Cleveland Hospital Bill Help 2026–27: Cleveland Clinic and MetroHealth Charity Care, Plus Ohio's HCAP
If you live in Cuyahoga County and owe a hospital bill, it is most likely to Cleveland Clinic or MetroHealth, the county's public hospital system. Both offer financial assistance (often called charity care), and both take part in Ohio's Hospital Care Assurance Program (HCAP). The rules differ, so it pays to know which system you owe and how its program works before you pay or set up a payment plan.
Last checked October 2026. Cleveland Clinic details come from its Financial Assistance page and its Financial Assistance Program Summary & Application. MetroHealth details come from its Financial Assistance page and its Financial Assistance Program / HCAP application.
The Short Version
Cleveland Clinic (uninsured patients, Ohio residents):
Family income up to 250% of the Federal Poverty Guidelines (FPG): free care.
251% to 400% of FPG: care discounted to the amount generally billed to insured patients.
At or below 100% of FPG (insured or uninsured), or receiving General Assistance or Disability Assistance: emergency and medically necessary hospital services are free under HCAP.
MetroHealth:
Up to 200% of FPG: 100% discount of charges, for residents and nonresidents.
201% to 250%: 100% for Cuyahoga County residents; 75% for others (100% for trauma or burn care).
251% to 400%: 70% to 75% off for county residents, 65% to 70% for others.
Over 400% or self-pay: 65% off charges.
Cleveland Clinic: Who Qualifies
Cleveland Clinic's summary says that if you do not have insurance, it provides financial assistance for emergency and other medically necessary care if your family income does not exceed four times the FPG and you are a resident of the state where you get care. Ohio patients must live in Ohio.
Every applicant is screened for Medicaid and must cooperate with the Medicaid representatives to be considered. This is important: Cleveland Clinic's website says it works with two vendors, Firstsource and ElevatePFS, and that if one of them contacts you, you are required to respond promptly. The page says that if you do not fully cooperate, you will receive a bill. It also states that these vendors are not collection agencies.
For Ohio patients, the page lists:
Last name A–L: Firstsource, 1-866-268-4324
Last name M–Z: ElevatePFS, 1-216-238-9565
If you have insurance, you can still qualify under the income rules if your in-network insurance does not cover the medically necessary service you need, or if you have used up your lifetime maximum benefits.
2026 income limits used by Cleveland Clinic
From Cleveland Clinic's 2026 Federal Poverty Guideline table:
| Family size | HCAP (100% FPG) | Financial Assistance limit (400% FPG) | |---|---|---| | 1 | $15,960 | $63,840 | | 2 | $21,640 | $86,560 | | 3 | $27,320 | $109,280 | | 4 | $33,000 | $132,000 | | 5 | $38,680 | $154,720 | | 6 | $44,360 | $177,440 |
The page notes that HCAP income levels apply to insured and uninsured patients, while the 400% limits are for uninsured patients (and insured patients whose coverage doesn't include the service or whose benefits are exhausted).
Other ways to qualify at Cleveland Clinic
If your income is over the limits, Cleveland Clinic says it will still consider you case by case for:
Catastrophic balance: a balance from one episode of care greater than 25% of your annual family income (this excludes insured patients for whom Cleveland Clinic is out of network).
Exceptional circumstances: extreme personal or financial hardship.
Special medical circumstances: treatment only Cleveland Clinic staff can provide, or continuity of care.
Life circumstances: patients who are homeless.
It also offers help with maternity care for pregnant Ohio residents whose insurance has no maternity benefits, if they meet the income criteria.
Anyone who qualifies will not be charged more than the amount generally billed to patients with commercial insurance, Medicare or Medicaid.
What is not covered
The summary says it does not apply to Cleveland Clinic Rehabilitation Hospitals, Select Cleveland hospitals, One Medical locations or Ashtabula Regional Medical Center, which have their own policies. Cleveland Clinic also publishes a list of doctors not covered by its policy on its Financial Assistance page, so check it if you received a separate physician bill.
How to apply at Cleveland Clinic
Get the Financial Assistance Program Summary & Application from the Financial Assistance page (available in English, Arabic, Spanish, Russian, Ukrainian and Nepali), at admissions, in an emergency department or from a Patient Financial Advocate.
You can apply at any point in the scheduling or billing process. Submit the application with income information in person, online, by delivery or by mail.
Need help? Call Customer Service at 866-621-6385 or ask a Patient Financial Advocate. They can mail you the policy and form for free, and can start an application for you if you think you have catastrophic or special circumstances.
Cleveland Clinic may also use a third party to presumptively decide eligibility, so you may be approved without a full application.
MetroHealth: Who Qualifies
MetroHealth says it uses the Federal Poverty Guidelines for medically necessary services to decide which program fits you. Its current table:
| Income (% FPG) | Cuyahoga County resident | Ohio resident or nonresident | |---|---|---| | Up to 200% | 100% discount | 100% discount | | 201–250% | 100% discount | 75% (100% for trauma or burn care) | | 251–300% | 75% (100% for trauma or burn care) | 70% | | 301–400% | 70% | 65% | | Over 400% or self-pay | 65% | 65% |
For patients at or below 100% of FPG who meet the other criteria, MetroHealth takes part in HCAP with a 100% reduction of the bill.
One exclusion stands out: MetroHealth says bariatric surgery and related services are not eligible for its financial assistance or discount program.
MetroHealth's billing menu also includes a page titled "Our Financial Aid Policy is Changing," so confirm the current percentages when you call.
How to apply at MetroHealth
Call the Financial Eligibility Team at 216-957-2325, option 2, Monday through Friday, 8 a.m. to 5 p.m., to schedule a consultation. Representatives can also help you apply for Medicaid or Marketplace coverage.
Download the Application for Financial Assistance (English or Spanish) and the Required Documentation list from MetroHealth's Financial Assistance page.
The application asks whether you were an Ohio resident and whether you had Medicaid or other insurance at the time of service, then asks for the monthly income of everyone in your immediate family who lives with you. For HCAP, family means the patient, a spouse and children under 18 living in the home.
If you are approved, you must tell MetroHealth about any change in household income or insurance.
Tips Before You Pay
Ask before you pay. Applying first can wipe out or shrink the bill. Ask the billing office to note that an application is pending.
Respond to Medicaid screening. At both systems, being screened for Medicaid is part of the process. At Cleveland Clinic, ignoring the screening vendor can lead to a bill.
Check every bill. Doctor, ambulance and outside lab bills may come from separate groups not covered by the hospital policy.
Keep copies of everything you send, plus dates and names of the people you spoke with.
Closing Thoughts
Cleveland has two strong charity care programs: free care up to 250% of poverty at Cleveland Clinic and full discounts up to 200% (250% for county residents) at MetroHealth, with HCAP covering the lowest-income patients at both. Apply early, cooperate with the Medicaid screening, and call the numbers above if you get stuck.
Comments