Columbus Hospital Financial Assistance 2026–27: Ohio HCAP Free Care, OhioHealth's Charity Discounts, Documents and Deadlines
Ohio's hospital financial assistance works in two layers, and Columbus patients should know both.
The floor is a state program: the Hospital Care Assurance Program (HCAP). Under Ohio Revised Code 5168.14, hospitals that receive HCAP funds must provide free basic, medically necessary hospital care to Ohio residents who aren't on Medicaid and whose income is at or below the federal poverty line.
On top of that, many hospitals run their own charity programs with higher income limits. OhioHealth, one of Columbus's largest systems, publishes discounts up to 400% of the poverty guidelines.
This guide explains HCAP rule by rule, uses OhioHealth's published policy as a worked example, and covers the documents and deadlines that trip people up.
Layer 1: HCAP, Ohio's Free Care Floor
Who qualifies. Under Ohio Administrative Code 5160-2-17, you're eligible if you:
are an Ohio resident, meaning you live here voluntarily and aren't receiving public assistance in another state,
are not a Medicaid recipient, and
have individual or family income at or below the current HHS poverty guideline.
2026 HHS poverty guidelines (the HCAP income limit):
Family size | Annual income at or below |
1 | $15,960 |
2 | $21,640 |
3 | $27,320 |
4 | $33,000 |
5 | $38,680 |
6 | $44,360 |
What's covered. "Basic, medically necessary hospital-level services" are all inpatient and outpatient services covered by Ohio Medicaid, except transplants and related services. They must be ordered by a physician and delivered at a hospital where that provider has privileges.
How income is counted. Income means total salaries, wages and cash receipts before taxes. Self-employment income counts after reasonable business expenses. The hospital uses either:
your income for the 3 months before the service, multiplied by four, or
your income for the 12 months before the service.
If you lost your job recently, the 3-month method may help you qualify.
Who counts as "family." For HCAP, family means the patient, the patient's spouse (even if they live elsewhere), and the patient's children under 18 who live in the home. If the patient is a minor, it means the minor, both natural or adoptive parents (even if they live elsewhere), and the parents' children under 18 living in the home.
How long eligibility lasts:
Outpatient: a determination can last 90 days from the first service date.
Inpatient: each admission is determined separately, unless you're readmitted within 45 days for the same condition.
Your HCAP Billing Rights
ORC 5168.14 lets hospitals bill HCAP-eligible people only if the hospital has a procedure to check income after billing and cancel the charges for those who qualify. The first bill and at least the first follow-up bill must include a written statement that:
explains that people with income at or below the poverty line get services without charge,
lists the poverty line for different family sizes, and
describes the procedure for applying.
Your deadline is long. Hospitals must accept HCAP applications until three years after the date of that follow-up notice.
Posted notices. Hospitals must post HCAP notices in admissions, the business office and the emergency room. The notices must be in plain language, in English and other common local languages, and readable from 20 feet away. If you can't read the notice, staff must make reasonable efforts to explain it.
Layer 2: Hospital Charity Programs (OhioHealth Example)
HCAP stops at 100% of poverty. Hospital charity programs often go much higher. OhioHealth's published Financial Assistance Policy procedure says its Charity Program provides:
Income (% of federal poverty guidelines) | OhioHealth charity discount |
Less than 200% | 100% off the patient's payment responsibility |
201% to 300% | 80% off |
301% to 400% | 65% off |
Key terms in OhioHealth's policy:
It covers emergency or other medically necessary care at OhioHealth hospitals, employed physician practices, urgent care centers and home care.
Other payment sources come first, such as insurance, HCAP and other government programs. Amounts you still owe after insurance may qualify.
Services billed separately by other providers, even inside an OhioHealth hospital, aren't covered by this policy. OhioHealth attaches a list of covered and non-covered providers to its policy.
Charity eligibility lasts 180 days.
There's a separate Hardship application for unusual circumstances. You send a letter explaining your situation, with supporting documents, after a financial assistance application.
Other Columbus hospitals have their own policies. If you were treated outside OhioHealth, ask that hospital's billing office for its financial assistance policy and application.
Documents: What OhioHealth Asks For
The OhioHealth application, titled "HCAP / Charity Care / Financial Assistance Application", asks for income for everyone in your immediate family for 3 months and 12 months. Its procedure lists acceptable proof:
Pay stubs for the 3 or 12 months before the service or application date, your choice. If you don't have them, a signed employer letter on company letterhead with a contact name and phone number may be accepted.
Your spouse's income, even if your spouse lives elsewhere.
Bank statements if pay or Social Security is deposited directly.
Sometimes W-2s or your most recent tax return.
Proof of child support or alimony received, unemployment, workers' compensation, tips, interest, rental, retirement or investment income.
Application tips from OhioHealth:
Don't write "N/A" in any field.
If you report $0 income, explain how you're being supported.
If you stopped working, give your last day of work.
Where to send it: OhioHealth, L-4312, Columbus, OH 43260, or upload it in MyChart. You can also email customercenter@OhioHealth.com. For help, call (614) 566-1505.
No paperwork? OhioHealth's procedure says it may decide eligibility from all available information in some situations. These include homelessness or a shelter address, a family member's statement about inability to pay, having been a Medicaid recipient before or after the service, or having been HCAP or charity eligible on another date.
Step-by-Step Plan for Columbus Patients
Find the HCAP statement on your first bill or follow-up bill. Compare your income with the poverty line listed there.
Ask the hospital for its financial assistance application. Many hospitals use one form for HCAP and their own charity program.
Choose 3-month or 12-month income, whichever is lower for you.
Apply for Medicaid if you might qualify. Hospitals may require it before processing HCAP.
Ask for a list of separately billing providers, such as ER doctors or radiology. Apply with each one separately.
Keep copies and note the date you sent everything.
If You're Denied
Ohio's HCAP rule doesn't create a formal appeal, but hospitals must keep a written HCAP policy describing how they take applications and decide eligibility, including what income proof they accept. If you're denied:
Ask for the reason in writing, and ask for a copy of the hospital's HCAP and financial assistance policy.
Fix the gap. Send missing pay stubs, recalculate using the other income method, or correct your family size under HCAP's definition.
Reapply. HCAP applications are accepted until three years after the follow-up notice.
Ask about hardship. At OhioHealth, send a hardship letter if you were denied under the income tiers but face unusual financial strain.
More Help
More help in Columbus: Columbus financial help guides
Related Guides
Sources
This guide gives general information, not legal advice. Hospital policies change. Confirm details with your hospital's financial assistance office.
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