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

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Hill-Burton Free and Reduced-Cost Health Care

In 1946, Congress passed a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area. The program stopped providing funds in 1997, but about 170 health care facilities nationwide are still obligated to provide free or reduced-cost care.

Since 1980, more than $6 billion in uncompensated services have been provided to eligible patients through Hill-Burton.

Steps to Apply for Hill-Burton Free or Reduced-Cost Care

1. Find the Hill-Burton obligated facility nearest you from the list of Hill-Burton obligated facilities.
2. Go to the facility's admissions or business office and ask for a copy of the Hill-Burton Individual Notice. The Individual Notice will tell you what income level makes you eligible for free or reduced-cost care, what services might be covered, and exactly where in the facility to apply.
3. Go to the office listed in the Individual Notice and say you want to apply for Hill-Burton free or reduced-cost care. You may need to fill out a form.
4. Gather any other required documents (such as a pay stub to prove income eligibility) and take or send them to the obligated facility.
5. If you are asked to apply for Medicaid, Medicare, or some other financial assistance program, you must do so.
6. When you return the completed application, ask for a Determination of Eligibility. Check the Individual Notice to see how much time the facility has before it must tell you whether or not you will receive free or reduced-cost care.

More about Hill-Burton Free or Reduced-Cost Care

You are eligible to apply for Hill-Burton free care if your income is at or below the current HHS Poverty Guidelines. You may be eligible for Hill-Burton reduced-cost care if your income is as much as two times (triple for nursing home care) the HHS Poverty Guidelines.

Care at a Hill-Burton obligated facility is not automatically free or reduced-cost. You must apply at the admissions or business office at the obligated facility and be found eligible to receive free or reduced-cost care. You may apply before or after you receive care — you may even apply after a bill has been sent to a collection agency.

Some Hill-Burton facilities may use different eligibility standards and procedures.

Hill-Burton facilities must post a sign in their admissions and business offices and emergency room that says: NOTICE - Medical Care for Those Who Cannot Afford to Pay, and they must provide you with a written Individual Notice that lists the types of services eligible for Hill-Burton free or reduced-cost care, what income level qualifies for free or reduced-cost care and how long the facility may take in determining an applicant's eligibility.

Only facility costs are covered, not your private doctors' bills. Facilities may require you to provide documentation that verifies your eligibility, such as proof of income.

Hill-Burton facilities must provide a specific amount of free or reduced cost care each year, but can stop once they have given that amount. Obligated facilities publish an Allocation Plan in the local newspaper each year. The Allocation Plan includes the income criteria and the types of services it intends to provide at no cost or below cost. It also specifies the amount of free or reduced cost services it will provide for the year.

When you apply for Hill-Burton care, the obligated facility must provide you with a written statement that tells you what free or reduced-cost care services you will get or why you have been denied.

The facility may deny your request if

  • Your income is more than the income specified in the 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 a governmental program such as Medicare/Medicaid or insurance.
  • The facility asked you to apply for Medicare/Medicaid or other governmental program, and you did not.
  • You did not give the facility proof of your income, such as a pay stub.

You may file a complaint with the U.S. Department of Health and Human Services if you believe you have been unfairly denied Hill-Burton free or reduced-cost care. Your complaint must be in writing and can be a letter that simply states the facts and dates concerning the complaint. You may call your local legal aid services for help in filing a complaint. Send complaints to:

Director, Division of Poison Control and Healthcare Facilities
5600 Fishers Lane
Room 10-105
Rockville, MD 20857

Hill-Burton Hotline

1-800-638-0742
(1-800-492-0359 in Maryland)

The following is a H R S A flash movie. The movie contains a link to http://findahealthcenter.hrsa.gov/ where you can search for health centers by location.

HRSA Find a Health Center Widget.