Financial Assistance Program (for DSH Patients)

Financial Assistance Program (for DSH Patients) is sponsored by California Department of State Hospitals (DSH). This program assists eligible patients admitted to a DSH facility who cannot afford to pay their cost of care balance. Patients can apply after discharge to determine if their debt qualifies for reduction or cancelation.

California Department of State Hospitals - Financial Assistance Program Department of State Hospitals Financial Assistance Program As required by statute, the Department of State Hospitals (DSH) must collect for cost of care, treatment and maintenance provided to patients during their hospital admission.

The 2022 Budget Act, Health Omnibus via Chapter 47, Statutes of 2022 (Senate Bill 184) included statutory changes to provide DSH the authority to develop and implement a Financial Assistance Program. DSH recognizes that medical costs can be burdensome and therefore developed the Financial Assistance Program to assist eligible patients who cannot afford to pay their cost of care balance.

Patients who apply for financial assistance and are approved may have their debt to DSH canceled or reduced. Implementing a Financial Assistance Program is permissible under Centers for Medicare and Medicaid Services rules and regulations as well as state law pursuant to Welfare and Institutions Code section 7276(b)(1). Patients or their representative may submit an application.

Applicants can complete the Financial Assistance Program Application by: Downloading the electronic version, filling it out online and saving it to their computer or device. Filling out a paper copy, either by downloading and printing or the copy received at discharge or by mail. If a patient is unable to complete a printed or electronic application, please contact DSH by phone (916) 654-1501 or email DSHSacTrustOffice@dsh.

ca. gov for assistance. Once completed, the application can be mailed, emailed, or faxed to DSH.

Department of State Hospitals Attention to: Patient Cost Recovery Section, Trust Office Email: DSHSacTrustOffice@dsh. ca. gov For additional information on how to complete the application, access the Financial Assistance Program Application Instructions.

Applying for Financial Assistance If a patient was admitted to a DSH facility and is liable for their cost of care, the patient can complete an Financial Assistance Program Application to determine if their debt qualifies for cancelation or reduction. Eligible patients may apply after discharge from DSH.

Once DSH receives a completed application and supporting documents as listed in the Financial Assistance Program Application Instructions, the patient will receive written confirmation of receipt and the application review process will begin. DSH may request additional documents to help determine debt cancelation or reduction. Examples of additional documentation can be found under the section titled "Documents."

What to Expect After Applying for Financial Assistance DSH will complete the review of the patient's application and determine if their debt is eligible to be canceled or reduced. A letter will be mailed to the patient explaining the decision. If their debt is not canceled or reduced and the patient feels they qualify, the patient may submit an appeal in writing.

--> Documentation can include, but are not limited to: Proof of income and assets. This can include a W-2 or document confirming benefits such as Supplemental Security Income (SSI), disability, retirement, etc. Documents showing stocks and bonds. Bills showing monthly living expenses.

This can include bills for mortgage or rent. If it is determined the debt will not be canceled or reduced, appeals may be submitted in writing. DSH will review the appeal to determine if the initial decision is upheld.

If the appeal is approved, the Department will reduce or cancel the debt owed and provide a letter explaining the decision. If the initial determination is upheld, the Department will work with the applicant to set up a reasonable payment plan.

Financial Assistance Program FAQs What is the Financial Assistance Program (FAP) Answer: FAP will provide financial relief for patients who are liable for their cost of care and meet the eligibility requirements.

Welfare and Institutions Code (WIC) section 7276(b)(1) states 'The State Department of State Hospitals shall develop and implement a financial assistance program that may reduce or cancel the amount that a patient owes for the cost of care and treatment.

The financial assistance program shall provide a process for a patient to apply for financial assistance and the criteria used by the department to determine whether a patient is eligible for a waiver of all costs or discounted payment.' Do all patients have to pay for their stay at a Department of State Hospital (DSH)? Answer: No. Per California WIC section 7275, 'The patient in a state hospital...

shall be liable for their care, support, and maintenance in a state institution of which they are a patient. The liability shall exist whether the person has become a patient of a state institution pursuant to the provisions of this code or pursuant to the provisions of Sections 1026, 1368, 1369, 1370, and 1372 of the Penal Code'.

Patients may contact Patient Cost Recovery Section (PCRS) Trust Office staff if they would like to know if they are liable for their cost of care. Email: DSHSacTrustOffice@dsh. ca.

gov Who is responsible for telling the patient that they may owe for the cost of their treatment at DSH? Answer: Upon admission, the Hospital Trust Office notifies patients about their liability for the care, support, and maintenance in a state institution (WIC section 7275). After discharge from DSH, patients liable for their cost of care will be sent an FAP Application packet.

The cover letter sent to the patient will serve as an additional notification of the patient's responsibility. Who at DSH is responsible for notifying patients about the FAP? Answer: PCRS Trust Office, the Hospital Trust Offices, and Social Workers will be informing patients of the existence of the FAP.

Social Workers and Hospital Trust Offices will be asked to provide informational guides and FAP Applications to patients that are being discharged from the hospital. Upon discharge, the FAP Application packet will be sent to the patient by PCRS Trust Office and will include information about the program. Can hospital staff tell patients how much they owe?

Answer: Yes. Hospital Trust Office staff may provide a patient's account balance upon request. However, the account balance in the Cost Recovery System is the unadjusted account balance and may not reflect all charges and credits applied to the account.

A final account balance will be provided when a patient applies for financial assistance. How will patients be notified about the FAP if they are transferred from the hospital and discharged from the court? Answer: When a patient's care at DSH has ended, PCRS Trust Office will notify liable patients by mail of their debt owed to the department.

PCRS Trust Office will also provide patients with information about the FAP, including eligibility requirements, how to apply to the FAP, and an FAP Application. Will patients be provided guidance on completing the FAP Application? Answer: Yes, instructions on completing the application will be part of the FAP Application packet sent to all discharged patients.

Additionally, instructions on completing the application will be posted on the DSH internet site. Lastly, patients may contact the PCRS Trust Office for assistance in completing the application. The following contact information for PCRS Trust Office will be included in the application packets sent to all discharged patients.

Email: DSHSacTrustOffice@dsh. ca. gov What if the patient requires assistance in completing the application?

Answer: The patient will need to complete a DSH 5671 Authorization for Release of Information (ROI) form, specify "FAP Application" as the reason for the ROI and identify the third-party who may discuss the FAP with the Department. Where should completed FAP Applications be submitted?

Answer: FAP Applications and supporting documents may be sent to: Department of State Hospitals Attention to: Patient Cost Recovery Section, Trust Office Will patients be notified of a decision regarding their FAP Application? If so, when will they be notified? Answer: Yes.

It may take up to 30 calendar days from receipt of the completed FAP Application and any supporting documents for a decision to be made. Every effort will be made to render a determination within 30 calendar days of receiving all required documents, however, extenuating circumstances may delay a decision. Patients will be notified of the decision via written correspondence.

What if the FAP Application is denied? Answer: if DSH denies a patient's FAP Application they may appeal the decision within 30 calendar days of receipt of the notice of denial. Written notification of the determination will be mailed within 30 calendars days of receipt of all information needed for the appeal.

Will patients have to apply for FAP again if they are re-committed to a DSH hospital in the future? Answer: Yes. If a patient is recommitted to DSH, they will need to complete a new FAP Application after discharge.

Will DSH refer the patient to a collection agency if the patient is not eligible for FAP and does not pay for their care? Answer: No, DSH does not report patient debt to collection (or credit) agencies. If a patient is not eligible for financial relief, PCRS Trust Office will work directly with the patient to establish a payment plan for their cost of care balance.

Forms and Additional Resources For additional questions, please reach out to DSH Patient Cost Recovery Section (PCRS), Trust Office Monday through Friday between the hours of 8:00 a. m. and 5:00 p.

m. at the contact below: Email: DSHSacTrustOffice@dsh. ca.

gov Operational Procedure 1502 DSH 10268 Financial Assistance Program Application DSH 10268A Financial Assistance Program Patient Guide (Admission) DSH 10268A Financial Assistance Program Patient Guide (Upon Discharge) DSH 10268E Financial Assistance Program Application Attachment 1 DSH 10268F Financial Assistance Program Application Instructions DSH 10269 2025 Financial Assistance Program Sliding Fee Schedule DSH 5671 Authorization for Release of Patient Information Program Eligibility by Federal Poverty Level for 2025