San Jose Hospital Bills: Santa Clara County's Healthcare Access Program
If you got care at Santa Clara Valley Medical Center, O'Connor Hospital or St. Louise Regional Hospital and the bill is more than you can handle, the county has a program built for exactly that. It used to be called the Ability to Pay program. Today it's the Healthcare Access Program, or HAP. Depending on your income, it can wipe out the bill entirely or cut it by up to 70%. Here's who qualifies, what to send in, and what to do if the county says no.
AT A GLANCE
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The old Ability to Pay program is gone
You may still see older letters or websites mention "APD," the Ability to Pay Determination at Valley Medical Center. That program has been retired. The county's current policy, CSCHS #715.0, says it replaces the old VMC sliding scale, the Ability to Pay Determination program, and the separate financial assistance policies O'Connor and St. Louise used to have. Every county hospital and clinic now uses one set of rules.
The county social services agency's eligibility handbook describes HAP the same way. It reduces what you owe based on income, and for some people the cost drops to zero.
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Who can get help
You need to meet two tests. First, your gross family income must be below 650% of the federal poverty level. Second, you must fit one of these situations:
You're uninsured. You have no insurance or other source of payment for the care.
You're insured, but your costs at county facilities are high. Your out-of-pocket costs at county facilities in a year are more than 10% of your current family income or your income over the past 12 months, whichever is lower.
You're insured, but your total medical costs are high. You or your family paid more than 10% of your family income in out-of-pocket medical costs to any provider. You'll need proof of what you paid in the past 12 months.
Out-of-pocket costs include copays, coinsurance, deductibles, Medicare copays and Medi-Cal cost sharing.
Under the policy, "family" means you, your spouse or domestic partner, and dependent children under 21 (or any age if disabled), whether they live with you or not. Alimony and child support you pay come off your income.
How much help you get
The county's chart for residents:
Family income (share of federal poverty level) | What you pay |
|---|---|
At or below 400% | Nothing (100% charity care) |
401% to 449% | 30% of the bill (70% discount) |
450% to 549% | 50% of the bill (50% discount) |
550% to 649% | 75% of the bill (25% discount) |
To help you place yourself, here's our own math using the federal poverty guidelines HHS published for 2026. The county applies the official figures it has on file, so treat these as estimates.
Household size | 400% (free care up to) | 650% (discounts end) |
|---|---|---|
1 | $63,840 | $103,740 |
2 | $86,560 | $140,660 |
3 | $109,280 | $177,580 |
4 | $132,000 | $214,500 |
The County does not consider a patient's assets when determining eligibility for Charity Care or a Discounted Payment. (County of Santa Clara Health System, Policy #715.0)
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Residents versus non-residents
Where you live changes what you can get.
County residents who send proof of residency get help for up to a year. The year starts on the earlier of two dates: the first day of the month you applied, or the first day of the care your application covers. You have to reapply each year. The county says proof of residency can be a lease, mortgage statement, utility bill, vehicle registration, driver's license, a declaration of homelessness, or a letter from the person you live with plus proof of where they live.
Non-residents, or anyone who doesn't send proof of residency, can still get free care if family income is at or below 400% of poverty. But it covers only one episode of care at a time. You apply again for each visit or hospital stay. The 70/50/25% discounts above 400% are for county residents.
The policy also says non-residents generally aren't eligible for non-emergency care at county facilities unless there's spare capacity.
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What HAP doesn't cover
The policy covers medically necessary services and supplies from county providers. It generally leaves out:
infertility treatment
cosmetic or plastic surgery
vision correction such as LASEK or PRK
ambulance rides you request yourself
"lifestyle" medications, as Valley Medical Center's pharmacy committee defines them
separately billed physician fees
There's one important protection for ER visits. Under California law, emergency physicians at county facilities must give discounts to uninsured patients and patients with high medical costs who are at or below 400% of poverty. If a separate ER doctor's bill arrives, ask that group about its own discount.
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How to apply
YOUR APPLICATION PACKET
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The policy defines "recent" carefully. Tax returns should show your income for the year you were first billed, or for the 12 months before that. Pay stubs should fall within six months before or after the date you were first billed.
You can submit the application three ways:
Fax: 408-494-7848
In person or by mail: Patient Financial Services, 770 S. Bascom Avenue, San José, CA 95128
Email: HHSVCApp@hhs.sccgov.org. The county recommends encrypting your email because you're sending personal documents.
Staff will also screen you for Medi-Cal, Medi-Cal presumptive eligibility and Covered California. You can apply for those and HAP at the same time, and a pending application for one doesn't block the other.
If you can't gather the paperwork
The policy allows presumptive enrollment. For patients who can't finish the application or supply every document, the county may use a screening tool to enroll them based on programs they're already in, such as homeless services, WIC, CalFresh (SNAP) or certain subsidized housing. Patients who are homeless or who die while getting care, with no funding source or estate, can also be approved case by case by Patient Financial Services or Revenue Cycle leadership.
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Decisions, changes and appeals
The county decides within 30 days of getting a complete application. If you're approved, report changes in income, insurance, family size or medical costs within 60 days or at your next visit, whichever comes first. If you don't, the county can cancel your help back to the date things changed.
If you're denied, you can appeal in two rounds:
First appeal: write down why you disagree and what you want. It must arrive within 30 days of the denial at County of Santa Clara Health System, Patient Business Services, 5750 Fontanoso Way, 1st Floor, San José, CA 95138, Attention: Revenue Cycle Director. The director decides within 30 days.
Second appeal: if the first is denied, write to the Chief Financial Officer within 30 days of that denial at County of Santa Clara Health System, Finance Department, 2325 Enborg Lane, Suite 360B, San José, CA 95128. The CFO decides within 30 days, and that decision is final.
The appeal form is posted on the county's HAP page.
If you still think you were wrongly denied, California's Hospital Bill Complaint Program reviews hospital financial assistance decisions. The free Health Consumer Alliance (888-804-3536) can help you understand a bill.
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Paying what's left
If you qualify for a discount but still owe something, you can ask for a long-term, interest-free payment plan. You and the county negotiate the terms, based on your family income and essential living expenses like rent, food, utilities, child care and transportation. If you can't agree, the county uses the state formula: monthly payments of no more than 10% of your monthly family income after essential expenses.
One more safeguard: the county can't deny you help that was available under the version of the policy posted online when you were first billed.
Not uninsured long-term? Look at PCAP
HAP pays bills. If you're an adult without insurance who needs a regular doctor, the county's Primary Care Access Program (PCAP) is a low-cost coverage program run by Valley Health Plan. You pick a community clinic for primary and preventive care. It's for Santa Clara County residents 19 and older with household income at or below 650% of poverty and no access to employer coverage, Medicare, full-scope Medi-Cal or Covered California. To enroll, call or visit a participating community clinic and ask for an enrollment counselor. Valley Health Plan's PCAP line is (888) 363-3394, option 1.
Related guides
Official sources
Last checked: October 30, 2026. Program rules come from the county's HAP page and Policy #715.0. Income estimates are our math from the 2026 HHS poverty guidelines.
The county can update HAP at any time. Call Patient Financial Services at (866) 967-4677 (TTY 711) to confirm current income limits before you apply.
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