# St. Rose Hospital

Hospital in Hayward, CA. Verified from the hospital's own policy.

St. Rose Hospital likely gives free care to households with a yearly income up to $63,840 for 1 person, $86,560 for 2, $109,280 for 3, $132,000 for 4, $154,720 for 5 or $177,440 for 6. It likely gives a discount to households with a yearly income up to $79,800 for 1 person, $108,200 for 2, $136,600 for 3, $165,000 for 4, $193,400 for 5 or $221,800 for 6.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $63,840 | $79,800 |
| 2 | $86,560 | $108,200 |
| 3 | $109,280 | $136,600 |
| 4 | $132,000 | $165,000 |
| 5 | $154,720 | $193,400 |
| 6 | $177,440 | $221,800 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 400% of poverty level, patient pays $0 (uninsured patients, and insured patients with high medical costs)
- 401% to 500% of poverty level, patient pays 30% of the remaining balance for patients with high medical costs (a 70% write-off); the upper limit is less than 500%
- 0% to null% of poverty level, patient pays 30% of billed charges for any uninsured patient (a 70% write-off), no income limit

## How to apply

- Call (510) 782-6200 and ask for financial assistance.
- [Application form](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=65b3e7f8-76c0-4695-9e90-e71c44b550e8)
- [Charity Care Policy and Discounted Care Policy (last approved 11/2025)](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=9d8a4546-88b9-450c-93db-1403bb502ed0)
- We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.
- Bring proof of income such as the most recent tax return, 2 recent pay stubs, a letter from your employer, or proof of unemployment, a signed self-declaration of income if you have no proof.
- Savings and property. The policy looks at income only, not savings or property.
- Very large bills. Out-of-pocket medical costs over 10% of family income count as high medical costs. At or below 400% of the poverty level, the rest of the hospital balance is written off. Above 400% and under 500%, 70% of it is written off.

## If you have insurance

Insured patients can also apply for help with deductibles and copays.
Keep your insurance. Financial assistance covers bills from this one place only.

## What is covered

Covered. Medically necessary care billed by St. Rose Hospital.

Not covered. Doctors who bill separately are not covered, such as anesthesiologists, radiologists, emergency doctors, and pathologists. Emergency doctors must give their own discount up to 400% of the poverty level.

## State program in California

### Hospital Fair Pricing Act (Health and Safety Code 127400 et seq.)

Every licensed general acute care, acute psychiatric, and special hospital in California must have a charity care policy and a discount payment policy. A patient can ask for help if they are uninsured (self-pay) or have high medical costs, and their family income is not more than 400% of the federal poverty level. Hospitals may choose to help people with higher incomes. With a discount, the bill is capped at about what Medicare or Medi-Cal would pay, whichever is greater. You can apply at any time, even after a bill goes to collections. Immigration status does not affect eligibility.

Income levels in the program are discount up to 400% of poverty level.

Applies to each licensed general acute care hospital, acute psychiatric hospital, and special hospital in California.

How to apply. Apply to the hospital's financial assistance office. Each hospital's policies and applications are posted on its website and on HCAI's Hospital Fair Pricing Policy Lookup (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-fair-pricing-policy-lookup/).

> Is a self-pay patient OR a patient with high medical costs; AND Patient's family income is not more than 400 percent of the federal poverty

Source https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/frequently-asked-questions/, checked 2026-11-10

### Hospital Bill Complaint Program (HCAI)

A free state program at HCAI. If a hospital wrongly denied you financial assistance, did not tell you about its programs, or sent you to collections the wrong way, you can file a complaint online (English and Spanish) or by mail (many languages). You must have applied to the hospital first for HCAI to review an eligibility decision. If HCAI finds you paid too much, the hospital must refund you within 30 days. It covers problems on or after January 1, 2022. It does not handle general billing disputes, price transparency, Good Faith Estimates, or bills from emergency room doctors.

Applies to complaints about any hospital covered by the Hospital Fair Pricing Act.

How to apply. File online through the Patient Complaint Portal (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/should-i-file-a-complaint/) or mail the Patient Complaint Form to Department of Health Care Access and Information, Hospital Bill Complaint Program, 2020 West El Camino Avenue, Suite 1101, Sacramento, CA 95833.

> If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.

Source https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/, checked 2026-11-10

### Emergency physician discount rule

Most hospital policies cover only the hospital's own bill. Emergency room doctors often bill separately. California law also requires an emergency physician to give discounts to uninsured patients and patients with high medical costs whose family income is at or below 400% of the federal poverty level. Ask the doctor group's billing office for its discount policy. HCAI's complaint program does not handle emergency doctor bills.

Income levels in the program are discount up to 400% of poverty level.

Applies to emergency physicians who provide emergency medical services in a California hospital that provides emergency care.

How to apply. Ask the emergency physician group named on the bill for its discount payment policy.

> an emergency physician who provides emergency medical services in a hospital that provides emergency care is also required by law to provide discounted care

Source https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=c7bdd7eb-bcc0-4a84-bcab-a21b5e578d9c, checked 2026-11-10

## Notes

Free care for uninsured patients at or below 400% of the poverty level. Insured patients at or below 400% whose out-of-pocket medical costs are over 10% of family income also owe nothing on the rest of the hospital bill. Every uninsured patient gets 70% off billed charges without applying, with no income limit. Patients with high medical costs and income above 400% but under 500% get 70% off the rest of the bill. Savings and other assets are not counted, except when the hospital waives Medicare or Medi-Cal cost sharing. You do not have to apply for Medi-Cal first. There is no deadline to apply. Approval lasts six months. Payment plans have no interest. Disputes go in writing to the Chief Financial Officer within 30 days. The policy documents do not print a billing or financial counseling phone number. The charity care and discounted care rules are in two separate documents filed with the state.

## Sources

- Free care level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=9d8a4546-88b9-450c-93db-1403bb502ed0
  > a patient whose Family Income does not exceed 400% of the Federal Poverty Level.
- Discount level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=94b0e888-4727-43d4-8e08-2b4394db7ffb
  > A patient with a Family Income that exceeds 400% of the Federal Poverty Level but is less than 500% of the Federal Poverty Level.
- Discount steps https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=94b0e888-4727-43d4-8e08-2b4394db7ffb
  > the Self-Pay Patient will be provided discount equal to a 70% write-off of St. Rose Hospital’s billed charges.
- Insured patients https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=9d8a4546-88b9-450c-93db-1403bb502ed0
  > will be eligible for a complete (100%) write-off of the balance due to St. Rose Hospital, including cost sharing amounts
- Asset test https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=9d8a4546-88b9-450c-93db-1403bb502ed0
  > St. Rose Hospital shall not consider the monetary assets of the Patient Family when determining the Family Income or eligibility for Charity Care.
- Very large bills https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=9d8a4546-88b9-450c-93db-1403bb502ed0
  > Annual out-of-pocket expenses that exceed 10% of the patient's family income
- What is not covered https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=9d8a4546-88b9-450c-93db-1403bb502ed0
  > including anesthesiologists, radiologists, emergency department physicians, pathologists, etc., not included in the hospital bill.
- Application deadline days none https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=94b0e888-4727-43d4-8e08-2b4394db7ffb
  > There is no time limit for applying for Charity Care or Discounted Care
- Documents https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=65b3e7f8-76c0-4695-9e90-e71c44b550e8
  > Acceptable proof of income documents include: Most recent tax return, 2 most recent check stubs, a letter from employer stating earned wages
- Facility named in policy https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=9d8a4546-88b9-450c-93db-1403bb502ed0
  > It is the policy of St. Rose Hospital to provide charity care, consistent with this policy

Last checked 2026-11-10.

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