(hospital and Missouri Delta Rural Health Clinics)
Our HOSPITAL Financial Assistance is a program for low-income people who do not have health care coverage and are not eligible for other programs like Medicaid or people who may be unable to pay for their co-ins, co-pays or deductible.
If your income fits within the Poverty Guidelines you may pay nothing or receive a reduced amount on the balance of the account. Our application review is based on family size as well as Federal Poverty Guidelines. All information submitted may be investigated, and the application may be placed in pending status, until we receive all necessary information.
Your gross income includes your earnings and all other money you or your family members/household receive. Health Care facilities are required by federal and state law to obtain supporting documents to place in their files, so you will be asked for the documentation of your income and assets.
Financial Assistance may be denied or restricted by the following:
- Your family or household annual or yearly income
- Your level of assets that can be turned into cash
- You must apply for and be rejected by Medicaid, if you have a categorization for Medicaid
- No documentation of your income and assets
Your annual or yearly income includes the following that you received in the prior 12 months:
- Salary (gross wages before taxes)
- Public Assistance (cash assistance)
- Social Security benefits
- Unemployment benefits
- Pension payments
- Dividends and interest
- Net rental and business income (after expenses)
- All other types of cash support and income
There are 2 separate application forms…one for HOSPITAL services and the other for our OUTPATIENT CLINICS. You may be obtain them by stopping by the Financial Counselors Office at 1008 N. Main St., Sikeston, MO, the Missouri Delta outpatient clinic you are needing assistance with or print from the links below.
Missouri Delta Outpatient Clinic Application (Rural Health Clinics only)