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Health Care
Can Charity Care Help Me With My Hospital Bills?

Do you not have health insurance that covers bills for medical care that you received from a hospital in New Jersey? Do you have insurance, but like Medicare or some other health insurance, it covers only part of your hospital bills? If you do not have insurance coverage or you have coverage that does not cover all of your hospital bills—and you don’t have Medicaid/NJ FamilyCare—you may be eligible for the New Jersey Charity Care program to pay all or some of your hospital bills.

What does Charity Care cover?

If you are eligible, Charity Care will cover the costs of hospital services that you receive in an acute care/general hospital in New Jersey. It will also cover the costs of hospital outpatient services, including dialysis and advanced life support services (often provided during emergency or ambulance services) if you are found eligible. Be aware, however, that some doctors who treat you in the hospital in which you have been approved for Charity Care will bill you for their services. These doctors claim that their services are not covered by Charity Care because they are not employees of the hospital, but there is a strong legal argument that all services provided in or by the hospital are covered by Charity Care. If you have been found eligible for Charity Care but you get bills afterwards from doctors connected to your hospital care, you should call the Legal Services office nearest you for assistance or LSNJLAWSM, Legal Services of New Jersey’s statewide, toll-free legal hotline, at 1-888-576-5529.

Who is eligible for Charity Care?

To be eligible for Charity Care, you must meet the following requirements:

  • Financial Eligibility—Income: You will be eligible for full Charity Care coverage in 2018 if your annual gross income for the 12 months before your hospital care was not more than 200% of the federal poverty level, which is $24,280 in 2018 for a single person. If your annual gross income is more than 200% of poverty but does not exceed 300%, Charity Care will cover up to 80% of your total bill based on a sliding income scale. This scale can be found at the New Jersey Hospital Care Payment Assistance Fact Sheet (from the New Jersey State Department of Health and Senior Services). If family size is larger—your family includes you, your spouse, any minor children you support, and adults for whom you are legally responsible—the income eligibility limit is higher. For example, an applicant in a family of four will be eligible for full Charity Care coverage in 2018 if the family’s annual gross income is $50,200 (200% FPL) or less. And the applicant will still be eligible for partial Charity Care coverage in a family of four with income that is greater than $50,200, if the income does not exceed $75,300 (300% FPL). The income eligibility limit usually increases a small amount every year. Therefore, if you are being billed for hospital care that you received in 2016, 200% of the poverty level in 2016 was $23,760 for a single person and $48,600 for a family of four.

  • Financial Eligibility—Assets: Assets are items that can be easily converted into cash. They include such things as savings and checking accounts, certificates of deposit (CDs),and Individual Retirement Accounts (IRAs). If you own the home you live in, however, the value of your home will not be counted as an asset. Assets are valued as of the date of the medical care you received at the hospital. The asset limit for one person is $7,500; for a family it is $15,000.

  • New Jersey Residency: You must show that you lived in New Jersey at the time you received the hospital care. Non-New Jersey residents can also apply for Charity Care if their health or life would have been at serious risk if they had not sought immediate medical care at a New Jersey hospital. There is no citizenship or immigration status requirement for Charity Care eligibility.

  • Ineligibility for Medicaid/NJ FamilyCare:  You will not be eligible for Charity Care if you are eligible for Medicaid or NJ FamilyCare. The hospital can require that you apply first for Medicaid/NJ FamilyCare to show that you are not eligible for these programs before the hospital considers your application for Charity Care. You may have commercial insurance (individual or group insurance) or Medicare, however, and still be eligible for Charity Care. Often, these types of health insurance do not cover all the costs of your hospital care.

How is your income calculated?

When you apply for Charity Care, the hospital can calculate your annual income in three different ways. The hospital must then use the calculation for the period of time when your income was the lowest to determine your eligibility.

  1. You may give the hospital proof of your gross income for the entire 12 months immediately before you received the hospital care;
  2. You may give the hospital proof of your gross income for the three months immediately before your hospital care, and the hospital will multiply the three months’ total by four to determine your gross annual income; and
  3. You may also give the hospital proof of your gross income in the month immediately before you received the hospital care, and the hospital will calculate your annual income by multiplying this amount by 12.

Therefore, if your income had not been the same in the 12 previous months before you received the health care, then you want the hospital to calculate your income with one of the alternate methods. Therefore, it is very important to provide the hospital with the proofs of your income that allow them to make a decision most favorable to you.

What if I make too much money?

If your medical expenses are greater than 30% of your family’s annual income (and you meet the Charity Care asset limit), the amount greater than 30% will be fully covered by Charity Care.

If your income meets the Charity Care income limit, but your assets are too high ($7,500 for an individual; $15,000 for a family), you may spend down your assets on the unpaid hospital bill until your assets are within the Charity Care limit. This can make you eligible for Charity Care coverage for the rest of your bill.

There is also a special program for children in New Jersey with very large medical bills that are not covered by insurance. For more information, call 1-800-335-FUND (3863).

How much should a hospital charge me if my annual income is more than 200% of the poverty level?

In February 2009, a law went into effect in New Jersey that requires hospitals to charge uninsured patients no more than 15% above what the Medicare program pays the hospital for the same procedure.  Medicare’s fee schedules can be found online by matching the CPT codes (Current Procedural Technology, 4th Edition) at All Fee-For-Service Providers (from Centers for Medicare & Medicaid Services (CMS).

The law also requires the creation of a sliding scale, based on income up to 500% of poverty for the percentage of that amount that an uninsured patient must pay, but that sliding scale has not yet been established by the State. If your income is between 200% and 300% of the poverty level, however, the Charity Care discount applied must be applied to a hospital bill that has already been adjusted to not more than 15% of the Medicare rate.

When and where do I apply?

The hospital is required to inform you in writing about the availability of Charity Care.  You must apply for Charity Care at the hospital where you received the medical care. When you apply, a hospital may accept your Charity Care determination from another hospital, but is not required to. You can apply for Charity Care at the hospital’s business office or billing department.

You may submit a completed application for Charity Care up to a year from the date that you were discharged from being admitted as an inpatient at the hospital or a year from the date you received outpatient care at the hospital. That is why it is very important to apply for Charity Care as soon as possible after you receive the medical care.  The hospital may accept an application within two years of these dates, but the hospital is not required to take an application past one year.

If the hospital thinks you may be eligible for another medical assistance program to pay for your hospital bill, like Medicaid/NJ FamilyCare, the hospital must refer you to that program. If you do not apply for that medical assistance program within three months, the hospital may bill you for the cost of your hospital care. But if the hospital fails to inform you in writing that you can apply for Charity Care and Medicaid/NJ FamilyCare to cover the cost of your care, the hospital cannot bill you.

For more information…

If you have been denied Charity Care or you would like legal help because you are being billed for medical care, please contact your regional Legal Services office or call LSNJLAWSM at 1-888-LSNJ-LAW (1-888-576-5529).

4/9/2018