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Under a federal law called Hill-Burton, you may be eligible to receive free or reduced cost care at your local hospital, nursing home or medical facility.

Services are determined by the facility and don't include care by a private doctor. However, they may include care by a doctor on staff.

Eligibility for Hill-Burton care is based on family size and income. There is no citizenship requirement, but there is a residency requirement. Hill-Burton facilities may not discriminate based on race etc. Hill-Burton does not cover services which are covered under private insurance, Medicare or Medicaid.

The amount of Hill-Burton care a facility must give per year is set at the beginning of the year and can be used up quickly

To learn about Hill-Burton availability in a particular medical center, call the finance department. Speak with a supervisor if possible. Ask:

  • Does the program still has availability?
  • If so, what services are provided?
  • What are the eligibility requirements? 

For additional information about Hill-Burton, see

TIP: You can maximize care under Hill-Burton if you choose a doctor who also teaches at a Hill-Burton Hospital. If a facility's Hill-Burton allotment is used for the year, you can set an appointment for early the following year.

What is Hill-Burton?

Hill-Burton is a federal law which requires that any facility which used federal funds to build, expand or renovate its facilities must provide a percentage of its services free or at a low charge.

The amount of funds available for Hill-Burton care is set each year and is used on a first-come, first-served basis.

Since facilities are not required to provide free or low cost services beyond the percentage specified in the law, all the Hill-Burton care available in a facility tends to be used early in the year.

Hill-Burton facilities must provide emergency treatment.

In a very real sense, the amount of free or low cost care Hill-Burton facilities are obligated to provide repays the federal government for the investment. The obligation to provide Hill-Burton care ends a period of years after the government investment.

What Are Some Reasons I Could Be Denied Hill-Burton Assistance?

The facility may deny your request for Hill-Burton assistance if:

  • Your income is higher than the guidelines used by the facility. The facility, in its Allocation Plan,sets an income limit of either one, two, or sometimes three times the federal poverty level as the maximum income eligible for Hill-Burton financial assistance. The facility will inform you of its maximum income level at the time of application.
  • The facility has given out its required amount of free care for the year as specified in its Allocation Plan.
  • The services you requested or received are not covered in the facility's Allocation Plan.
  • The services you requested or received are to be paid by Medicare/Medicaid, insurance or other financial assistance program. The facility asks you to first apply for Medicaid/Medicare or a financial assistance program and you do not cooperate.

You do not give the facility requested proof of your income, such as a pay stub.

How Can I Maximize My Use Of Hill-Burton Facilities?

Look only for facilities that provide the care you need. Also be sure the facility has doctors on staff with other specialties in case there are complications.

If you need a doctor's care, look for Hill-Burton facilities that employ doctors. Hill-Burton will not pay a private doctor's charges, but will pay for a doctor's services which are provided by the facility. One way to do this is to look for hospitals which teach young doctors (Teaching Hospitals) when you go through the list of Hill-Burton facilities in your area. By using a teaching hospital, you will likely be treated by physicians who are also teachers or under the direction of teachers who are likely to be providing the most current and some of the best treatment available.

If the doctor you want to see teaches at a Hill-Burton facility in addition to his or her private practice, ask the doctor if you can see him or her at the facility under Hill-Burton.

If you need a procedure or treatment on an elective rather than an emergency basis toward the end of a year when a Hill-Burton facility has used up it's financial allotment, speak with Patient Representative about setting an appointment for having it done early in the following year.

If you have a choice of Hill-Burton facilities, look at How To Choose A Hospital.

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How To Chose A Hospital

Who Can Receive Free Care?

Eligibility for Hill-Burton care is based on family size and income. There is no citizenship requirement, but there is a residency requirement. Hill-Burton facilities may not discriminate based on race etc.

Income Requirement

You may qualify if your income falls within the poverty guidelines, as published in the Federal Register every year. To see the poverty guidelines for 2016, click here offsite link.

You may also qualify for free or reduced cost care at some facilities if your income is up to double (or triple for nursing home services) the poverty guidelines.

When considering eligibility for Hill-Burton assistance, income is calculated based on your actual income for the last 12 months or your last 3 month's income times 4, whichever is less.

  • Examples of income that are counted are gross income (before taxes), interest/dividends earned, and child support payments.
  • Examples of items that are not included as income are assets, food stamps, gifts, loans or one-time insurance payments.
  • For self-employed people, income is determined after deductions for business expenses.
  • Assets are not counted for purposes of Hill-Burton.

For details of what is counted, and what is not counted as income, see the next section.

No Citizenship Requirement

United States citizenship is not required for Hill-Burton eligibility.

Residency Requirement

In order to be eligible for Hill-Burton assistance, you must have lived in the U. S. for at least 3 months.

Hill Burton Facilities Cannot Discriminate

Hill-Burton facilities are responsible for treating all persons residing in the service area, regardless of race, color, national origin, creed or Medicare or Medicaid status. This assurance is in effect for the life of the facility. If you feel you were unfairly denied services or discriminated against you should contact the Office for Civil Rights at 800.368.1019.

What Is The Definition Of "Income" For Purposes of Hill-Burton?"

For purposes of determining financial eligibility under the Hill-Burton uncompensated services program, income includes:

  • Total annual cash receipts before taxes from all sources, with the exceptions noted below.
  • Wages and salaries before any deductions.
  • Net receipts from non-farm self-employment (receipts from a person's own unincorporated business, professional enterprise, or partnership, after deductions for business expenses).
  • Net receipts from farm self-employment (receipts from a farm which one operates as an owner, renter, or sharecropper, after deductions for farm operating expenses).
  • Regular payments from Social Security, Railroad Retirement, Unemployment Compensation, strike benefits from union funds, Workers' Compensation, Veterans' payments, public assistance (including Aid to Families with Dependent Children or Temporary Assistance for Needy Families, Supplemental Security Income, and non-Federally-funded General Assistance or General Relief money payments) and training stipends.
  • Alimony, child support, and military family allotments or other regular support from an absent family member or someone not living in the household.
  • Private pensions, government employee pensions (including military retirement pay), and regular insurance or annuity payments; college or university scholarships, grants, fellowships, and assistantships.
  • Dividends, interest, net rental income, net royalties, periodic receipts from estates or trusts, and net gambling or lottery winnings.

Income does not include the following types of money received:

  • Capital gains
  • Any assets drawn down as withdrawals from a bank.
  • The sale of property, a house, or a car.
  • Tax refunds, gifts, loans, lump-sum inheritances, one-time insurance payments, or compensation for injury.
  • Non-cash benefits, such as the employer-paid or union-paid portion of health insurance or other employee fringe benefits, food or housing received in lieu of wages, the value of food and fuel produced and consumed on farms, the imputed value of rent from owner-occupied non-farm or farm housing, and such Federal non-cash benefit programs as Medicare, Medicaid, food stamps, school lunches, and housing assistance.

What Services Are Covered Under The Hill-Burton Program?

On your request, a Hill-Burton facility must give you a written individual notice which will tell you what types of Hill-Burton free or reduced charge services it provides.

Each Hill-Burton facility can choose which types of services to provide at no charge or reduced cost.

  • The covered services are specified in a notice (Allocation Plan) which is published by the facility and also in a notice provided to all people seeking services in the facility.
  • Only facility costs are covered, not your private doctor's bills. Private pharmacy and private doctor fees are not covered by this program. However, services provided by doctors who are hired by the facility may be covered under the Hill-Burton program if included in the published notice.
  • Services fully covered by a third-party insurance or a government program such as Medicare and Medicaid are not eligible for Hill-Burton coverage. However, Hill-Burton may cover services not covered by government programs.

Hill-Burton facilities must also provide emergency treatment.

Medicare And Hill-Burton Assistance

Services fully covered by Medicare are not eligible for Hill-Burton coverage.

Medicare deductible and coinsurance amounts are also not eligible under the program. You must pay them. (See Medicare-Financial Assistance for programs that may help pay them).

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Medicaid And Hill-Burton Assistance

Services fully covered by Medicare are not eligible for Hill-Burton coverage.

Any Medicaid co-payments can be waived by the Hill-Burton provider, except by a long-term care facility.

Even if the bill is waived entirely under Hill-Burton, it can be used as part of your spend-down to qualify for Medicaid in case your income is otherwise too high. For more about spend-downs, see Medicaid.

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When Can I Apply For Hill-Burton Assistance?

You may apply for Hill-Burton assistance at any time, before or after you receive care. You may even apply after a bill has been sent to a collection agency. Of course, it is always better to apply before you receive services to lessen the stress of worrying how you will pay for your care.

If a hospital obtains a court judgment against you before you apply for Hill-Burton assistance, the solution must be worked out within the judicial system. However, if you applied for Hill-Burton before a judgment was rendered and are found eligible, you will receive Hill-Burton even if a judgment was rendered while you were waiting for a response to your application.

Do I Have To Wait Until I Am Sick Before I Can Apply For Hill-Burton Assistance?

Hill-Burton is meant to help with care when the need arises.

In order to apply for Hill-Burton assistance you must know that you will require a specific service in the near future or have already received services and are looking for help to pay for them.

How Do I Apply For Hill-Burton Assistance?

Contact the Admissions, Business or Patient Accounts Office at a Hill-Burton facility. They will tell you:

  • Whether the facility is still offering free or low cost service (in other words, whether it has used up it's Hill-Burton obligation for the year.)
  • If you qualify for assistance.

Whether or not a facility provides the specific services needed.

How Can I Find Out Which Facilities In My Area Are Hill-Burton Facilities?

A listing of all Hill-Burton facilities in the country is posted online at: offsite link or call the hotline at 800.638.0742 or 800.492.0359 for Maryland residents.

Keep in mind that even though a facility is listed in the Directory, that doesn't mean it still has services available or provides the services you desire. Call the facility to be certain.

What If I Have A Complaint Against A Hill-Burton Facility?

If you feel you were unfairly denied free care or reduced cost care, you may file a complaint with the Department of Health and Human Services.

A complaint:

  • Must be in writing.
  • Can be a letter that simply states the facts and dates concerning the complaint.
  • The complaint must include:
    • The name and address of the person making the complaint.
    • The name and location of the facility.
    • A statement of the actions that you consider violate the requirements of the Hill-Burton program.

Send your complaint by a means which provides proof of receipt such as via an overnight service or the U.S. Postal Service, Return Receipt Requested to:

                        Director, Division of Facilities Compliance and Recovery
                        5600 Fishers Lane, Room 10C-16
                        Rockville, MD 20857