Charity Care and Financial Assistance

In accordance with its mission to enhance the health of the community and the state of Texas, the University of Texas Southwestern Medical Center (UT Southwestern) provides care for the most vulnerable patients in the community, including patients with financial hardships. At the same time, UT Southwestern must preserve the fiscal integrity and strength of the institution for the future.

It is therefore the policy of UT Southwestern to provide financial assistance to Texas Residents who meet the eligibility requirements for the UT Southwestern Charity Care Program (Program); who have no other means to meet their financial obligations to UT Southwestern hospitals and physicians; and who have completed an application for assistance and have been approved by the screening process. Even if a patient is financially eligible for the Program, he or she may not qualify for assistance through it, since the availability of institutional resources needed for a particular patient’s medical care and the overall resources needed for patients already in the Program must be taken into account as factors. All decisions to provide or deny financial assistance are reviewed by at least the supervisor of the employee who made the qualification decision, and any applicant who wishes to have an eligibility decision reviewed may follow a defined appeals process.

Since providing specialty services is fundamental to UT Southwestern’s patient care and academic missions, a non-Texas Resident may be considered for eligibility in the Program in certain very limited circumstances, such as the diagnosis, urgency, or level of care required. A special request for an exception to the residency requirement must come from a physician, and it must be approved in writing by the Executive Vice President for Health System Affairs before the patient begins the application process.

Nevertheless, any individual, regardless of ability to pay, who comes to UT Southwestern University Hospital property, including the University Hospital Emergency Department, for a potential emergency medical condition or emergency services will receive an appropriate medical screening examination, consistent with University Hospital Policy UHRI 1-1 04 Emergency Medical Treatment and Active Labor (EMTALA). UT Southwestern is fully committed to fulfilling EMTALA and to ensuring that neither the initial medical screening nor lifesaving treatment will be impeded by inquiries about the individual’s method of payment or insurance status.

The purpose of this policy is to define the eligibility criteria for qualified Texas Residents applying for the Program and subsequent charity care discounts; to define the process by which patients are evaluated for assistance; and to provide guidelines that will ensure consistency in the Program’s review and approval process.

Program eligibility for full or partial charity care discounts is based on the eligibility criteria, which are indexed to the published Federal Poverty Guidelines (FPG) in place at the time of consideration for eligibility (except for the Program category of Catastrophic Medically Indigent). Charity care discounts may also be allowed for coinsurance and deductible amounts. As long as the patient continues to qualify for the Program, the qualifying application and status will be valid for the Effective Period (which may be less than, or at most equal to, one year). The Program will recheck a participant’s financial status periodically during the Effective Period.

The charity care discount must be approved by UT Southwestern Medical Center. Please call 469-291-2000 (Toll free 866-648-2455) for an application.

Elective and non-medically necessary services will not be considered for charity care discounts. Medically necessary services that are not covered under an individual’s payor plan may be covered by the Program. Parkland Health Plus, a charity care program within Parkland Health & Hospital System, is not a recognized payor under the Program.

A determination of an individual’s charity care eligibility by Parkland Health and Hospital System (Parkland) or Children’s Medical Center (Children’s) only applies to professional services rendered at either Parkland or Children’s and does not extend to UT Southwestern facility fees or professional fees for services provided at a UT Southwestern facility.

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Program Eligibility, Categories, and Resulting Charity Care Discount

Eligibility for the UT Southwestern Charity Care Program (Program) is based on a patient’s residency/citizenship status, number of dependents, and household income, including specific calculated assets. In addition to the criteria outlined below, patients eligible for financial assistance must meet criteria including, but not limited to, status as a Texas Resident, a U.S. Citizen, or a Qualified Legal Alien. Demographic information such as race, ethnicity, gender, disability, national origin, and age is not considered in determining eligibility for financial assistance.

UT Southwestern utilizes three processes to determine whether a patient may be entered into the Program:

  1. Determining what institutional funds and resources are available for such care;
  2. Prioritizing requests for care; and
  3. Determining a patient’s eligibility for charity care discounts.

Charity care discounts shall be applied to a Patient Balance after all third-party payments or Private Pay discounts have been applied to facility and professional fees. All patients will be screened for third-party sources of other coverage such as the following:

  1. Medicare, Medicaid, Commercial, or any other third party coverage;
  2. Eligibility for public assistance programs;
  3. Third party coverage from an employer or family member’s employer;
  4. Coverage by their county of residence if a tax-supported hospital is not provided by the home county or needed services are not available at the home county’s tax-supported hospital.

The Program encompasses three categories: (1) Financially Indigent, (2) Medically Indigent, and (3) Catastrophic Medically Indigent.

  1. Financially Indigent: A patient qualifies for the category of Financially Indigent if the patient is uninsured or underinsured, and the patient’s annual household income is at or below 200% of FPG (see Eligibility and Discount Summary Table, below). Approved applicants are still responsible for any deposits or amounts indicated in any financial agreements and may receive a bill for any balances due; however, those amounts or deposits may be addressed by the charity care discount, which is 100% for the Financially Indigent category.
  2. Medically Indigent: A patient qualifies for the category of Medically Indigent if the patient’s medical bills would threaten the household financial viability, as determined by responses to standardized criteria. UT Southwestern considers the patient’s ability to pay without liquidating assets critical to living or earning a living (such as home, car, personal belongings, etc.) and the patient's outstanding UT Southwestern balance for both facility and professional fees as a percentage of the applicant’s household income. Patients with income at or below 200% of the FPG do not qualify under the Medically Indigent category, as these patients are eligible for the Program under the Financially Indigent category.

    To be eligible for the Medically Indigent category, a patient’s annual household income must be less than 400% of FPG, which is essentially consistent with the guidelines established by the Affordable Care Act, and total medical expenses billed as the patient’s responsibility for the current episode of care must exceed 25% of the patient’s gross income. Outstanding medical bills from other facilities can be included in the charity assistance formula, but UT Southwestern will not be responsible for the write-off of these amounts. Medical expenses do not reduce the annual gross income in determining the HHS Poverty Level/FPG percentage. The charity care discounts for the Medically Indigent category are:
    1. 55% for household income between 201% – 249% FPG.
    2. 50% for household income between 250% – 299% of FPG.
    3. 45% for household income between 300% – 400% of FPG.
  3. Catastrophic Medically Indigent: A patient qualifies for the category of Catastrophic Medically Indigent if the patient’s balance exceeds the patient’s annual household gross income by 100% after any and all discounts or contractual adjustments have been applied. Any patient who is receiving or has received medically necessary services can qualify for the Program under the category of Catastrophic Medically Indigent even if the patient does not meet the eligibility criteria for Financially Indigent or Medically Indigent. Patients qualifying for the Program under the Catastrophic Medically Indigent category are eligible for a charity care discount calculated as a percentage of the patient’s household income. See scale below:

Discount for Catastrophic Medically Indigent Individuals

% of Patient Balance to Income

% of Income Owed Towards Patient Balance

100% – 125%

40%

126% – 150%

30%

151% – 175%

20%

176% or greater

10%

Repayment of the calculated percentage of income owed towards the Patient Balance would be eligible for interest-free payments in accord with the current monthly payment schedule.

Example: If a person's outstanding account balance is $150,000 and their verifiable household income for a Family of Four is $95,000 per year, this person would not normally qualify for an indigent discount. However, because the bill is more than their annual yearly income, the patient would qualify for the Program under the Catastrophic Medically Indigent category.

$150,000 outstanding bill divided by $95,000 annual income = 158%

$95,000 income x 20% (from chart above) = $19,000 patient owes to settle debt

Summary Table of Eligibility Criteria and Discount Amounts

Eligibility and Discount Summary Table

Category

Eligibility Criteria

Charity Care Discount

A

Financially Indigent

Income at or below 200% of the FPG, based on number in household.

Full indigent discount (100%)

B

Medically Indigent

Income at or below 400% of the FPG, based on number in household, AND Patient Balance exceeds gross income by 25%.

Income between 201% – 249% of FPG = 55% discount
Income between 250% – 299% of FPG = 50% discount
Income between 300% – 400% of FPG = 45% discount

C

Catastrophic Medically Indigent

Patient Balance exceeds the annual gross household income by 100%.

% Patient Balance to Income

% Income Owed towards Patient Balance

100% – 125%

40%

126% – 156%

30%

151% – 175%

20%

176% or greater

10%

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Definitions

Applicant – An individual who applies to the UT Southwestern Charity Care Program (Program) for a charity care discount. Generally, this is the patient unless the patient is a minor child or has a legal guardian, in which case the applicant is the parent or legal guardian of the patient. When a patient is a child or has a legal guardian, the evaluation will generally be based on the patient’s Texas residency and citizenship status, and the income/asset evaluation will be based on the household income as defined. If the patient is a child whose custodial parent is a Texas Resident, then the child can be considered a Texas Resident.

Assets – Resources including but not limited to the following:

  • Cash
  • Checking and savings accounts
  • Certificates of deposit
  • Stocks
  • Bonds
  • Other securities
  • The equity value of real or personal property, including income-producing property but excluding Primary Residence and vehicle
  • Retirement accounts

Dependent – A spouse, minor child, or parent whose Family member is responsible for his or her support (see definition of Family).

Effective Date – The admitting date of the encounter determined after a patient has qualified for the Program.

Effective Period – A span of time, less than or equal to one year, during which the charity care discount is in effect.

Emergency Medical Condition – Definition based on the Emergency Medical Treatment and Active Labor Act (EMTALA), as amended, and found in UT Southwestern’s University Hospital Policy UHRI 1-104 Emergency Medical Treatment and Active Labor Act.

Family – All persons who are legally responsible for the financial obligations of the patient or for whom the patient is legally responsible. The Family may or may not live in the same home as the patient (e.g., custodial parent living away). This designation includes legal guardians, anyone who has claimed the patient as a Dependent on his or her most recent federal income tax return, or anyone who takes the Federal Elderly Income Tax Credit for the patient on his or her most recent federal income tax return. Spouses are included in this definition. Spouses who live apart but are not divorced are included, unless it can be demonstrated that they have lived apart for at least two years, with separate addresses, separate financial accounts, and separate income tax returns. Common Law or Informal Marriages are included in the Family definition if either of the following conditions is met:

  1. The couple has filed a Declaration of Informal Marriage, or
  2. The couple meets all of the following conditions:
    1. They have made a declaration of their marriage under Section 1.92 of the Texas Family Code on a form prescribed by the Bureau of Vital Statistics, and
    2. They have agreed to be married, and after the agreement, have been living together in Texas as husband and wife and representing to others that they are married.

For the purposes of this policy, “Family” does not include non-custodial parents who are not legally obligated to support the applicant or who do not claim the applicant as a Dependent; adult (age 18 or over) children or siblings with no financial responsibility for the applicant; friends; renters; or any others not financially responsible for the applicant.

Federal Poverty Guidelines (FPG) – Guidelines issued each year in the Federal Register by the Department of Health and Human Services (HHS); they are a simplification of the poverty thresholds for use for administrative purposes— for instance, determining financial eligibility for certain federal programs.

Household Income – Money or its equivalent received by those who are legally responsible for the support of the patient, who claim the patient as a dependent or tax credit, or who are defined as Family in this policy. If an applicant has received voluntary support from someone who is not legally obligated to provide support, the amount of that support should be considered as part of the applicant’s total income and documented, but the total income of the person providing that support is not considered. The value of anticipated or future voluntary income or gifts cannot be considered.

Medically Necessary Service – A treatment that is reasonable and medically necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, consistent with the applicable standard of care, and that is not considered an elective procedure or treatment.

Patient Balance – The medical expenses that are the responsibility of a patient after any and all applicable third party coverage payments, discounts, or contractual adjustments have been applied.

Primary Residence – The address at which a person resides most of the time, considers as his or her home, and does not use on a temporary or sporadic basis (such as a vacation or second home). See Appendix A for examples of proof of Primary Residence. If a person divides his or her time equally between two residences (e.g., one in-state and one out-of-state), and that person provides one Residence Proof and two Residence Indicators that show in-state residence, that residence shall be considered primary for the purposes of this policy.

Private-Pay – Patients with no insurance or third party coverage who are responsible for their medical bills are eligible for a private-pay discount. The total charges that are not part of a package plan, fee schedule, or elective are eligible for a 25% discount on total professional fees and 40% discount on facility fees. Patients who are approved for the UT Southwestern Charity Care Program will be granted the applicable charity care discount in addition to the private pay discount.

Qualified Legal Alien – a person who:

  1. Has been admitted to the U.S. for Lawful Permanent Residence under the Immigration and Nationality Act, or
  2. Has been admitted to the U.S. under the following designations: as an asylee or refugee; an alien whose deportation is being withheld; a Cuban or Haitian entrant; an Amerasian Lawful Permanent Resident; a victim of severe trafficking; a U.S. military active duty service member’s or veteran’s spouse or dependents; special immigrants from Iraq and Afghanistan; or the alien battered spouse or child(ren) of a U.S. military active duty service member or veteran, regardless of the length of residence in the United States.

An alien whose presence in the United States is based solely upon a non-immigrant visa (e.g., student visas, work permits, visitors’ permits, or other temporary circumstances) is not a Qualified Legal Alien.

Note: Qualified alien status is not required for emergent or unplanned services (e.g., Emergency Department outpatients or Emergency Department generated admissions).

Texas Resident – A person who:

  1. Physically and lawfully resides within the geographic boundaries of the State of Texas for at least six (6) months prior to the date of the application for a financial discount.
  2. Maintains a permanent residence (e.g., house, apartment, or trailer, and not just a post office box) in Texas. If the applicant cannot show a permanent physical residence, then a Notarized Letter of Support may be provided.
  3. Claims permanent residency in Texas and can provide two Residence Proofs found in the Verification Sources document.
  4. Is a minor child residing in Texas, with at least one parent, Managing Conservator, Guardian and/or other person or entity with primary legal responsibility for the child who is a Texas Resident.
  5. If claimed as a dependent of a parent or guardian, is not an emancipated adult and is enrolled and attending a post-secondary educational institution outside of Texas, maintains permanent residency in Texas, and does not claim residency in any other state for tuition purposes; or
  6. Does not claim permanent residency in any other states or country and is not eligible to receive or does not receive any of the following benefits in another state or country:
    1. Has the right to vote in another state or country, unless holding dual citizenship in that country;
    2. Owns a Primary Residence in another state or country, although the ownership of second homes or property is acceptable;
    3. Pays personal state income tax in another state;
    4. Receives homestead tax benefits in another state or country, unless holding dual citizenship in that country;
    5. Is registered (or has custodial children registered) and attends elementary or secondary school in another state or country, unless holding dual citizenship in that country; or
    6. Receives in-state or in-country residency tuition benefits in another state or country, unless holding dual citizenship in that country.