| 4 |
1,855 |
2,226 |
2,505 |
2,783 |
3,432 |
3,710 |
| 5 |
2,168 |
2,601 |
2,927 |
3,252 |
4,010 |
4,335 |
| 6 |
2,480 |
2,976 |
3,348 |
3,720 |
4,588 |
4,960 |
| 7 |
2,793 |
3,351 |
3,770 |
4,189 |
5,167 |
5,585 |
| 8 |
3,105 |
3,726 |
4,192 |
4,658 |
5,745 |
6,210 |
For each additional
person, add |
313 |
375 |
422 |
469 |
579 |
625 |
NOTE: Monthly guidelines
calculated from annual figures; figures rounded-up
to the nearest dollar.
This resource was developed in 2004. Some of the content may be out of date or no longer relevant. PHA is working to update and re-organize this guide. We apologize for any inconvenience.
