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) 293-4464 or 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

Monthly Expenses

  • Write the usual amount of household expenses.

Proof of Income, Residency, and Identification

All applicants must provide PROOF of all of the following verification documents:

  • (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.

Eligibility Determination

Classification as Financially Indigent: To be eligible for charity care as a financially indigent patient, a person's gross annual income [1] 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 eligibility.

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.