Austin Hospital Charity Care: The Application Nobody Hands You

Every nonprofit hospital in America is required by the tax code to publish a financial assistance policy, to publicize it widely, and to check whether you qualify for it before it takes an extraordinary collection action against you. Austin has four nonprofit systems. Their published top-tier thresholds run from 200% to 300% of the federal poverty level, which is a wider band than most people assume they’re outside of. The application is free, the deadlines are real and different at each system, and nobody at the registration desk is going to hand you the form unless you ask.

Section 501(r) of the Internal Revenue Code sets four requirements for a tax-exempt hospital facility. It must conduct a community health needs assessment. It must establish a written financial assistance policy and an emergency medical care policy. It may not charge a FAP-eligible patient more than the amounts generally billed to insured patients for emergency or medically necessary care. And it must make reasonable efforts to determine whether you are FAP-eligible before pursuing an extraordinary collection action — selling your debt, reporting it to a credit bureau, or going to court.

Two timing rules inside 501(r)(6) do most of the practical work. There is a 120-day period after the first post-discharge bill during which the hospital must refrain from extraordinary collection actions, and a separate 240-day period during which you may still submit an application. The second window is longer than the first, which is why a bill already in collections is not automatically a closed matter.

501(r)(4) also requires the policy to list which providers delivering care in the facility are covered by the FAP and which are not. That list is worth finding, for reasons in section IV.

Ascension Seton — top tier at 250% of the poverty level

Ascension Seton’s policy, dated July 1, 2025, covers Dell Seton Medical Center at UT, Dell Children’s, Ascension Seton Medical Center Austin, and the Hays, Williamson, Northwest, Southwest, Cedar Park, Bastrop, Smithville, Edgar B. Davis and Highland Lakes facilities. Patients with household income at or below 250% of the federal poverty level are eligible for 100% charity care on the portion of charges they are responsible for. Above that, the policy sets a sliding scale: 95% assistance from 251–300%, 90% from 301–350%, and 85% from 351–400%. Above 400%, a means test can still apply where total medical debt equals or exceeds household gross income. There is an asset test — assets above 250% of your poverty-level income amount may disqualify you — and eligible patients may still owe a nominal flat charge of up to $30. Eligibility is limited to residents of a defined community: Travis; Hays and Caldwell; Williamson; Burnet, Blanco and Llano; and Bastrop, Fayette, Gonzales, Lee and San Saba counties. Patient Financial Services: 800-749-7624.

Baylor Scott & White — top tier at 200%, with a second tier to 500%

BSW’s hospital financial assistance policy took effect January 1, 2025, and its dollar tables were updated effective February 1, 2026 against the poverty guidelines issued January 15, 2026 — which makes it the most transparently current of the four. Patients at or below 200% of the poverty guidelines are classified “Financially Indigent” and eligible for a 100% discount on patient account balances. The published 200% thresholds are $31,920 for one person, $43,280 for two, $54,640 for three, and $66,000 for a household of four. A second classification, “Medically Indigent,” covers income above 200% and up to 500% where BSW bills equal or exceed 5% of yearly household income; those patients owe the lesser of the account balance or 10% of gross charges, capped at amounts generally billed. The 500% ceiling is $79,800 for one person and $165,000 for a household of four. Austin-area facilities include BSW Medical Center Austin, Buda, Marble Falls, Pflugerville and Round Rock. Every patient qualifies for emergency-care assistance regardless of residency; non-emergency assistance is limited to the service area. Phone: 1-800-994-0371.

St. David’s HealthCare — and why it isn’t a plain nonprofit

St. David’s describes itself, in its own words, as “a unique partnership between our national hospital operating partner HCA Healthcare and two local nonprofits: St. David’s Foundation and Georgetown Health Foundation,” dating to 1996. That structure is unusual and worth stating plainly rather than flattening — it is a joint venture with a for-profit operating partner, not a conventional nonprofit system. Its financial assistance policy nonetheless states that it is intended to comply with what IRC 501(r) requires. St. David’s publishes both a charity discount policy and a separate uninsured discount policy. On the charity side it states that in most cases patients between 0 and 200% of the federal poverty guidelines may have a 100% charity discount processed, subject to income verification, and that other discounts ranging from 40% to 90% may apply above those thresholds. Eligible patients are not charged more than amounts generally billed to insured patients. The policy also states that St. David’s reserves the right to limit or deny financial assistance at its sole discretion — read that sentence before you plan around the outcome.

CHRISTUS Santa Rosa – San Marcos — top tier at 300%

The system most Austin lists leave out. CHRISTUS Health is a nonprofit sponsored by the Sisters of Charity of the Incarnate Word and the Sisters of the Holy Family of Nazareth, and CHRISTUS Santa Rosa Hospital – San Marcos, at 1301 Wonder World Drive, is a participating hospital under its financial assistance policy. Its full charity care tier reaches gross family income at or below 300% of the federal poverty level — the most generous published threshold of the four. Between 300% and 401%, responsibility is capped at amounts generally billed. A separate hardship discount applies a 100% discount to any balance exceeding 10% of gross family income regardless of income tier. The asset test excludes your primary residence, primary vehicle, and retirement accounts. Applications are due within twelve months of the first post-discharge billing statement; CHRISTUS states it will not pursue an extraordinary collection action until 120 days after that statement, with at least 30 days’ written notice first. Phone: 800-756-7999.

This is where money is actually lost. Each system sets its own application window, and at least one of them makes late applications materially worse rather than simply void.

• Ascension Seton — on or before the 240th day after your first discharge bill.
• Baylor Scott & White — from the date of scheduling or service through the 365th day after the first billing statement.
• CHRISTUS — within twelve months of the first post-discharge billing statement.
• St. David’s — its published policy text did not state an application deadline we could verify; ask when you request the form.

One surgery generates bills from several businesses — the facility, the surgeon, anesthesia, pathology, radiology. A hospital financial assistance policy does not automatically reach the independent groups. This is why 501(r)(4) requires the policy to publish a list of which providers practising in the facility are covered and which are not, and the lists are narrower than people expect: Baylor Scott & White’s names three provider groups and then states that, except as listed, no other physicians are covered.

So the question to ask is not “does this hospital have financial assistance.” It is “which of the bills I am about to receive does this policy actually cover, and who do I apply to for the rest.” Ask for the covered-provider list by name.

1. 1
   Ask for three documents

   The financial assistance policy itself, the application form, and the plain-language summary. 501(r)(4) requires all three to be widely available free of charge, on a website and on paper. Ascension Seton and St. David’s publish theirs in ten or more languages.

2. 2
   Gather income documentation

   Expect to show income: W-2s, recent pay stubs, tax returns, bank statements, or proof of participation in a public benefits program, plus household size. Several systems also apply an asset test.

3. 3
   Ask about presumptive eligibility

   Ascension Seton, Baylor Scott & White and CHRISTUS all describe presumptive determinations — using credit reports or other public information to establish eligibility without a full application. It is worth asking whether you have already been screened.

4. 4
   File before the system's deadline, and before paying

   240 days at Seton, 365 at BSW, twelve months at CHRISTUS. Note the date of your first bill and work backwards from it.

5. 5
   If you're denied, ask about appeal

   Ascension Seton describes an appeals committee with a 14-day window; CHRISTUS allows a written appeal within 45 days. Ask what the appeal path is at the time you're denied, not later.