NOTICE MEDICAL CARE FOR THOSE WHO CANNOT AFFORD TO PAY
In accordance with 22 MSRA 396-F (1) and the rules of the State of Maine, this hospital is required to provide Free Care to patients whose income falls below the poverty income guidelines.
| Size of Family | 2022 HRH income Guidelines | 2022 poverty guidelines | |||
| 1 | 20,385.00 | 13,590.00 | |||
| 2 | 27,465.00 | 18,310.00 | |||
| 3 | 34,545.00 | 23,030.00 | |||
| 4 | 41,625.00 | 27,750.00 | |||
| 5 | 48,705.00 | 32,470.00 | |||
| 6 | 55,785.00 | 37,190.00 | |||
| 7 | 62,865.00 | 41,910.00 | |||
| 8 | 69,945.00 | 46,630.00 |
| Amount for each add’l person: | ||
| HRH $7080.00 | ||
| FPL $4,720.00 | ||
If you believe you qualify for Free Care, please apply at the Cashier Office.
Before providing Free Care, the hospital will ask for information about your income and also ask you to show that insurance or a governmental medical assistance program will not pay for your care.
Proof of income (FOR THE LAST 3 MONTHS) is needed at the time of application.
Services that are not medically necessary are not provided as free care (ex. dental, circumcision, sterilization)
Sliding Fee Scale for those who cannot pay.
| If your income is in one of these columns: | ||||||||
| Size of Family | 2022 HRH income Guidelines | 0% | 20% | 40% | 60% | 80% | 2022 poverty guidelines | |
| 1 | 20,385.00 | 20,385.00 | 22,423.50 | 24,462.00 | 26,500.50 | 28,539.00 | 13,590.00 | |
| 2 | 27,465.00 | 27,465.00 | 30,211.50 | 32,958.00 | 35,704.50 | 38,451.00 | 18,310.00 | |
| 3 | 34,545.00 | 34,545.00 | 37,999.50 | 41,454.00 | 44,908.50 | 48,363.00 | 23,030.00 | |
| 4 | 41,625.00 | 41,625.00 | 45,787.50 | 49,950.00 | 54,112.50 | 58,275.00 | 27,750.00 | |
| 5 | 48,705.00 | 48,705.00 | 53,575.50 | 58,446.00 | 63,316.50 | 68,187.00 | 32,470.00 | |
| 6 | 55,785.00 | 55,785.00 | 61,363.50 | 66,942.00 | 72,520.50 | 78,099.00 | 37,190.00 | |
| 7 | 62,865.00 | 62,865.00 | 69,151.50 | 75,438.00 | 81,724.50 | 88,011.00 | 41,910.00 | |
| 8 | 69,945.00 | 69,945.00 | 76,939.50 | 83,934.00 | 90,928.50 | 97,923.00 | 46,630.00 | |
If you believe you may qualify for the Sliding Fee Discount, please apply at the Cashier’s Office. Before providing the discount, we will ask for information about your income. Also, you will be asked to show proof you are not covered by insurance or a government assistance program. Proof of income will be needed at time of application.
Revised: 2/7/2022