Eligibility Requirements


Eligibility requirements are set for those who request Community Care. The HSHS Financial Assistance Program is not a substitute for personal responsibility. We look at income along with family size for those individuals at or below 200% of the most current Federal Poverty Guideline (FPG). Applications for Community Care will be accepted from any patient without regard to the individual’s sex, race, color, religion, sexual orientation, national origin, age, disability or marital status. Guidelines and applications are updated annually. For individuals and families above 200% FPG, HSHS will look at income and cash assets along with family size. No one will be denied access to services due to inability to pay. There is a discounted/sliding fee scale schedule based on family size and income.

This policy does not offer a provision for assistance to patients with sufficient means who refuse to pay for the medical services rendered to them or to their family members. The Financial Assistance Program is intended to help patients resolve their HSHS medical balances after exhausting all other financial options.

We will make every effort to secure financial assistance to those who qualify. We will make available upon request an application for Community Care (charity) to any patient or responsible party. If you intend to apply for Community Care you will be required, at a minimum to furnish a copy of your most recent federal tax return to assist in identifying potential need. Contact Patient Financial Services at 920-433-8122 or 800-211-2209 for more information. 


Note: These forms are being updated to reference the latest FPG, and to reflect that we look at income along with family size only for those individuals at or below 200% of the most current Federal Poverty Guideline (FPG). In addition, those at or below 200% FPG will not be required to apply for public programs.