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You may qualify for help paying your bills from the County of Santa Clara Health System (CSCHS). Our Healthcare Access Program (HAP) provides free or discounted medically necessary services and supplies to eligible patients who (1) are uninsured or (2) have insurance and high out-of-pocket medical costs. Applicants can also get free help applying for Medi-Cal, Medi-Cal presumptive eligibility, Covered California, and other public healthcare programs.

A patient may be eligible for the HAP if they have gross 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 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.

Please visit aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines to find the FPL guidelines for larger households.

How to apply for financial assistance

Step 1: Complete the CSCHS Financial Assistance Application

The application is available online at scvh.org/bill-help. Patients are encouraged to apply as soon as possible.

Step 2: Collect All Required Supporting Documents

A patient needs to provide one of each of the following documents with their application:

1. Proof of identity (for example: driver’s license, passport, government-issued ID, work or school ID, or birth certificate plus other ID, such as gym or Costco membership); and
2. Proof of income (recent pay stubs or income tax returns).

If you are a Santa Clara County resident and want to apply for long-term financial assistance lasting up to one year, please also submit proof of residency (for example: rental contract/lease/mortgage, utility bill, vehicle registration, or declaration of homelessness). Proof of residency is not required to qualify for charity care or a discount payment.

Eligibility for healthcare coverage programs other than HAP may require additional documentation. Applicants will be instructed which documents to provide, as necessary.

Step 3: Submit Your Complete Application and Supporting Documents to CSCHS

Completed applications with all the required documents can be faxed to 408-494-7848, delivered to Patient Financial Services (770 S. Bascom Avenue, San José, CA 95128), or 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.

Eligible Santa Clara County residents may qualify for the HAP for a one-year period (unless they qualify for a third-party source of payment for healthcare services). Eligible non-County residents must apply for the HAP each time they receive care from CSCHS. Patients may apply for financial assistance from CSCHS and other healthcare coverage, such as Medi-Cal or Covered California, at the same time.