Hospital charity care in Ohio
Ohio operates the Hospital Care Assurance Program (HCAP), a statewide free-care program for low-income residents who are not on Medicaid, layered on top of federal 501(r) requirements for nonprofit hospitals and individual hospital financial assistance policies.
Hospital Care Assurance Program (HCAP)
Ohio’s HCAP provides free basic medically necessary hospital services to eligible residents at or below 100% of the federal poverty level who are not enrolled in Medicaid.
Under 100% FPL
HCAP requires free care for qualifying patients at or below 100% FPL. Many hospital FAPs go higher (often to 200–400% FPL).
Up to 3 years
For certain state-benefit hospitals, applications must be accepted for up to 3 years after notice. Federal 240-day window applies to nonprofits.
Most hospitals
HCAP is a condition for many hospitals receiving state payments. Nonprofit hospitals also face full federal 501(r) rules.
Who qualifies for free or discounted care in Ohio
Ohio has two overlapping layers:
| Program / Income level | Typical benefit |
|---|---|
| HCAP — Under 100% FPL (~$15,960 for 1 person) | 100% free care (if not on Medicaid and meet residency rules) |
| Hospital FAP — Commonly 100–200% FPL | Free or deep discount (varies by hospital) |
| Hospital FAP — Up to 300–400% FPL | Sliding-scale discount at many large systems (OhioHealth, Cleveland Clinic, etc.) |
| Above hospital thresholds | Standard policy + possible hardship review |
For 2026, 100% FPL for a family of four is $33,000. Always check both HCAP eligibility and the specific hospital’s Financial Assistance Policy — many Ohio systems are more generous than the state HCAP floor.
What Ohio law requires
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Required
HCAP free care mandate
Hospitals participating in HCAP must provide free basic hospital-level services to eligible patients at or below 100% FPL.
-
Required
Notification requirements
Hospitals must post clear notices about free care and financial assistance in admissions, ER, and billing areas, and on paperwork.
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Protected
Extended application window
For certain programs, hospitals must accept applications for up to 3 years after sending notice with a bill.
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Federal right
Federal 501(r) for nonprofits
240-day application period, AGB pricing limit, and collections restrictions apply to all nonprofit hospitals.
Medicaid first
HCAP is only for people not enrolled in Medicaid. Always screen for Ohio Medicaid (and other public programs) before or while applying for charity care — hospitals can help with this.
How to look up a specific hospital’s rules
Search the hospital name + “financial assistance policy” or “HCAP application.” Large systems such as OhioHealth, Cleveland Clinic, University Hospitals, and Premier Health publish clear FAP documents and applications online. You can also call patient financial services and ask for both the HCAP application and the hospital’s own charity care / financial assistance application.
Where this page’s claims come from
- Ohio Hospital Association — Hospital Care Assurance Program (HCAP)
- Ohio Administrative Code 5160-2-17 (HCAP rules)
- IRS Section 501(r) — irs.gov
- Dollar For and National Consumer Law Center state summaries (Ohio)
General information, not legal advice
State rules and hospital policies change. Confirm current details with the Ohio Department of Medicaid, the hospital association, or the specific hospital’s financial assistance office.