Financial Help for Healthcare
The County of Santa Clara Health System is committed providing high quality, affordable and accessible health care. While every patient is responsible for the costs of the healthcare services they receive, there may be a program that can help to cover or reduce costs for patients who do not have health insurance or who have high medical costs. Go to “How to Apply” below.
If you are covered by insurance, please know, and fully understand your policy, responsibilities, and insurance benefits. Our Financial Counselors are available to help, but it is your responsibility to understand your benefits and insurance policy. You will also need to provide your insurance information when you come to the hospital and at every clinic visit.
If you have no insurance and do not qualify for a financial assistance program, a deposit will be requested. You will be expected to pay for your healthcare. Payment installment plans are available by cash, check, Visa, or MasterCard. You may also qualify for a discount for prompt payment of your medical bills.
If you have applied for a program, the program will be billed for regular charges. Depending on the program, you may be responsible for co-pays, deductibles, or share-of-costs that the program does not cover.
Medi-Cal expanded to age 50 and older
Effective 5/1/2022, Medi-Cal coverage is now available to low-income residents who are age 50 and older, regardless of their immigration status. This program provides free or low-cost healthcare coverage. If you have any questions or need assistance, please contact us at 1-866-967-4677 or visit the Patient Access Department at 770 South Bascom Avenue in San José between 8 a.m. and 5 p.m., Monday through Friday.
How to Apply for Financial Help
Our staff can help you apply for a program. You will need to fill out an application and provide all the required documents. The information you provide will determine which program you may qualify for.
STEP 1: COMPLETE A FINANCIAL ASSISTANCE APPLICATION
Applications must be complete to be processed and all the required documents must be completed. Applications that are not finished and/or do not have all the documents will not be processed..
- Financial Assistance Application Form
- Formulario de Solicitud para la Asistencia Financiera
- Mẫu đơn xin hỗ trợ về tài chính
- Form ng Aplikasyon para sa Tulong Pinansyal
- ਵਿੱਤੀ ਸਹਾਇਤਾ ਬਿਨੈ-ਪੱਤਰ ਫਾਰਮ
- فرم درخواستنامه کمک مالی
STEP 2: PROVIDE ALL REQUIRED DOCUMENTS
You will need to provide copies of the documents in the Document Checklist with your application. Documents include:
- Proof of identity
- Proof of Santa Clara County residency
- Proof of income
When you have all your documents, attach them to your completed application and turn them in.
STEP 3: GET ALL INFORMATION TO THE PATIENT ACCESS DEPARTMENT
Completed applications with all the required documents can be faxed to 408-494-7848, delivered in person to the CSCHS Patient Access Department (770 S. Bascom Avenue San José, CA 95128), or scanned and e-mailed to [email protected]. Should you wish to e-mail CSCHS, we recommend that you encrypt your message to protect the privacy and security of your personal documents. They can also be delivered to Patient Access Department, 770 S Bascom Ave, San Jose Ca.
The information will be reviewed according to the rules for each program or agency. The staff uses these rules to determine if you are eligible for a state program, a county program, as discount or full financial assistance.
To complete your Financial Assistance Application, please review this checklist.
Provide copies of the following documents:
- Proof of Residency in Santa Clara County – Provide ONE of the following:
- Rental Contract/Lease
- Mortgage Statement
- Utility Bill (Water, Electric Gas, Garbage)
- Homeless (Completion of patient statement form)
- Vehicle Registration
- Driver License (Current)
- Letter of support from person with whom applicant is living and proof of residency for that person
- Proof of Identity (Photo ID Required) – Provide ONE of the following:
- Driver’s License
- Government-issued ID Card
- Work or School ID Card
- Birth Certificate along with any identification (such as gym/Costco)
- Proof of Income – Provide ALL that Apply:
- Check Stubs (all stubs not older than 45 days from application date)
- Tax Return (current tax year)
- Award Letter (Social Security, Disability, Unemployment, Worker’s Compensation)
- Cash Income Statements (including tips)
- Military Benefits Statement
- Rental Income Receipts
If required – these documents must be originals:
- Eligibility for some programs requires that a person provides proof of U.S. Citizenship or U.S. Permanent Residency. If you are eligible for a program that requires proof of citizenship or permanent residency, you will be instructed to bring original documents. Copies will not be accepted. Undocumented individuals may be eligible for programs that do not require proof of U.S. Citizenship or U.S. Permanent Residency.
- Depending on a person’s declarations and/or differences in documentation, additional documents may be required. If more documents are required, you will be instructed which documents to provide. You will also be given a deadline for returning additional documents to the Patient Access Department.
Financial Assistance Programs
The County of Santa Clara Health System is committed to ensuring residents understand what health care options are available.
This state program serves low-income individuals including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level.
Covered California and the Affordable Care Act
Covered CA is the health insurance marketplace started under the federal Affordable Care Act (ACA). Covered CA helps eligible individuals and small businesses purchase private health insurance coverage at federally subsidized rates. The ACA, also known as Obamacare, means more people have access to affordable health insurance. You can go to www.coveredca.com for more information about Covered California plans and apply online.
Healthcare Access Program
This program reduces the amount you owe for services and/or medicines based on your income. For some people there will be no cost. Our team will assist you in completing an application and turning in any documents needed to determine if you are eligible. The information you share will be kept confidential and will only be used for providing you care.
Interest-Free Payment Plans
If you have difficulty paying your bill, our staff can help set up long-term interest-free payment plans.
Prompt Pay Patient Discount
If you do not have health insurance coverage and do not receive assistance under any of the programs listed above, ask about this program. The program offers a discount on the amount due if it is paid within thirty days of getting your bill.
Please call the Patient Access Department to update your information when it changes. 866-967- 4677.
ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-888-334-1000 (TTY: 711).
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-888-334-1000 (TTY: 711).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-334-1000 (TTY: 711).
注意：如果您說國語或粵語，免費語言協助服務將會提供給您。請聯繫 1-888-334-1000 (TTY: 711)。
注意：如果您说普通话，免费语言协助服务将会提供给您。 请拨打1-888-334-1000 (TTY: 711)。
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-334-1000 (TTY: 711).
ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। 1-888-334-1000 (TTY: 711) 'ਤੇ ਕਾਲ ਕਰੋ।
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-334-1000 (TTY: 711) 번으로 전화해 주십시오.
ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-888-334-1000 (TTY: 711) पर कॉल करें।
ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-334-1000 (TTY: 711).
If you have questions or need to speak with a Financial Counselor, please call: Toll Free: 866-967-4677
Depending on your income and family size, you may qualify for financial help to pay these costs.
For most programs, medically necessary services are covered. This includes preventive care and well-care visits for men, women, and children. Other benefits include immunizations, cancer screenings, prescriptions, laboratory services, behavioral health services, hospital, and emergency care.
The County of Santa Clara Health System is here to help. Santa Clara County residents who cannot be on other programs because of citizenship, residency, age, or other reasons still get care a nearby clinic.
To apply follow these easy steps:
1. Complete a Financial Assistance Application
2. Provide all required documents
3. Return your completed packet to the Patient Access Department
Several documents are required and include Proof of Identity; Proof of Residency in Santa Clara County; Proof of U.S. Citizenship or Permanent Residency; Proof of Income and Assets. You can see the full list in the Document Checklist.
No. Applications are only accepted when complete and processed only when all the required documents are included.
Every effort will be made to find a program you can qualify for. If you do not qualify for any discount or program, you will be notified, and you will be responsible to pay for your medical bills.
No. Each program has set conditions and measures for acceptance. The information you provide will determine whether you qualify for a state or county program, a discount program, or another financial assistance program. A review of your information will determine which program best suits your needs and offers you the most financial assistance, based upon your financial qualifications.
Yes. All information you provide is held in the strictest confidence. Only authorized employees and official representatives of a program or agency providing services have access to your information. Federal confidentiality rules apply to your application and documents.
If you have questions or need to speak with a Financial Counselor, please call: Toll Free: 866-967-4677