Healthcare Access Program (HAP)

The County of Santa Clara Health System (CSCHS) is committed to providing quality medical services regardless of a patient’s ability to pay.

Our Healthcare Access Program (HAP) offers emergency and other medically necessary services and supplies at low or no cost to qualified patients. Both uninsured patients and insured patients with high out-of-pocket medical expenses may qualify. Applicants will also be screened for Medi-Cal, Medi-Cal presumptive eligibility, Covered California, and other public healthcare coverage programs.

A patient may be eligible for the HAP if they have family income below 650% of the Federal Poverty Level (FPL) AND fit into one of the following categories:

1. The patient does not have health insurance (or another third-party source of payment for medically necessary services or supplies); OR
2. The patient has health insurance but has incurred annual out-of-pocket costs at CSCHS that are higher than 10% of the patient’s current family income or family income over the past 12 months, whichever is lower; OR
3. The patient has health insurance but they and/or their family members have paid annual out-of-pocket medical expenses that are higher than 10% of the patient’s family income.

A patient who meets one of the above categories and whose family income is at or below 400% of the FPL is eligible for 100% discounted medically necessary services or supplies. A patient who is a Santa Clara County resident and whose family income is above 400% but below 450%, 550%, or 650% of the FPL is eligible for discounts of 70%, 50%, or 25%, respectively.

*Note: Please also see this chart for health coverage eligibility information. These charts are provided for informational purposes only. Patients with incomes up to 138% of the FPL may be eligible for Medi-Cal. If ineligible for Medi-Cal, patients may qualify for a Covered California health plan with financial help.

To learn how to apply for the HAP, please review the notice and policy documents below. To get more information and free help applying for financial assistance and healthcare coverage, please contact the CSCHS Patient Access Department:

• by phone at (866) 967-4677 (TTY: 711) (8am to 5pm, Monday to Friday); or
• in person at 770 S. Bascom Avenue, San José, CA 95128 (8am to 4:30pm, Monday to Friday).
   

Healthcare Access Program (HAP) Notice

• Healthcare Access Program (HAP) Notice
• Aviso sobre el Programa de Acceso a la Atención Médica (HAP, por sus siglas en inglés)
• Thông báo về Chương trình tiếp cận chăm sóc sức khỏe (HAP)
• 醫療保健獲取計劃 (HAP)通知
• 医疗保健获取计划 (HAP)通知
• Paunawa sa Health Access Program (HAP)
• ਹੈਲਥਕੇਅਰ ਐਕਸੈਸ ਪ੍ਰੋਗ੍ਰਾਮ (HAP) ਸੂਚਨਾ
• (HAP) آگهی برنامه دسترسی به خدمات درمانی 

Healthcare Access Program (HAP) Policy

• Healthcare Access Program (HAP) Policy
• Política sobre el Programa de Acceso a la Atención Médica (HAP, por sus siglas en inglés)
• Quy định về Chương trình tiếp cận chăm sóc sức khỏe (HAP)
• 醫療保健獲取計劃 (HAP)政策
• 医疗保健获取计划 (HAP)政策
• Patakaran sa Health Access Program (HAP)
• ਹੈਲਥਕੇਅਰ ਐਕਸੈਸ ਪ੍ਰੋਗ੍ਰਾਮ (HAP) ਨੀਤੀ
• (HAP) سیاست برنامه دسترسی به خدمات درمانی 

Financial Assistance Application Form

• Financial Assistance Application Form
• Formulario de Solicitud para la Asistencia Financiera
• Mẫu đơn xin hỗ trợ về tài chính
• 財物援助申請表
• 财务援助申请表
• Form ng Aplikasyon para sa Tulong Pinansyal
• ਵਿੱਤੀ ਸਹਾਇਤਾ ਬਿਨੈ-ਪੱਤਰ ਫਾਰਮ
• فرم درخواست‌نامه کمک مالی

Healthcare Access Program (HAP) Appeal Form

• Healthcare Access Program (HAP) Appeal Form
• Formulario de Apelación para el Programa de Acceso a la Atención Médica (HAP, por sus siglas en inglés)
• Mẫu đơn khiếu nại về Chương trình tiếp cận chăm sóc sức khỏe (HAP)
• 醫療保健獲取計劃 (HAP)上訴表
• 医疗保健获取计划 (HAP)上诉表
• Form ng Apela sa Health Access Program (HAP)
• ਹੈਲਥਕੇਅਰ ਐਕਸੈਸ ਪ੍ਰੋਗ੍ਰਾਮ (HAP) ਅਪੀਲ ਫਾਰਮ
•  فرم اعتراض - (HAP) برنامه دسترسی به خدمات درمانی

Learn more!

• How to Apply for Financial Assistance
• Document Checklist
• Financial Assistance Programs
• Frequently Asked Questions​

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).