FINANCIAL ASSISTANCE

How It Works 

JCHC is able to provide eligible patients with discounted medical care through its Financial Assistance Program.  In order to qualify, a patient/patient’s family must be current Iowa resident(s) and must fall within the Federal Poverty guideline requirements.  Based on family size and where the household income lies, a discount of 20% - 100% could be applied to Hospital accounts.  

 Family Size  100% Charity 80% Charity 60% Charity  40% Charity 20% Charity 0% Charity
 1  12,140 15,175 18,210 21,245 24,280 >24,280
 2  16,460 20,575 24,690 28,805 32,920 >32,920
 3 20,780 25,975 31,170 36,365 41,560 >41,560
 4 25,100 31,375 37,650 43,925 50,200 >50,200
 5 29,420 36,775 44,130 51,485 58,840 >58,840
 6 33,740 42,175 50,610, 59,045 67,480 >67,480
 7 38,060 47,575 57,090 66,605 76,120 >76,120
 8 42,380 52,975 63,570 74,165 84,760 >84,760

 *For family units over eight (8), add $4,320 for each additional member.


Once a patient qualifies for JCHC’s Financial Assistance, the application and approval percentage will be good for (6) months, at which time the approval will expire and a patient would need to resubmit an application to see if the financial situation has changed.

Please Note: Services performed by non-JCHC consultants (Specialty Clinics), Radiology Consultants of Iowa, Collaborative Lab Services, Midwest Ambulance, or any other third-party affiliate not billed through JCHC will not be considered for Financial Assistance.
Additionally, previously discounted Hospital services, charges, and/or accounts will not receive additional discounting through Financial Assistance.

Requirements for Financial Assistance

In addition to meeting Federal Poverty guidelines and being a current Iowa resident, the following items are required:

  1. Completed and signed application.
  2. Proof of Income (current source from any of the following: pay stubs, tax return/W-2, self-employment worksheet, bank statement indicating monthly deposit, etc.).
  3. Documentation that you have also applied for assistance with the Iowa Department of Human Services (DHS).  If you have not yet applied, please click here to create an account and start the application, or call (641) 472-5011. This process can take up to 45 days, but do not delay getting the other documentation in because you are waiting for DHS.  Applications can also be submitted at the Jefferson County DHS office, or at the Hospital.

Financial Assistance Information

Financial Assistance Application

Please return the completed application and required documentation to:

1. Mailing Address:
Attn: Financial Counselor
2000 S. Main
Fairfield, IA 52556

2. Fax: (641) 469-4216, Attn: Financial Counselor

3. Email: billing@jeffersoncountyhealthcenter.org, Attn: Financial Counselor

4. Drop off in person! We are located behind the front Registration desks through the main (east) entrance to the Hospital.

Questions? Please feel free to call our Financial Counselor at (641) 469-4311 or our Billing Office at (641) 469-4301.

Additional Online Resources