METROHEALTH SYSTEM

"| | | | --- | --- | | **% FPL** | **FAP Eligibility** | | At or under 100% | Resident: 100% discount of charges Nonresident: 100% discount of charges | | 101-125% | Resident: 100% discount of charges Nonresident: 100% discount of charges | | 126-150% | Resident: 100% discount of charges Nonresident: 100% discount of charges | | 151-200% | Resident: 100% discount of charges Nonresident: 100% discount of charges | | 201-250% | Cuyahoga County Resident: 100% discount of charges Ohio Resident and Nonresident: 75% discount of charges; 100% discount for Trauma or Burn Care | | 251-300% | Cuyahoga County Resident: 75% discount of charges; 100% discount for Trauma or Burn Care Ohio Resident or Nonresident: 70% discount of charges | | 301-400% | Cuyahoga County Resident: 70% discount of charges Ohio Resident or Nonresident: 65% discount of charges | | Over 400% or Self-Pay | Cuyahoga County Resident: 65% discount of charges Ohio Resident or Nonresident: 65% discount of charges |"

documented · checked 2026-10-14 · Financial Assistance - MetroHealth | Cleveland, OH

"Photo ID: • Current Photo ID such as Driver’s License, State Issued ID, Permanent Resident Card or Passport Residency: • Utility bill or other commercial mail received in your name within the last 60 days • Signed rental agreement • Passport or visa for citizens of other countries Family Members: • Your birth certificate and those of your minor children • Adoption documents of minor children • Marriage certificate or divorce decree Income: Documents describing gross income for the past 3-12 months including: • Current tax return, including W-2s, or proof of non-filing • Pay stubs from each employer • Report of gross income and dates of employment from temp agency • Social Security benefits • Pensions • Unemployment income • Workers Comp income • Self-employment income • Rental income • Letter of support • Other income Please Note: • We can also assist with identifying other medical benefit programs that may be available for you. • We can assist you with applications for other medical benefit programs. • All proof of income and residency must be current – within the last 60 days."

documented · checked 2026-10-14 · Financial Assistance Program and Hospital Care Assurance Program Information Sheet

"call our Eligibility Team at (216) 957-2325"

documented · checked 2026-10-14 · Financial Assistance Program and Hospital Care Assurance Program Information Sheet

"* [Required Documentation for Medicaid Assistance and Financial Assistance Program](/globalassets/metrohealth-documents/patients-and-visitors/billing/2026_financial_documentation_sheet-9-15-26.pdf) * [Required Documentation for Medicaid Assistance and Financial Assistance Program (haga clic aquí para español)](/globalassets/metrohealth-documents/patients-and-visitors/billing/2024_financial_documentation_sheet_spanish_1-9-24.pdf)"

documented · checked 2026-10-14 · Financial Assistance - MetroHealth | Cleveland, OH

"The MetroHealth System . 2500 MetroHealth Drive . Cleveland, Ohio 44109-1998 . www.metrohealth.org"

documented · checked 2026-10-14 · Financial Assistance Program and Hospital Care Assurance Program Information Sheet