Financial Assistance
Financial assistance is available to eligible patients who cannot afford to pay for their healthcare services. Eligibility is determined by family income, size and other factors. Patients whose gross family income is at or below 500% of the federal poverty guidelines for their family size will be eligible for financial assistance and will not be charged more than the current amounts generally billed. More information regarding this calculation is available in the full financial assistance policy below or you can call 337.494-3265, 337.480-8218 or email charityfinancialassistance@lcmh.com. Financial assistance is always considered secondary to all other sources of coverage.
- Financial Assistance Policy English
- Política de Ayuda Financiera
- UCC (financial assistance) Application in English
- UCC (financial assistance) Application in Spanish
Family Income Guidelines
To qualify for Financial Assistance your gross family income must be at or below:
| UCC Full Coverage 200.99% and below FPG | ||
| # in HH | Annual Income | Monthly Income |
| 1 | $29,304 | $2,442 |
| 2 | $39,635 | $3,304 |
| 3 | $49,966 | $4,165 |
| 4 | $60,297 | $5,025 |
| 5 | $70,628 | $5,887 |
| 6 | $80,956 | $6,747 |
| 7 | $91,290 | $7,607 |
| 8 | $101,621 | $8,470 |
| UCC Partial Coverage 201% to 500% FPG | ||
| # in HH | Annual Income | Monthly Income |
| 1 | $72,900 | $6,075 |
| 2 | $98,600 | $8,220 |
| 3 | $124,300 | $10,360 |
| 4 | $150,000 | $12,500 |
| 5 | $175,700 | $14,645 |
| 6 | $201,400 | $16,785 |
| 7 | $227,100 | $18,925 |
| 8 | $252,800 | $21,070 |
| 138 % and below FPG- consider Mcaid expansion 1st | ||
*Amounts are based on the 2022 FPG and are subject to change.
Our staff is ready to assist you. Please call the Business Office at (337) 494-3265 or reach our phone screeners at Moss Memorial Health Clinic by calling (337) 480-8218 or or email charityfinancialassistance@lcmh.com.
What To Do Now
You have the option of printing the application at the links above or paper applications are available at each campus. An application can also be mailed to you by calling one of the numbers listed above.
To complete the financial assistance application (UCC) you will need the following documents:
- One month’s verification of income for all household income
- Copy of your previous year tax return
- Copy of photo ID for the person responsible for the account
- If unemployed, a letter of support
- Social security cards for all individuals that are part of the household
- Copies of all outstanding medical bills (for individuals who do not qualify for 100% UCC)
Patients who are covered under Medicare are also required to provide the following:
- Documentation of assets
- Documentation of liabilities and expenses
- Most current statement for checking and savings accounts
Programs
Our Financial Counselors are also able to assist in applications for the following programs:
- Children's Health Insurance Program (LaCHIP)
- Medicaid
- Indigent Program
- Crime Victims
- CMS 1011
- Financial Discount Program
- Out of State Medicaid Programs
- Social Security Disability
- QMB Qualified Medicare Beneficiary Medicaid
- Veterans (VA) / Millennium Bill
