HMH Financial Assistance
Speak with Us about Affordable Healthcare in Walker County
If you are in need of services at Huntsville Memorial Hospital and you
are without health care coverage or have financial challenges, please
print and complete a copy of the Texas Form 100.pdf and return the application
to the Huntsville Memorial Hospital Financial Department within 30 days
of your visit. Instructions for the application are below, and you may
contact the Huntsville Memorial Hospital Financial Department at (936)
firstname.lastname@example.org for additional information.
Financial Counseling hours: Monday -Thursday 8 a.m. to 5 p.m.; Closed Fridays
Financial Assistance Policy and Related Documents below:
Financial Assistance Application Instructions
- Write the usual amount of household expenses.
Proof of Income, Residency, and Identification
All applicants must provide PROOF of all of the following verification
- (2) Paycheck stubs -or- letter from employer verifying income
- Most recent income tax return
- Social Security award letter
- Food stamp /Medicaid/TANF letter of approval or denial
- Support letter (from person supporting the household)
- (2) Proofs of residency (phone/electric bill, rent receipt, etc.)
- Proof of identification - photo I.D.
- Copy of student loans, grants and/or scholarships
Additional information may be required to determine your eligibility, depending
upon the program for which you are applying.
Classification as Financially Indigent: To be eligible for charity care
as a financially indigent patient, a person's gross annual income
 shall be at or below 200 percent of the federal poverty guidelines
and have no alternative resources available. The hospital may consider
other financial assets and liabilities of the person when determining
Classification as Medically Indigent: A medically indigent patient is a
person whose medical or hospital bills after payment by third-party payers
exceed a specific percentage of the person's annual gross income as
set forth in this policy and who is unable to pay the remaining bill.