Financial Assistance

If you’re uninsured or have trouble paying for healthcare, Ascension may be able to help through our financial partnerships and resources.

Ascension St. Vincent’s HOPE (Health Outreach Patient Eligibility) program aims to improve access to medical care for all individuals. Our Financial Counselors work diligently to enroll qualified applicants into financial assistance programs.

Our program offers assistance for:

  • Florida and Georgia Medicaid applications
  • HOPE applications
  • Financial counseling and payment arrangements
  • Finding medical resources
  • Other state and federally funded assistance programs

HOPE Checklist

  • To help the application process move along, applicants are encouraged to be prepared to answer questions regarding household members and employment/income information.
  • You must apply for and comply with the application process for any available local, state, or federally funded program for which you may qualify. Failure to do so will result in a denial of your application.
  • You are responsible for all medical service charges until your application for financial assistance is approved.
  • Approval is subject to the assurance that you will apply for and assign to this facility any benefits available from insurance, liability insurance (PIP/Bodily Injury), Medicare, Medicaid, or public assistance as a result of our service provided to you. All other funding sources not limited to those listed above and including settlement funds take precedence to financial assistance.
  • Additional information and/or documentation may be required to complete your application. All information is subject to verification. Providing false information may result in a DENIAL of any type of financial assistance.

Required Documents

Please have the following items with you when you apply:

  • Photo ID
  • Copy of Social Security Card
  • Previous year Income Tax Return (not 1099 or W2) OR Verification of Non Filing (visit www.irs.gov/form 4506-T for instructions)
  • If employed, the last 3 months of pay stubs
  • If unemployed and receiving no income Affidavit of Support with copy of provider’s photo ID
  • Social Security Disability Letter of Benefits/Social Security
  • Retirement Letter of Benefits/Pension or Retirement Letter of Benefits/Child support/Unemployment Compensation Letter of Benefits
  • If you are homeless, a Homeless Attestation Form
  • If you are Self-Employed, a current year-to-date Profit & Loss statement. If you were self-employed in the previous year, Schedule C of the previous year's tax returns

Please send your completed HOPE applications to one of the following locations:

Ascension St. Vincent's Riverside
Attn: HOPE Office
1 Shircliff Way
Jacksonville, FL 32204

Ascension St. Vincent's Southside
Attn: HOPE Office
4201 Belfort Road
Jacksonville, FL 32216

Ascension St. Vincent's Clay
Attn: HOPE Office
1670 St. Vincent's Way
Jacksonville, FL 32068

You may also fax your HOPE application to 904-308-5910. Our phone number is 904-308-1956.

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