Financial Assistance Application
University of Iowa Hospitals & Clinics has a long history of providing care to patients regardless of their ability to pay. Our primary value is "the needs of the patient come first."
UI Hospitals & Clinics provides services to meet the needs of people who are unable to pay for care. These services include:
- Helping people find sources to fund their care, including opportunities to work with outside agencies.
- Using fair and consistent collection practices that are in the best interest of all parties involved.
- Providing individualized payment plans.
- Providing emergency care to stabilize you, regardless of your ability to pay.
UI Hospitals & Clinics has developed a process for directing people to alternative sources of funding for their medical care. UI Hospitals & Clinics determines your need for charity care based on financial information and the medical services needed.
Annual Income Guidelines for Financial Assistance Eligibility Determination
Effective Jan. 22, 2019
| Family Size | Poverty Guidelines | 200% | 250% | 300% | 350% |
|---|---|---|---|---|---|
| 1 | $12,490 | $24,980 | $31,225 | $37,470 | $43,715 |
| 2 | $16,910 | $33,820 | $42,275 | $50,730 | $59,185 |
| 3 | $21,330 | $42,660 | $53,325 | $63,990 | $74,655 |
| 4 | $25,750 | $51,500 | $64,375 | $77,250 | $90,125 |
| 5 | $30,170 | $60,340 | $75,425 | $90,510 | $105,595 |
| 6 | $34,590 | $69,180 | $86,475 | $103,770 | $121,065 |
| 7 | $39,010 | $78,020 | $97,525 | $117,030 | $136,535 |
| 8 | $43,430 | $86,860 | $108,575 | $130,290 | $152,005 |
| * | $4,420 | $8,840 | $11,050 | $13,260 | $15,470 |
(*) For family units over eight (8), add the amount shown for each additional member.
Source: Department of Health and Human Services - Federal Poverty Guidelines
Eligibility:
- You must be a documented resident of Iowa.
- Your income is at or below 350% of the Federal Income Poverty Guidelines.
- You must provide proof of income (income includes gross wages, rental income, gross income from self-employment, public assistance, social security, unemployment compensation, strike benefits, alimony, child support, military family allotments, pensions, veteran's benefits, etc.) Sources of income apply to all applicable family members.
- Family members include patient's spouse and patient's child under the age of eighteen living at home.
- You must comply with the Medicaid eligibility process with the University of Iowa Hospitals & Clinics/UI Health Care system designated vendor or an on-site representative.
- You must have active, full coverage medical insurance for all visits prior to Jan. 1, 2019 to comply with the Federal Affordable Care Act (ACA) or an ACA exemption letter.
To learn more about general financial resources available visit the General Financial Assistance Resources page.
