In compliance with the Ohio Hospital Care Assurance Program (HCAP), Hillcrest Hospital offers basic, medically necessary hospital-level services free of charge to Ohio residents whose incomes are at or below the Federal Poverty Income Guideline, and who are not recipients of Medicaid. Current recipients of the Disability Assistance Program also qualify for HCAP assistance.
In addition to the HCAP program, Hillcrest Hospital provides financial assistance to patients who do not have insurance coverage at family income levels up to four times the Federal Poverty Income Guideline. Hillcrest Hospital also gives consideration to all patients, whether or not they have insurance and regardless of income level if there are exceptional circumstances. The Hillcrest Hospital financial assistance program applies to hospital services.
* Assistance is provided by Hillcrest Hospital on a sliding scale based on the listed income levels
(Family income level up to four times Federal Poverty Income Level).
Hillcrest Hospital provides financial assistance on a sliding scale to patients who do not have insurance at family income levels up to four times the Federal Poverty Guidelines. Patients with exceptional circumstances will be considered for assistance on a case-by-case basis.
Eligibility:
- You must be a resident of Ohio, Florida or Nevada, respectively, depending upon where services are provided, and meet the geographic requirements identified in the policy.
- Your income is at or below 400% of the Federal Income Poverty Guidelines.
- You must provide proof of income (income includes gross wages, rental income, gross income from self employment, public assistance, social security, unemployment compensation, strike benefits, alimony, child support, military family allotments, pensions, veteran’s benefits, etc.) Sources of income apply to all applicable family members.
- Family members include patient's spouse and patient's children under the age of eighteen living at home
- You must comply with the Medicaid eligibility process with the Cleveland Clinic health system designated vendor or on-site representative.
In addition:
- Insured patients may be considered in exceptional circumstances.
- If you qualify for financial assistance, you will be asked to reapply every 90 days or prior to an admission/ procedure.
- If you qualify for less than 100% financial assistance coverage, you will be asked to pay 50% of the uncovered estimated balance, according to Cleveland Clinic’s financial assistance policy.
2011 Federal Poverty Income Guidelines
|
Family Size
|
*(HCAP) 2011 Federal Poverty Income Level
|
CC Financial Assistance Program
(Family income up to 400% of Federal Poverty Level)
|
|
1
|
$10,890
|
$43,560
|
|
2
|
$14,710
|
$58,840
|
|
3
|
$18,530
|
$74,120
|
|
4
|
$22,350
|
$89,400
|
|
5
|
$26,170
|
$104,680
|
|
6
|
$29,990
|
$119,960
|
|
7
|
$33,810
|
$135,240
|
|
8
|
$37,630
|
$150,520
|
For each additional family member add $3,740*
Have questions or want to apply for assistance?
If you received medical services at Hillcrest Hospital and feel you would qualify to receive these services without cost or at a reduced cost to you please complete this application and return it to:
Cleveland Clinic Health System
Patient Financial Services – Customer Service
6801 Brecksville Rd – RK90 – Suite 20
Independence, OH 44131