Free Care for the Uninsured

If you need medical care but are unable to pay for it either because you have no insurance or your insurance does not cover all of your medical bills, you may be eligible for free or partial free care at acute care hospitals and health centers in Massachusetts.

As part of the 1988 Universal Health Care Law, hospitals and health centers are required to provide free and/or reduced cost care to uninsured and underinsured people, regardless of citizenship or immigrant status. The program covers inpatient, outpatient and emergency medical services. There are limitations to what is covered. Doctor's bills are covered only if the doctor is an employee of the hospital or health center. In most cases this means doctors bills are covered for services at a health center and in the emergency room but the services of specialty doctors who treat you in a hospital may not be. Lab services are likewise only covered if provided by the hospital or health center itself. If the faciliity sends out its labs to be processed they may not be covered. In Lynn, labs at both the hospital and the health center are covered by free care.

WHO IS ELIGIBLE FOR FREE CARE?

• Patients enrolled in the CenterCare Program.
• Patients whose family income is under 200% of the federal poverty level (see chart).
• Patients whose family income is between 200% and 400% of the federal poverty level (see chart) are eligible for partial free care. Hospitals must provide partial free care; health centers have the option.
• If paying a hospital bill will cause financial hardship on a patient or his family -- even if the family income is greater than 400% of poverty -- the patient may be eligible for free or partial free care. (See "Special Circumstances.")
  

HOW DO I APPLY FOR FREE CARE?

To apply for free care, you must complete a written application (the same one used for MassHealth) signed by you, a relative or legal guardian, and provide information verifying that you are eligible for free care. The application should be filed with the Office of Medicaid's Central Processing Unit. You can print an application from their website, get one by calling 1-888-665-9993. You can also compete an application at a hospital or community health center. To download and print an application, click here.

CAN A HOSPITAL OR HEALTH CENTER REQUIRE A PRE-ADMISSION DEPOSIT?

A hospital or health center cannot require a pre-admission deposit from anyone needing emergency treatment. Hospitals cannot require a pre-admission deposit from patients who are members of CenterCare; or who have family incomes below 200% of poverty. Hospitals may charge other patients a pre-admission deposit, but must describe, in writing, the method used to determine the amount of the deposit. Health centers may request a $7 charge in advance of care, but cannot refuse care because of an inability to pay.

CAN A HOSPITAL OR HEALTH CENTER TURN ME AWAY FOR FINANCIAL REASONS?

A hospital or health center cannot turn any patient away in cases of emergency. If the medical facility is a Medicaid provider and the patient is a Medicaid recipient, the medical staff cannot deny care. If a hospital or health center wants to reject other patients for financial reasons, it must have procedures for doing so in its Credit and Collection Policy.

CAN A HOSPITAL OR HEALTH CENTER TAKE MY HOME OR CAR TO PAY MEDICAL BILLS?

A hospital or health center cannot take the house or car of any patient without the approval of its Board of Trustees.

CALCULATING PARTIAL FREE CARE

Using the "Annual Family Poverty Income Guidelines," find the number on the chart that corresponds to 200% of the federal poverty level for your family's size. If your family income is below this amount, you are entitled to total free care. If your family income is above 200%, but below 400%, you qualify for partial free care. To find out your share of a medical bill under partial free care, subtract the 200% figure on the chart from your income. Your share of the medical bill is 40% of the difference.

Example: A family of three has an annual income of $30,000. The family has a hospital bill of $2,500. To figure the family's share of the medical bill:

Take the family's income:                                         $30,000
Subtract 200% of poverty for a family of 3: -                $26,660
Income in excess of poverty:                                      $3,340
Multiply excess by .40 (40%)                                      X .40
Family's share of bill:                                                 $1,336

Note: If the patient's share exceeds $500, the hospital or health center must offer the patient a repayment plan lasting at least two years. (The hospital or health center may charge interest during this period.)

SPECIAL CIRCUMSTANCES

If paying a medical bill could cause financial hardship on you or your family even if your family's income exceeds 400% of poverty -- you may be eligible for full or partial free care. The hospital has the right to determine what constitutes financial hardship, but by law, it must consider the following: the amount of remaining family income; other expenses; the patient's future earning capacity; any prolonged unemployment caused by the patient's illness or condition; and the patient's ability to make payments over an extended period of time.

CAN I APPEAL THE DECISION OF A HOSPITAL OR HEALTH CENTER?

There is a review process by no formal appeal available. Patients who believe they have been wrongfully denied free or partial free care should contact the Division of Health Care Finance and Policy at (617) 451-5340 or Health Care For All at the number below.

For More Information Contact:

Health Care For All    30 Winter Street, Suite 1007 Boston, MA 02108 (617) 350- 7279 or 1-800-272-4232

or contact the Task Force Access Helpline.