Free Care

(Information as of March 15, 1999.)

Free Care is a state assistance program that provides free or partially-covered healthcare for those who qualify. It can cover services for certain people who are without insurance, but also, may cover costs not paid by an insurance plan for certain people who do have insurance.

Qualifying

The qualifications for Free Care are based on income and residency as follows:

Income

There are 3 different types of Free Care, with different income qualifications:

Full Free Care

Requires the individual to have annual income no more than 200% of federal poverty guidelines (see income limits).

Partial Free Care

Requires the individual to have annual income no more than 400% of federal poverty guidelines (see income limits).

Medical Hardship

This is for those that don't meet the above qualifications, but that have medical bills which they cannot pay. To qualify for this:

Qualifying medical expenses must exceed 30% of the person's gross family income.
Available assets must be insufficient to cover qualifying medical expenses that exceed 30% of income. (Assets may be things like bank accounts and are different from income. Note that certain assets may be included, while others may be excluded, when qualifying.)

Residency

The person must reside in Massachusetts, but they need not be a U.S. citizen. Non-residents are eligible, however, for coverage of emergency and urgent care.

Although qualification is based on family income, each family member must apply separately.

Your qualification status is re-assessed every year. Nonetheless, after you have qualified, you are required to inform them if your income/residency changes such that it might change your qualifications.

Coverage

In all cases, Free Care only covers medically necessary services. But, specifically:

Full Free Care

Covers medical services 100% (at facilities at which you have qualified).

Partial Free Care

Covers medical services partially (or not at all--see difference for hospitals and health centers below) up until the patient meets the following yearly deductible:

(Gross Family Income - "Full Free Care" Income Limit) x 40%

Once the deductible is met, the patient may receive Full Free Care until that year's eligibility period ends.

Before the deductible is met, the following are the costs to the patient:

At a hospital, the patient must pay 100% of costs (the hospital may require a deposit or a payment plan for non-emergency services).
At a health center, patients must pay a percentage of fees. Percentages are 20%, 40%, 60% or 80% and depend on your family income. Only the portion the patient pays (e.g., 40%) goes towards fulfilling the deductible.

Medical Hardship

Medical Hardship only pays the costs that exceed 30% of gross family income and that exceed the available assets. In other words, based on the family income and assets, the patient must pay a portion of their bills, then Free Care will cover the rest.

No claim forms are necessary in any case.

Facilities

Coverage under Free Care is available only at hospitals and community health centers. It does not cover costs at private physicians or care groups.

Note: Although patients are responsible for all costs at private physicians or care groups, allowable costs at such places may be used in the Medical Hardship case to determine qualification. Again though, those bills will have to be paid by the patient; Free Care only covers costs at hospitals and health centers.

Normally, you apply for Free Care at a specific hospital or health center. If you have qualified at that facility, but then need medical services at another facility, you'll have to reapply at the new facility (although there is a condensed form of the application that can be used in such cases).

Services

Free Care covers all medically necessary services, but never covers:

non-medical services, such as social, educational, and vocational services,
cosmetic surgery,
canceled or missed appointments,
telephone conversations and consultations,
court testimony,
research or the provision of experimental or unproven procedures including, but not limited to, treatment related to sex-reassignment surgery, and pre-surgery hormone therapy,
the provision of whole blood; provided, however, that administrative and processing costs associated with the provision of blood and its derivatives shall be payable.

Prescriptions

If you are concerned about having the costs of prescriptions covered, make sure you apply at a facility with its own pharmacy and make sure prescriptions filled at that pharmacy are covered.

Sponsorship

Free Care is run through the Massachusetts Division of Health Care Finance and Policy.

Applying

To apply, ask to speak to someone about financial assistance at the hospital or health center at which you wish to receive services. For general questions about the program, you may call the Division of Health Care Finance and Policy at 617-988-3100.

When you apply, financial counselors will often try to determine whether another program (like MassHealth) would be more appropriate for coverage. Even if they suggest such a program, you can decline to apply to that program and just apply for Free Care instead (declining other programs will not affect whether you qualify for Free Care).

To apply, you must fill out an application and provide any required documentation (e.g., proof of income and residency). (Those applying for Medical Hardship have an additional application to fill out.) Some of the the acceptable forms of proof are (not a complete list):

Income

Pay stubs from the previous 2 weeks (or longer)
Most recent tax forms

Residency

Driver's license
Passport
Paycheck stub
Student ID
Utility (e.g., electric, phone) bill
Tax forms

You should also bring information about insurance you currently have.

Notification of whether your application has been approved should be sent to you within 30 days.

Free Care Income Limits

For the current Free Care income limits, go to http://www.state.ma.us/dhcfp/, click on "Uncompensated Care", then find the appropriate link that lists "Income Limits".

*Family members are defined as the person, a spouse and any children (under 19, including an unborn child) living in the household.

Income guidelines are based on percentages (200% for Full Free Care, 400% for Partial Free Care) of the Federal Poverty Guidelines. Although new Federal Poverty Income Guidelines are scheduled to come out in approximately February each year, they sometimes come out a few months late.

Additional Information

For additional information on Free Care, visit the Division of Health Care Finance and Policy web site (http://www.state.ma.us/dhcfp/) and look under "Uncompensated Care".

To contact the Graduate Student Organization on healthcare issues, send mail to healthcare@gso.bu.edu.