Financial Assistance (FAP)

The CCP is available for patients who do not have major medical insurance, Medicare, Medicaid, or other third party payment services.

This temporary assistance includes In-Patient and Out-Patient services at Palacios Community Medical Center. Our Charity Care Program does not include private physician charges, tests performed by other facilities, or care provided at other hospitals.

Applicant must provide:

• Completed Indigent/Charity Application for each person applying.
• Proof of all household income (wages, self-employment, child support, SSI, Social Security and retirement benefits, cash contributions, unemployment benefits, workman’s comp, etc.) for all household members
• Current income tax return (forms 1040) and all W-2’s
• Valid Matagorda County ID or DL (mandatory)
• Social Security Card
• Verification of any assistance received such as Food Stamps, Medicaid &/or TANF
• Verification of any pending SSI or Social Security Administration Applications
• Copy of vehicle titles and/or verification of amount owed for all vehicles listed for all household members
• Current bank statements for all bank accounts for all household members
• Current electric, gas or water bill for residence

Processing time for a Charity Care application is 14 days from the date a completed application is received. (A completed application is considered as an application with all required information).

In the event of non-payment please refer to our collection policy available here.

Our program covers those who might be Financially Indigent or Medically Indigent and eligibility criteria varies. For more information or to request assistance please click on Charity Policy Link below to learn about the requirements to our Financial Assistance Policy.

Charity Policy 2019 PCMC