ECMC Financial Assistance: How Buffalo Patients Get Hospital Bills Cut or Erased
If you were treated at Erie County Medical Center (ECMC) on Grider Street in Buffalo and can't afford the bill, the hospital's Charity Care/Financial Assistance Program can wipe out or sharply cut a hospital bill for uninsured and underinsured patients. Under the policy revised in June 2026, households at or below 200% of the federal poverty level can get up to a 100% discount, and help reaches up to 400%. New York's uniform application also gives you state-law protections that many patients don't know about. Here's who qualifies, what you'd pay at each level, what the program won't cover, and how to apply and appeal.
QUICK FACTS
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Who can get help at ECMC
ECMC's financial assistance page says the program is for patients "with limited incomes and no health insurance, or those individuals who are under-insured." The New York State uniform application that ECMC uses spells out four groups:
low-income people without health insurance;
underinsured people, meaning their out-of-pocket medical costs over the past twelve months were more than 10% of gross annual income;
people who've exhausted their health insurance benefits and can show they can't pay full charges; and
at the hospital's discretion, people who can show they can't pay a co-pay or deductible.
Medicare beneficiaries aren't left out. ECMC's policy recognizes that low-income Medicare patients may struggle with deductibles and coinsurance. It says they're eligible under the same rules and income guidelines as everyone else.
Non-U.S. citizens can qualify too, as long as they provide identification and proof of income. The policy says income can be shown in the currency of your home country, and ECMC will use the U.S. conversion. ECMC's FAQ adds that you can apply "regardless of immigration status." Emergency care is open to anyone in New York State or northern Pennsylvania who meets the income guidelines.
You will not be denied medically necessary care because you need financial assistance. (ECMC, Financial Assistance FAQ)
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The three coverage levels
ECMC's policy sets three levels based on household income compared with the federal poverty guideline:
Level | Household income | Discount on covered services | What you owe |
|---|---|---|---|
Level 1 | 200% of poverty or less | Up to 100% | Nothing for covered services |
Level 2 | 300% of poverty or less | Up to 90% | 10% patient cost share |
Level 3 | 400% of poverty or less | Up to 80% | 20% patient cost share |
The policy says the Level 2 and Level 3 cost share is due at the time of service unless ECMC's In-House Collection Department agrees to a repayment arrangement. Before any of these discounts are applied, qualifying patients also get the amounts generally billed (AGB) discount on gross charges. ECMC uses the Medicaid fee-for-service schedule to set it. In practice, that means a qualifying patient isn't charged more than people with insurance would be.
The state application describes the same bands slightly differently. For uninsured patients between 200% and 300% of poverty, it says the charge is a sliding scale "up to 10% of the amount that would have been paid for the service(s) by Medicaid." Between 301% and 400%, it's up to 20%. For underinsured patients, the cap is 10% or 20% of what their insurance cost-sharing would have been.
2026 income limits
These are yearly gross household income limits (before taxes). They come from the 2026 federal poverty levels in ECMC's application and income table, which ECMC says are effective February 1, 2026, to January 31, 2027.
Household size | 200% (Level 1) | 300% (Level 2) | 400% (Level 3) |
|---|---|---|---|
1 | $31,920 | $47,880 | $63,840 |
2 | $43,280 | $64,920 | $86,560 |
3 | $54,640 | $81,960 | $109,280 |
4 | $66,000 | $99,000 | $132,000 |
5 | $77,360 | $116,040 | $154,720 |
6 | $88,720 | $133,080 | $177,440 |
7 | $100,080 | $150,120 | $200,160 |
8 | $111,440 | $167,160 | $222,880 |
Your household includes you, your spouse or domestic partner, and your children or other dependents. In general, that's everyone on the same tax return. Gross income covers wages, tips and self-employment earnings, Social Security, disability and unemployment benefits, money from family or friends, temporary assistance and SSI. If you're self-employed, ECMC's policy uses net income from a three-month ledger or similar record, the same method the county Department of Social Services uses.
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What the program doesn't cover
ECMC's policy says approved assistance applies to the hospital's technical charges for emergency and medically necessary inpatient, outpatient and emergency room care. It excludes:
prescriptions;
Level 2 dental work such as dentures, partials, root canals and implants;
private physician charges, for example from a radiologist or anesthesiologist;
elective, non-medically necessary procedures, and services a clinician decides are non-emergent;
private room differentials and telephone or television charges; and
services at Terrace View Long Term Care Facility.
Payment for services that aren't covered is due when you get them, unless you set up a repayment arrangement. The state application also warns that you may be billed separately for physician fees outside the program. Ask the counselor which doctors who treated you are covered. ECMC links a list of affiliated providers from its financial assistance materials.
Dental patients are handled separately. A patient who's seeking only dental care, has no dental insurance and meets the income rules can be approved for ECMC's Dental Financial Assistance Program.
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How to apply
You can apply before an appointment, when you come in for care, or after the bill arrives. ECMC's policy says you can apply "at any point, starting from the date of service and throughout the collections process." A counselor can take your application in writing or over the phone, and free help is available in your own language through an interpreter.
What ECMC's policy says must come with the application:
Income source | What to send |
|---|---|
Wages | Two weeks of recent pay stubs for every working household member (the state form also accepts an employer letter or your latest tax return) |
Social Security or disability | Award letter or annual benefit letter from SSA |
Unemployment | Award letter, benefit statement or printout from the NYS Department of Labor |
Workers' compensation | Award letter or check stub |
Child support or alimony | Court order, or 3 months of cashed checks or receipts |
Interest or dividends | Recent dividend or account statements |
Other income or no income | A signed letter stating the amount, or a signed statement of no income |
If you have the eligibility page from NY State of Health, the state application says that alone is enough proof of income. If ECMC can't verify your income any other way, its policy says the request will be denied unless you sign a self-attestation witnessed by a notary or commissioner of deeds.
STEPS TO APPLY AT ECMC
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Presumptive eligibility and hardship write-offs
Some patients can be approved without finishing an application. ECMC's policy says a counselor may presume eligibility using information such as a partly completed application, past account notes or collection data. If that presumption later turns out to be wrong, the award is reversed. The policy also says:
if you're confirmed homeless and can't complete a Medicaid or financial assistance application, self-pay balances are adjusted to zero;
Medicaid patients who get an Admission Denial notice, or whose Medicaid coverage is limited, can have balances adjusted without an application; and
requests for services that fall outside the standard rules are reviewed case by case as hardships, with a written decision within 30 days.
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Your protections under New York law
ECMC's uniform application lists rights that apply at every New York hospital:
No payment while you wait. You don't have to pay anything until you get a decision, and the hospital can't send your account to collections while the application is pending.
A 180-day buffer. Hospitals can't send unpaid bills to a collection agency for at least 180 days after your first bill.
No lawsuits under 400%. Hospitals can't take legal action, including filing lawsuits, to collect unpaid medical bills from patients below 400% of the poverty level.
Affordable installments. Monthly payments can't exceed 5% of your gross monthly income, and any interest can't exceed 2%.
Care isn't cut off. A hospital can't refuse medically necessary services because you owe a bill.
ECMC's own policy goes further on payment plans. It says its installment plans are non-interest bearing and won't be accelerated if you miss a payment.
One rule cuts the other way. The policy says payments made on covered services before you're approved "are non-refundable." If you think you qualify, apply before you pay.
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After a decision
Approval. You'll get an approval letter. Bring it when you register for future visits so staff can apply the discount. The approval lasts 12 months if your income is fixed unearned income, such as Social Security retirement, SSI, SSDI, survivors benefits or a pension. It lasts 6 months if you have earned income. After that, you reapply with a new application and documents.
Denial. ECMC must tell you why in writing. To appeal, send a written grievance to ECMC's Financial Assistance Program department within 20 days of the date on the denial letter, and include any new information. An appeals committee reviews cases every two weeks and answers in writing within 30 days.
Still not eligible? Uninsured patients who don't qualify for a government program or the charity program are offered ECMC's self-pay rate. A counselor will give you a cost estimate, a self-pay quote and a down-payment agreement. ECMC's FAQ also says it can set up payment plans if you can't pay your bill.
Where to get outside help
Community Health Advocates: 888-614-5400, for help with the application or an appeal.
New York State Department of Health complaint hotline: (800) 804-5447, if you have a problem with ECMC you can't resolve.
If the bill itself looks wrong, request an itemized bill before you pay. Our guide to hospital bill errors shows what to check.
Related guides
Official sources
Last checked: October 30, 2026. Facts come from ECMC's financial assistance page, its Charity Care/Financial Assistance Program policy revised June 2026, its 2026 NYS uniform application, and its 2026 income guidelines.
Discounts depend on ECMC's review of your household income. Confirm your eligibility, covered services and deadlines with ECMC Financial Counseling Services at (716) 898-5566.
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