HCAP – Hospital Care Assurance Program Guidelines
For patients whose income is at or below (0 to 100 percent of) the Federal Poverty Guidelines (FPG), UH participates in Ohio’s Hospital Care Assurance Program (HCAP). Through HCAP, UH provides basic, medically necessary hospital services free of charge to Ohio residents. Federal Poverty Guidelines are available from the U.S. Department of Health & Human Services at its website: aspe.hhs.gov/poverty.
Print the HCAP/UH Hospital Charity/Financial Assistance application (PDF), or request an application online.
In order to be considered for the HCAP adjustment, you MUST meet the requirements and provide the following:
- 3 Standard Requirements:
- Individuals must be residents of the State of Ohio
- Individuals cannot be enrolled in the Medicaid Program; and
- Personal or family income is at or below the Federal Poverty line
- Complete and SIGN the HCAP Application in its entirety; Incomplete or unsigned applications will be immediately denied.
NOTE: A new application is required for each month hospital services were received.
- Household Income Verification Documentation – Include all documents verifying your household income for the three (3) months or the twelve (12) months prior to the date(s) of service. This may include W2s, social security award letter, pay stubs or letters from employers. For Self-employed ONLY – Income Tax Forms and schedules are acceptable. If you have not filed your tax return, you can call 1-800-829-1040 to obtain a Proof of Non-Filing letter from the IRS.
- NOTE: If there is no income to list for the household (includes food stamps), please use the space provided on the front of the application to explain how you/your family survived financially during the timeframe specified. This option requires the family member/friend to provide a brief, written statement stating how they support you.
- NOTE: This program is for “hospital charges” ONLY. ER and Physician professional charges, home health costs, ambulance services, life flights, transplant services take home medications, patient convenience items and infertility related charges are excluded from this program and will be the responsibility of the patient.