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Get healthcare coverage with Retroactive Financial Assistance Program

FAQs

Individuals who received one or more medical bills from the County of Santa Clara Health System that were sent to collections between October 28, 2018, and December 31, 2021. The County has identified all potentially eligible individuals and will send each of them a notice encouraging them to apply for the program, along with a copy of the application form.

Individuals who received a notice of potential eligibility for a discount under the program and who choose to apply must:

  1. Complete the application form and return it to the County within 65 days of the date on their notice; and
  2. Submit all supporting documents required to verify their income, identity, and residency to the County within 215 days of the date on their notice.

The County may contact an applicant to request additional information.

If a notice recipient completes and submits the application form and all required verifying documents on time, the County will determine whether they are eligible for full or partial financial assistance. 

This eligibility determination will be based on the notice recipient’s family income and size, according to the below Federal Poverty Level-based standards that depend on the time the notice recipient’s bill(s) went to collections. Eligibility for a discount on medical bills sent to collections between October 28, 2018, and June 30, 2020, will be evaluated under the County's Ability to Pay Determination and related Charity Care Program and Discount Program policies that were in effect at that time. Eligibility for a discount on medical bills sent to collections between July 1, 2020, and December 31, 2021, will be evaluated under the Healthcare Access Program Policy in effect at that time.

Income means a notice recipient’s total gross family income in the year(s) their medical bill(s) went to collections. Family size includes the notice recipient, their spouse or domestic partner, and dependent children under age 21, whether living at home or not, in the year(s) the notice recipient’s medical bill(s) went to collections.

Time period bill(s) went to collectionsMaximum Income Level to be Eligible for Full Discount of Bill, by Family SizeMaximum Income Level to be Eligible for Partial Discount of Bill, by Family Size
October 28, 2018
to June 30, 2020

2018 (138% of FPL)

1 Person: $16,753

2 Persons: $22,715

3 Persons: $28,677

4 Persons: $34,638


2019 (138% of FPL)

1 Person: $17,236

2 Persons: $23,336

3 Persons: $29,435

4 Persons: $35,535 


2020 (138% of FPL)

1 Person: $17,609

2 Persons: $23,791

3 Persons: $29,974

4 Persons: $36,156

2018 (350% of FPL)

1 Person: $42,490

2 Persons: $57,610

3 Persons: $72,730

4 Persons: $87,850


2019 (350% of FPL) 

1 Person: $43,715

2 Persons: $59,185

3 Persons: $74,655

4 Persons: $90,125


2020 (350% of FPL)

1 Person: $44,660

2 Persons: $60,340

3 Persons: $76,020

4 Persons: $91,700

July 1, 2020 to
December 31, 2021

2020 (400% of FPL) 

1 Person: $51,040

2 Persons: $68,960

3 Persons: $86,880

4 Persons: $104,800


2021 (400% of FPL)

1 Person: $51,520

2 Persons: $69,680

3 Persons: $87,840

4 Persons: $106,000

2020 (650% of FPL)

1 Person: $82,940

2 Persons: $112,060

3 Persons: $141,180

4 Persons: $170,300


2021 (650% of FPL)

1 Person: $83,720

2 Persons: $113,230

3 Persons: $142,740

4 Persons: $172,250

View the Federal Poverty Level amounts for all years and family sizes online.

Applicants must submit proof of their total gross family income in the year(s) their bill(s) for medical services went to collections. Examples include tax returns or pay stubs.

Applicants must submit proof of their identity (including their photo). Examples include a driver’s license, passport, other government-issued ID, or a work or school ID.​

Applicants must submit proof of their county of residence for the year(s) their bill(s) for medical services went to collections. Examples include a rental contract, lease, mortgage statement, utility bill, driver’s license, or vehicle registration.

Please note: Partial discounts for notice recipients whose bills went to collections between July 1, 2020, and December 31, 2021, and whose gross family income is between 400% and 650% of the Federal Poverty Level, are only available to residents of Santa Clara County.

Applicants must submit all required supporting documents to the County within 215 days of the date on their initial notice. The County will contact every applicant who has not promptly submitted all required supporting documents by phone and in writing to remind them of the deadline. If an applicant does not submit all required verifying documents on time, their application will be marked as incomplete and will be denied.​

Yes. If an individual’s application for a discount was denied, or they think they should have received a higher discount, they may appeal by completing and submitting the below Appeal Form within 30 days of the denial or decision they disagree with. Please see the Appeal Form for further instructions.

Download the Appeal Form

No. Individuals who apply for and are found eligible for retroactive financial assistance under this program will receive a one-time discount on their medical bills from the County of Santa Clara Health System that were sent to collections between October 28, 2018, and December 31, 2021.

For free help applying for healthcare coverage and other financial assistance programs, please visit this webpage or contact the CSCHS Patient Access Department:

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