{"hospital":{"ccn":"141347","name":"CARLINVILLE AREA HOSPITAL","city":"CARLINVILLE","state":"IL","zip":"62626","phone":"217-854-3141","ownership":"Voluntary non-profit - Private","website_domain":"cahcare.com","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Household / Family Size Maximum annual Household Income for free care (200% of 2024 Federal Poverty Guidelines)","source_id":"fap-a83fe40b7363c2bd","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"discount_tiers":{"value":[{"min_fpl_exclusive":"200","max_fpl_inclusive":"300","discount_percent":75}],"layer":"documented","quote":"Household / Family Size Maximum annual Household Income for free care (200% of 2024 Federal Poverty Guidelines)\nMaximum annual Household Income for 75% discount (300% of 2024 Federal Poverty Guidelines)\n1 $30,120 $45,180\n2 $40,880 $61,320\n3 $51,640 $77,460\n4 $62,400 $93,600\n5 $73,160 $109,740\n6 $83,920 $125,880\nFor each additional person, add $10,760 $16,140","source_id":"fap-a83fe40b7363c2bd","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"asset_test":null,"residency":null,"insured_patients_covered":{"value":true,"layer":"documented","quote":"Eligibility for financial assistance will be considered for patients receiving care at any CAH facility who are uninsured, underinsured, ineligible for government programs that would pay for services, or otherwise unable to pay for their care/or have exhausted their benefits for covered services.","source_id":"fap-a83fe40b7363c2bd","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Temporary Assistance for Needy Families (TANF)","Homeless or received care from a homeless clinic","Participation in Women, Infants and Children programs (WIC)","Supplement Nutrition Assistance Program (SNAP)","Illinois Free Lunch and Breakfast Program","Low Income Home Energy Assistance Program (LIHEAP)"],"layer":"documented","quote":"Other sources of data used to make a presumptive eligibility decision may include the patient’s participation in certain programs or the availability of externally obtained information such as:\n1. Temporary Assistance for Needy Families (TANF);\n2. Illinois Housing Development Authority’s Rental Housing Support Program;\n3. Homeless or received care from a homeless clinic;\n4. Participation in Women, Infants and Children programs (WIC);\n5. Supplement Nutrition Assistance Program (SNAP);\n6. Illinois Free Lunch and Breakfast Program;\n7. Low Income Home Energy Assistance Program (LIHEAP);","source_id":"fap-a83fe40b7363c2bd","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":{"value":"https://www.cahcare.com/storage/app/media/fa-carlinville-area-hospital-clinics-2024-client-copy.pdf","layer":"documented","quote":"[FINANCIAL ASSISTANCE APPLICATION](https://www.cahcare.com/storage/app/media/fa-carlinville-area-hospital-clinics-2024-client-copy.pdf)","source_id":"fap-e74f96383bec482e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"form_version":null,"documents_required":{"value":["proof_of_income","tax_return","pay_stubs","bank_statements","medicaid_denial"],"layer":"documented","quote":"* Federal tax return with W-2’s\n* 3 months of income statements (pay stubs, rental income, Social Security, unemployment, worker’s compensation, alimony, child support or other forms of income)\n* 3 months of checking & savings account statements – If you do not have checking or savings, please send copies of all bills.\n* If you are potentially eligible for Medicaid, we must have a copy of your approval or denial letter from the Illinois Department of Public Aid.","source_id":"fap-e74f96383bec482e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"in_person","detail":"Requesting an application at the front desk or by contacting the Patient Financial Counselor at 217-854-3141 ext. 356."},{"kind":"portal","detail":"On the CAH website at https://www.cahcare.com/financial-assistance-process"}],"layer":"documented","quote":"Applications may be obtained in the following ways:\na. On the CAH website at https://www.cahcare.com/financial-assistance-process\nb. Requesting an application at the front desk or by contacting the Patient Financial Counselor at 217-854-3141 ext. 356.\nc. Assistance in completing an application can be obtained by contacting a Carlinville Area Hospital Patient Financial Counselor.","source_id":"fap-a83fe40b7363c2bd","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"window_days_from_first_bill":{"value":240,"layer":"documented","quote":"Patients are encouraged to apply for financial assistance within ninety (90) days from the date noted on the first “post-discharge” billing statement; however, patients are permitted a minimum of two hundred and forty (240) days to apply and submit an Application.","source_id":"fap-a83fe40b7363c2bd","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":{"value":"217-854-5092 or 855-262-4778","layer":"documented","quote":"If you have questions, please call [217-854-5092](tel:2178545092) or [855-262-4778](tel:8552624778) Monday through Friday from 8 AM-4:30 PM.","source_id":"fap-e74f96383bec482e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"hours":{"value":"Monday through Friday from 8 AM-4:30 PM","layer":"documented","quote":"If you have questions, please call [217-854-5092](tel:2178545092) or [855-262-4778](tel:8552624778) Monday through Friday from 8 AM-4:30 PM.","source_id":"fap-e74f96383bec482e","checked_on":"2026-10-10","confidence":1.0,"support_count":0},"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-a83fe40b7363c2bd","kind":"hospital_web","url":"https://www.cahcare.com/storage/app/media/Carlinville%20Area%20Hospital%20Financial%20Assistance%20Policy.pdf","title":"[PDF] Financial Assistance Policy - Carlinville Area Hospital","fetched_on":"2026-10-10","sha256":"a83fe40b7363c2bd9dde366b3ed0f5bd5eeee8e292b7d06a32f1b89bb5db13cf","effective_date":null},{"id":"fap-e74f96383bec482e","kind":"hospital_web","url":"https://www.cahcare.com/financial-assistance-process","title":"Financial Assistance Process","fetched_on":"2026-10-10","sha256":"e74f96383bec482e5adc9e5d737f2da89cc15e04dc327396d99488c35c574d2b","effective_date":null},{"id":"application-2a3f00aa0fbe4d81","kind":"hospital_web","url":"https://www.cahcare.com/storage/app/media/fa-carlinville-area-hospital-clinics-2024-client-copy.pdf","title":"FINANCIAL ASSISTANCE APPLICATION","fetched_on":"2026-10-10","sha256":"2a3f00aa0fbe4d81616442f12a02baf0374ad9b74cbae2bac78d6af8d9d09940","effective_date":null}],"accuracy":null}