What the public system’s own program does
Every hospital in New York State must run a financial assistance program under state law, and since October 20, 2024 that law reaches households up to 400% of the federal poverty level. The public system is bound by the same law as every private hospital. The statutory floor that binds everyone.
What the city system adds is scale and habit. Its financial counselors process these applications constantly, the sliding scale is published across the system rather than negotiated facility by facility, and the staff are used to households with irregular income and incomplete paperwork.
| Household income | What you pay for care in the system |
|---|---|
| At or below 200% of the federal poverty level | Nothing. The bill is written off |
| 201% to 400% | A discounted amount on a sliding scale, by where you fall in the range |
| Above 400% | The statewide floor ends; ask for the written policy anyway |
Where those percentages land for your household size:
| Household | 200% bill written off | 300% state cap: 10% of Medicaid rate | 400% state cap: 20% · no lawsuits |
|---|---|---|---|
| 1 | $31,920 | $47,880 | $63,840 |
| 2 | $43,280 | $64,920 | $86,560 |
| 3 | $54,640 | $81,960 | $109,280 |
| 4 | $66,000 | $99,000 | $132,000 |
| 5 | $77,360 | $116,040 | $154,720 |
| 6 | $88,720 | $133,080 | $177,440 |
Each additional person adds $5,680 to 100% FPL. Annual figures, before taxes.
Who to ask, and the words to use
Ask for a financial counselor. Every facility in the system has them, and they are the people who actually calculate eligibility rather than quote a policy.
“I need to speak to a financial counselor about financial assistance for my bill. I am uninsured, and I would like the state’s uniform financial assistance application and your written sliding scale.”
Say it at registration, at discharge, or by calling the number on the bill. You can ask before care, during a stay, after a bill arrives, and after an account has gone to a collection agency. There is no deadline in New York.
The three documents
Identity. A passport, an IDNYC card, a consular identification, or a driver’s licence. IDNYC is available to city residents regardless of immigration status and is accepted throughout the public system, which makes it the most useful card to obtain if you have nothing else.
Proof you live in the city. A lease, a utility bill, or mail addressed to you.
Proof of income. Pay stubs, a letter from an employer, a tax return, or a letter you write yourself stating what you earn if you are paid in cash. Cash work disqualifies nobody, and the self-attestation route exists precisely because a large share of the households this system serves have no pay stub to produce.
What they may not ask for: information about your assets. Since the 2024 amendments, no New York hospital may require asset documentation or deny an application only because a bank statement or tax return is missing. And immigration status may not be considered at all.
Financial assistance or NYC Care
They solve different problems and the confusion between them is constant.
| Financial assistance | NYC Care | |
|---|---|---|
| What it is | A reduction or write-off of a bill you already have | A membership giving you ongoing access to the system |
| Covers | Care already received | A primary care doctor, referrals, low-cost medications, mental health care |
| Immigration status | May not be considered | Not asked |
| Income limit | Determines the size of the discount, to 400% | No cutoff for membership; income sets what you pay |
| Applies at | Any New York hospital, by law | NYC Health + Hospitals and Gotham Health |
| How to start | Financial counselor, uniform state application | 1-646-NYC-CARE (1-646-692-2273) |
If you are uninsured and holding a bill from the public system, you want both: assistance for the bill, and membership so the next problem does not become another bill.
If it goes wrong
Get the decision in writing. State law requires a written determination within 30 days of a completed application, with the reason and the appeal procedure.
Compare the tier applied against the law. Free care at or below 200%, 10% of the Medicaid rate to 300%, 20% to 400%. A determination that uses a 300% ceiling is applying the pre-2024 law.
Escalate. The New York State Attorney General’s health care helpline, 1-800-428-9071, takes complaints about hospital financial assistance practices, as does the state Department of Health. Legal services organizations across the city handle medical debt at no cost.
Remember what cannot happen. No hospital may sue a patient with household income under 400% of the poverty level, may not garnish wages or place a lien on a home for medical debt, and may not refer a bill to collections within 180 days of the first bill. Every protection with its date.
Questions people ask
Does NYC Health + Hospitals write off bills?
For uninsured patients at or below 200% of the federal poverty level, yes, in full. Between 201% and 400% the bill is discounted on a sliding scale.
Do I need papers to apply?
Immigration status may not be considered in a financial assistance decision, and hospitals may not report applicants to immigration authorities. You do need identity, city residence and income documentation, and IDNYC is accepted.
I am paid in cash. How do I prove income?
A letter you write yourself stating what you earn is accepted. Cash work is not a disqualifier.
Is this the same as NYC Care?
No. Financial assistance reduces a bill you already have. NYC Care is a membership that gives you ongoing access to the system with a primary care doctor. Most uninsured New Yorkers benefit from both.
My bill already went to a collection agency. Too late?
No. In New York an application can be filed at any stage of collection, and the hospital, not the agency, decides it.
Can I apply before the care happens?
Yes, and for scheduled care you should also request a written good faith estimate. How that works.
Sources
- NYC Health + Hospitals — financial assistance sliding fee scale (checked 2026-09-07)
- New York State Attorney General — Hospital financial assistance (checked 2026-09-07)
- NYC Care (checked 2026-09-07)
More in Hospital Financial Assistance in New York: Who Pays Nothing, Who Pays 10%
- NewYork-Presbyterian Bills and Financial Assistance — One visit to an academic medical center produces a facility bill plus separate professional bills. How to read each envelope and which office answers for it.
- Hospital for Special Surgery: Apply Before Your Care, and Approval Lasts Two Years — HSS's own policy lets you apply before scheduled care, keeps an approval for two years, and reaches U.S. residents well beyond New York. How to use it.
- Memorial Sloan Kettering: Financial Assistance for Patients Anywhere in the U.S. — MSK's own policy opens its financial assistance program to patients who live anywhere in the U.S., with two conditions for new patients. How it works.
This page explains how the system works. It is not medical advice. More.