HCAP: Ohio’s Hospital Care Assurance Program

Ohio’s disproportionate share (DSH) program, called the “Hospital Care Assurance Program” (HCAP), provides Ohio residents free care for medically necessary hospital services if:

  • They are at or below 100% of the current Federal Poverty Guideline Level,
  • And ineligible for Medicaid.

HCAP is not a medical insurance plan; the program provides for the write-off of hospital bills once incurred. Free care is limited to hospital services, not other medical expenses such as physician and pharmacy services. Every Ohio hospital is required to post their free care requirements at patient registration points. 

Ohio hospitals are responsible for administering their own HCAP procedures under the general guidance of state law. In most hospitals, HCAP is the job of a financial counselor, a person who works within the Patient Financial Services department. If you have outstanding hospital bills and believe you may qualify for HCAP, you should discuss your situation with a financial counselor at your hospital.

Frequently Asked Questions – Ohio HCAP

Q: I was in the hospital in July and my hospital says I need to prove what my pay was for the 90 days before I was a patient there.  All I have is my W-2 for the previous year. What do I do?

A: The HCAP program income requirements are based on the immediate three months and twelve months prior to your date(s) of hospital service. Generally this disqualifies W2s as proof of income, unless your date of hospital service is January 1.  

Each hospital has its own policy regarding income verification and what to do if you are unable to produce paystubs. If you are unsure how to proceed, you can always discuss your specific situation with a financial counselor at the hospital. Request a copy of the hospital policy. It probably will contain alternative ways to show your income for the 90 days and 360 days previous to when you were in the hospital.

Q: Why did I have to fill out the HCAP application several times?  And how come I’m still getting doctor bills from that time?

A: An HCAP application for outpatient service is good for 90 days; this means if you receive outpatient care within 90 days of an HCAP application, you shouldn’t have to fill out another application. However, each inpatient admission requires a separate HCAP application. This is probably why you have completed several applications.

Once the hospital approves your application, the outstanding hospital service balance is forgiven and no collection activity may be initiated against you for hospital service. On the other hand, as noted above, HCAP is only applicable to hospital services and does not extend to doctor bills and other services. This means you could receive a bill for the charges from the physician who treated you at the hospital.

Q: Where do I send my HCAP application?

A:  Every hospital administers its own HCAP program, so it varies by hospital. Contact a financial counselor at the hospital where you were treated to find out where to send your application.

Q: I filled out an HCAP application and submitted it to my hospital, but I’m still getting invoiced for a part of my original bills.  Why is that?

A: HCAP requires hospitals to provide “free care” (a 100% discount) to people who meet the criteria. If you were given a discount less than 100%, you probably were not considered eligible for HCAP. It is very likely you were considered eligible for a “hospital financial assistance” program, which provides a partial level of forgiveness to those whose income is above the Federal Poverty Level Guideline. So, even though you filled out an HCAP application, if your income is higher than the guideline, the hospital uses a calculation to determine the discount you are eligible for within their guidelines.

Q: My hospital people say HCAP isn’t paying for the medicines or the doctor appointments they want me to have.  I just can’t afford these.  What can I do?

A: Please talk with the people at your local clinics to see if they can provide the medicines and physician appointments. And talk with several local pharmacists.  Chances are that at least one will have a discount program for situations like yours.  Finally, you can search online for free prescription services that might help.

Q: What does the application really mean when it asks my “family size” and how many family members I have?

A: Family members include parents, your spouse (regardless of whether he or she lives in your home), and any natural or adopted children under the age of 18 who live in the same home as you (the patient).



  • Medically Necessary Services

    Rules regarding medically necessary services

    view resource
  • The Ohio Hospital Association

    Features an all-inclusive HCAP FAQ section

    view resource

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