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Dominican Hospital — Financial Assistance & Charity Care
Santa Cruz, Santa Cruz County, CA
Under California law (the Hospital Fair Pricing Act), Dominican Hospital must offer free or discounted care to patients who can't afford their bills. Here's who qualifies and how to apply — you can apply even if your bill already went to collections.
Do you qualify for FREE care?
Dominican Hospital provides free (charity) care to patients at or below 250% of the Federal Poverty Level. If your yearly household income is at or below the amount for your household size, you likely qualify for 100% free care:
| Household size | Yearly income at or below | You likely qualify for |
|---|---|---|
| 1 person | $39,900/yr | 100% free care |
| 2 people | $54,100/yr | 100% free care |
| 3 people | $68,300/yr | 100% free care |
| 4 people | $82,500/yr | 100% free care |
| 5 people | $96,700/yr | 100% free care |
| 6 people | $110,900/yr | 100% free care |
| 7 people | $125,100/yr | 100% free care |
| 8 people | $139,300/yr | 100% free care |
Discounted care
Patients up to 500% of the Federal Poverty Level qualify for discounted care — you'd owe no more than the amount generally billed to insured patients:
| Household size | Yearly income at or below | You likely qualify for |
|---|---|---|
| 1 person | $79,800/yr | discounted care |
| 2 people | $108,200/yr | discounted care |
| 3 people | $136,600/yr | discounted care |
| 4 people | $165,000/yr | discounted care |
| 5 people | $193,400/yr | discounted care |
| 6 people | $221,800/yr | discounted care |
| 7 people | $250,200/yr | discounted care |
| 8 people | $278,600/yr | discounted care |
What you'll need to apply
- Income tax returns OR recent pay stubs (documentation for eligibility limited to these)
- Documentation of Essential Living Expenses (only if requesting an extended payment plan)
- Assets documentation may be accepted but shall NOT be required
- Base national FAP also lists: bank/checking account statements plus at least one income-verification document (federal tax return, Form W-2, current paystubs, or signed letter of support)
How to apply
📞 (831) 462-7703When you call, say: “I'd like to apply for financial assistance (charity care) for a hospital bill. Can you send me the application and tell me which documents I need?”
Based on this hospital's policy effective 07/02/2025.
Not sure if you qualify?
Answer 3 quick questions and get a personalized plan plus a ready-to-send request letter — free, in your language.
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