Hospital Care Assurance Program (HCAP)

A state and federal program maintained by the Ohio Department of Medicaid, which assists hospitals that have a disproportionately high share of uncompensated care costs for services to indigent and uninsured Ohioans. Part of the program offers Ohioans with family incomes at or below 100% of the current Federal Poverty Guidelines, and who are ineligible for Medicaid, help with unpaid hospital bills.

In 2014, Ohio hospitals anticipate receiving $373,186,082 in HCAP funding from the federal government in return for paying assessments totaling $219,540,149.  The distribution formula will likely require significant changes in 2014 due to the state' Medicaid expansion and the ability of federal DSH auditors to recoup overpayments from hospitals found to have received payments in excess of their hospital-specific limit.  

HCAP-Related Ohio Hospital Free Care Requirement 

OAC 5160-2-07.17 requires that all hospitals write off bills for basic, medically necessary hospital level services to patients with family incomes at or below federal poverty limits, as defined by the rule. 

OAC 5160-2-07.17 does not cover transplant services, physician charges, ambulance and patient convenience items (telephone, parking, television, personal items). In order for a patient’s care to qualify, (s)he must be an Ohio resident, not be covered by Medicaid recipient, and have a family income at or below the federal poverty line.

Each hospital has a policy for the review and approval of free care eligibility under the state rule. The patient should contact the hospital for an application. In some hospitals the patient will be required to provide proof of income (pay stubs or W-2s).  


For more information, please visit our most recent Frequently Asked Questions about HCAP/free care rules, eligibility and audit. If you are a hospital patient and have a question about the status of a pending HCAP application or need to request an application, please contact the hospital where you applied or would like to apply for the program.
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