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Hospital Care Assurance Program (HCAP)


A state and federal program maintained by the Ohio Department of Job and Family Services’ to comply with a federal requirement to implement additional payments through the disproportionate share (DSH) program to hospitals that provide a disproportionate share of uncompensated services to indigent and uninsured Ohioans who are at or below 100% of the current Federal Poverty Guideline Level and who are ineligible for Medicaid.

Overview

Ohio requires that all hospitals provide basic, medically necessary hospital level services to persons at or below the federal poverty level. This includes inpatient and outpatient hospital services covered under Medicaid. In order to qualify for reimbursement through HCAP, services must be ordered by an Ohio licensed physician and delivered at a hospital where the physician has clinical privileges and where such services are permissible to be provided by thehospital under its certificate of authority.

HCAP will 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 for HCAP, he or she must: be an Ohio resident; not be a Medicaid recipient; and have income at or below the federal poverty line; or be a current recipient of the Disability Assistance program

Each hospital has policies in place for the review and approval of HCAP eligibility. The patient should contact the hospital for an application. The patient will be required to provide proof of income (pay stubs or W-2s). The current HCAP program meets the federal requirement that the assessment rate be uniform across all non-psychiatric hospital providers and that at least 10 percent of the hospitals receive less than their assessed amount in HCAP funding. 

In 2011, Ohio hospitals received $346,775,857 in Medicaid HCAP reimbursement. 

Resources

For more information, please visit our most recent Frequently Asked Questions about HCAP rules, eligibility, and procedures. If you 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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