Patient Financial Assistance Program Summary
UC Davis Health strives to provide quality patient care and meet high standards for the communities we serve. This policy demonstrates UC Davis Health’s commitment to our mission and vision by helping to meet the needs of low income, uninsured and underinsured patients in our community.
The Financial Assistance Program applies to emergency or other medically necessary health care services provided and billed by UC Davis Health. Services that are separately billed by other/non-UC Davis Health providers are not eligible for consideration under the Financial Assistance Program.
Determination of Eligibility
Eligibility is determined based on review of a completed Financial Screening Form and supporting documents, including proof of income, assets and liabilities. Generally, patients with family income at or below 200% of the Federal Poverty Level will be eligible for a discount of 100%. Patients with family income between 201% and 350% of the Federal Poverty Level may be eligible for a partial discount based on income level.
If you receive financial assistance under our policy, you will not be charged more for emergency or other medically necessary care than the amount generally billed (AGB) to patients having Medicare coverage.
To view U.S. federal poverty guidelines used to determine financial eligibility, visit:
How to Obtain Copies of our Financial Assistance Program Policy and Application
You may obtain a copy of our Financial Assistance Policy and Application:
- On this page of the UC Davis Health website.
- In our Emergency Department, Financial Clearance Department (see address below), any UC Davis Health location where patient registration occurs, and in our Patient Billing Customer Service Office (see address below).
- To request documents by mail, contact the Customer Service Office at 916-734-9200 or 1-800-551-9411 (Monday through Friday, 8:30 a.m. to 4:00 p.m.).
The Financial Assistance Program Policy, the program application (called the "Patient Financial Information Form"), and a Plain Language Summary of the program are available in English, Spanish, Hmong, Chinese, Lao and Russian in the "Documents" section below on this page, or separately upon request.
How to Apply for our Financial Assistance Program
The Patient Financial Information Form is found below on this page, and may be hand-delivered or mailed, with all supporting documents, to:
Monday - Friday 8:30 a.m. to 4 p.m.
Financial Clearance Department
2315 Stockton Blvd, Suite 1P214
Sacramento, CA 95817
Patient Billing Customer Service Office
4900 Broadway, Suite 2600
Sacramento, CA 95820
UC Davis Health Patient Billing
Attn: FA Program
PO Box 168015
Sacramento, CA 95816-9979
Financial Assistance Program Documents
Patient Financial Information Form application (PDF)
Plain Language Summary (PDF)
Financial Assistance Policy (PDF)
Poverty Guidelines for Financial Eligibility
To view U.S. federal poverty guidelines used to determine financial eligibility for certain federal programs, visit: