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H H S Department of Health and Human Services
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Health Resources and Services Administration

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Compliance & Recovery

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Provider's Guide to the Hill-Burton Uncompensated Services Regulations (Persons using assistive technology may not be able to fully access information in this file. For assistance, contact comments@hrsa.gov or 888-275-4772, TTY: 877-489-4772)

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Frequently Asked Questions

  1. What services are covered under the Hill-Burton program?
    Each facility chooses which services it will provide at no or reduced cost. The covered services are specified in a notice which is published by the facility and also in a notice provided to all persons seeking services in the facility. Services fully covered by a third-party insurance or a government program (e.g., Medicare and Medicaid) are not eligible for Hill-Burton coverage. However, Hill-Burton may cover services not covered by the government programs.

  2. Can I receive Hill-Burton assistance to cover my Medicare deductible and coinsurance amounts or Medicaid co-pay and spenddown amounts?
    Medicare deductible and coinsurance amounts are not eligible under the program. However, Medicaid co-payment amounts are eligible, except in a long-term care facility. In addition, Medicaid spenddown amounts (the liability a patient must incur before being eligible for Medicaid) are eligible in all Hill-Burton facilities.

  3. Where can I get Hill-Burton free or reduced cost care?
    Hill-Burton obligated facilities are obligated to provide a certain amount of free or reduced-cost health care each year. Obligated facilities may be hospitals, nursing homes, clinics or other types of health care facilities. See the Hill-Burton Obligated Facilities List to find a Hill-Burton obligated facility in your State. You may apply for free or reduced-cost care before or after they are provided at the Admissions Office, Business Office or Patient Accounts Office at the obligated facility.

  4. Who can receive free or reduced cost care through the Hill-Burton program?
    Eligibility for Hill-Burton free or reduced cost care is based on a person's family size and income. Income is calculated based on your actual income for the last 12 months or your last 3 month's income times 4, whichever is less. You may qualify if your income falls within the U.S. Department of Health and Human Services poverty guidelines or, at some facilities, if your income is as much as twice (or triple for nursing home services) the poverty guidelines. For complete information on the Hill-Burton program, including the list of facilities obligated to provide it and a link to the poverty guidelines, please see the Hill-Burton Web site.

  5. What does "income" include?
    Gross income (before taxes), interest/dividends earned, and child support payments are examples of income. Assets, food stamps, gifts, loans or one-time insurance payments are examples of items not included as income when considering eligibility. For self-employed people, income is determined after deductions for business expenses. For more specific information, see the revised poverty guidelines.

  6. When can I apply for Hill-Burton assistance?
    You may apply for Hill-Burton assistance at any time, before or after you receive care. You may even apply after a bill has been sent to a collection agency. If a hospital obtains a court judgment before you applied for Hill-Burton assistance, the solution must be worked out within the judicial system. However, if you applied for Hill-Burton before a judgment was rendered and are found eligible, you will receive Hill-Burton even if a judgment was rendered while you were waiting for a response to your application.

  7. Is United States citizenship required for Hill-Burton eligibility?
    No. However, in order for a person to have a Hill-Burton eligibility determination made, one must have lived in the U.S. for at least 3 months.

  8. Can I apply for Hill-Burton assistance on behalf of an uninsured relative or friend?
    Yes. You can apply for Hill-Burton assistance on behalf of any patient for whom you can provide the information required to establish eligibility, (i.e., you must be able to provide information regarding the patient's family size and income.)

  9. Do I have to wait until I am sick before I can apply for Hill-Burton assistance?
    Hill-Burton is not health insurance. In order to apply for Hill-Burton assistance you must have already received services or know that you will require a specific service in the near future.

  10. What are some reasons I could be denied Hill-Burton care?
    The facility may deny your request if:
    for non-nursing homes, your income is more than the current poverty guidelines, or more than twice the guidelines if specified in the facility's allocation plan;
    for nursing home services, your income is more than the poverty guidelines, or double or triple the guidelines, if specified in the facility's allocation plan;
    the facility has given out its required amount of free care as specified in its allocation plan; the services you requested or received are not covered in the facility's allocation plan;
    the services you requested or received are to be paid by Medicare/Medicaid, insurance or other financial assistance program;
    the facility asks you to first apply for Medicaid/Medicare or a financial assistance program, and you do not cooperate;
    you do not give the facility requested proof of your income, such as a pay stub.

  11. What can I do if I have a complaint against a Hill-Burton facility?
    If you feel you were unfairly denied free care or reduced cost care, a complaint must be filed in writing to the Central Office. You must include: 1) the name and address of the person making the complaint; 2) the name and location of the facility; and 3) a statement of the actions that the complainant considers to violate the requirements of the Hill-Burton program. 
            Division of Poison Control and Healthcare Facilities
            Parklawn Building
            5600 Fishers Lane
            Room 16C-17
            Rockville, Maryland 20857

  12. What other service obligation does a Hill-Burton facility have?
    Under the community service assurance, Hill-Burton facilities are responsible for providing emergency treatment and for treating all persons residing in the service area, regardless of race, color, national origin, creed or Medicare or Medicaid status. This assurance is in effect for the life of the facility. If you feel you were unfairly denied services or discriminated against you should contact the Office for Civil Rights (OCR) at 1-800-368-1019.

  13. How do I apply for free care?
    You should contact the Admissions, Business or Patient Accounts Office at a Hill-Burton obligated facility to find out if you qualify for assistance and whether or not a facility provides the specific services needed.

  14. How can I find out which facilities in my area are Hill-Burton facilities?
    Check our Hill-Burton Obligated Facilities List for a facility in your State. Be aware that although a facility may be listed, you still need to call the facility to be certain that it still has funds available and that the service you desire would be covered.