Financial Assistance

Financial hardship

1. The application must meet the requirements listed on the form
2. Requested documents must be provided
3. You must meet the Poverty Guidelines – Please reference column 138% poverty guidelines – https://www.medicaidplanningassistance.org/federal-poverty-guidelines/
4. Submit a completed Financial Assistance application to the CBO in person or by mail ( Forms attached below to print for English and Spanish)
   

   
   English

   Spanish

Self-pay patients are expected to pay at the time of service rendered.