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GRMC's Financial Assistance Purpose and Policy

Purpose: The purpose of Grinnell Regional Medical Center and its affiliated clinic’s financial assistance/charity care policy is to protect qualifying individuals from financial hardship from unplanned medical bills. In addition, it aims to provide simplified guidelines for the determination of eligibility that are not overly burdensome and can be accomplished in a timely manner.

Policy: A financial assistance write-off may be provided for medically necessary services available at Grinnell Regional Medical Center and its affiliate providers. Financial assistance does not cover Hospitality care, elective surgical procedures, or services that are not billed by Grinnell Regional Medical Center. The financial assistance program also does not cover services already reduced by a sliding fee schedule. The hospital, in coordination with the patient’s physician, reserves the right to determine the medical necessity of health services.

All patients without regard to race, color, gender, age, handicap, religion, national origin, political belief or payer source are eligible to apply for and will receive financial assistance as long as they meet the guidelines outlined in this policy.

Notification of the financial assistance program will be posted at the admission desk by the emergency room and the patient accounting office. Applications will be made available at these locations and online at

Eligibility for financial assistance will be based on the income guidelines used by the U.S. Department of Health and Human Services Poverty Guidelines, which are updated annually.  These guidelines take into account family size and determine a 100 percent of poverty level amount. The applicant’s income is divided by the 100 % poverty level amount to come up with the percent of poverty level. Discounts are allowed according to where the applicant’s income falls on the scale below.

    150%  200%  250%  300%  350%  Above
 Discount  90%  80%  60%  40%  20%  0%

Income includes “other resources” in excess of $2,000 per family member. Resources are defined as all liquid assets, including cash in the bank and on hand, readily marketable investments, and any other assets that may be readily converted into cash. The primary residence and one vehicle per adult in the household are specifically excluded from this definition of resources. If a patient has no insurance, the financial assistance discount will be applied after an uninsured discount is applied. 

Patients or their guarantors who are unable to document their income or identification will be considered on a case by case basis with a maximum charity reduction of 40 percent.

Financial Assistance applications must be accompanied by:

  1. Most recent federal and state tax returns
  2. W-2 Forms for those returns
  3. Most recent bank statements
  4. List of other savings (e.g. CD’s, marketable securities)

Individuals who are claimed on another’s tax return will also need to provide a copy of that return so that the income from that return can be considered along with the individual’s own income. For purposes of determining the Federal Poverty amount, the family members will be considered the same number as the number of exemptions on the return(s). 

Liability claims (i.e., Motor Vehicle Accident Insurance, Workman’s Compensation Insurance, or any other Third Party Liability Payor) must have written confirmation that the balance due is the patient’s responsibility to pay for financial assistance to be applicable.

These are general criteria for determining the amount of financial assistance that will be granted by Grinnell Regional Medical Center. The Financial Assistance Committee reserves the right to deviate from the above criteria in unique situations.

Financial Assistance Application