Morrow County Health District (MCHD) is committed to providing financial assistance to people who have health care needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care. Financial assistance is based on the applicant’s financial situation and if it is within MCHD’s guidelines for eligibility.
• Financial Assistance Guidelines
- Financial assistance is only offered for medically necessary care billed by MHCD. The care must be provided by an MCHD facility or provider (see Attachment 2 to the FAP). Medically necessary care is services or items that are reasonable and necessary for the diagnosis or treatment of an illness or injury.
- Elective procedures and non-medically necessary services are not covered under the program.
- Eligibility is determined after MHCD reviews information regarding the applicant’s financial situation.
- Patients must use all other payor resources, including governmental payors such as Medicaid, prior to applying for financial assistance.
• Required Documentation to apply for financial assistance: To be complete, the Financial Assistance application must be completed and signed, and the following documentation must be submitted:
- Copies of previous year’s Federal Tax Return (Form 1040 or equivalent). Please include all schedules.
• Proof of current income (if any), for example: the last 3 months pay stubs, pension and retirement benefits, Social Security benefits, unemployment compensation, Workers Compensation, Veteran’s benefits, etc.
- Proof of insurance or that an application for coverage has been submitted.
- Copy of driver’s license, state issued ID card or other photo ID.
If an individual has no source of income, a letter of hardship and/or a letter of support will be accepted. Other documents may be requested by MCHD to validate information on the application.
- Financial assistance will be granted if an individual’s annual gross income meets certain criteria. Annual gross income includes the annual income of the person and their spouse or parents if applicable.
- Patients whose family income is at or below 150% of the Federal Poverty Level (FPL) are eligible to receive full financial assistance (free care).
- Patients whose family income is above 150% but less than 300% of the FPL are eligible to receive services that are discounted. The discount amount is based on a
- Services will be discounted to an amount no greater that the amounts generally received by MCHD for Medicare patients.
What If I Have Questions or Need Help Filling Out the Application?
If you have questions or need help filling out the Financial Assistance Application, you can contact the MCHD Business Office:
- Phone: (541) 676-9133 or 1-800-737-4113
- In Person: MCHD Business Office, 564 E Pioneer Drive, Heppner OR 97836
Download Applications Here:
More information can be obtained from the Business Office or Receptionist at the hospital or clinic, or by calling 1-800-737-4113 or 541-676-9133. Forms and information are also available on this web site.
Drop off Applications at: Pioneer Memorial Hospital, Home Health & Hospice, Pioneer Memorial Clinic, Irrigon Medical Clinic, or Ione Community Clinic
|Mail Applications to:||Drop off Applications at:|
P.O. BOX 9
Heppner, OR 97836
|Pioneer Memorial Hospital
Pioneer Memorial Home Health & Hospice
Pioneer Memorial Clinic
Ione Community Clinic
Irrigon Medical Clinic
Plain Language Summary
Financial Assistance Application
Financial Assistance Checklist
Billing and Collection Policy
SpanishSpanish Financial Assistance Policy
Spanish Plain Language Summary
Spanish Financial Assistance Application
Spanish Financial Assistance Checklist
Spanish Billing and Collection Policy