Financial Assistance Programs

The OHSU Financial and Medicaid Services office provides screening, intake or referral, and follow-up service for those uninsured and under-insured OHSU patients who might qualify for state and/or federal medical assistance programs. We can assist you with the application process, if appropriate.

You can also apply for the Oregon Health Plan directly by calling the Oregon Health Plan Application Center at 800-699-9075.

For more information, please call us at 503-494-8505 Monday through Friday, 8:30 a.m. to 4:30 p.m. Our office is located at Sam Jackson Hall, room 1306 on OHSU's Marquam Hill campus.

If you have questions about an OHSU bill you have received, please contact OHSU billing customer service at 866-617-6855 or

  • Washington Health Plan Finder - This is Washington’s health benefit exchange where Washingtonians can learn about and apply for health care coverage.
  • TANF - Temporary Assistance for Needy Families provides assistance and work opportunities to low income families with children while they strive to become self-sufficient. Washington Connection – The Washington Connection website, a link to services for senior, people with disabilities and caregivers.
  • SSA - The Social Security Administration (SSA) website provides information about retirement, survivors and disability insurance benefits, and supplemental security income. The site also provides wage reporting information for employers.
  • SHIBA - A statewide network of trained volunteers who educate, assist, and serve as advocates for people with Medicare. SHIBA volunteers help people with Medicare understand their rights and options in health insurance, so that they can make informed choices.

Financial assistance policy

Request for financial assistance may be made at any point before, during, or after the provision of care. We offer an application process for determining your initial interest in and qualification for financial assistance.

A patient or responsible party choosing not to apply for financial assistance will not automatically be considered for assistance.

Financial assistance is specific to each patient admission. Financial assistance related to outpatient services will require periodic screening for changes in eligibility. Financial assistance is granted for medically necessary procedures only.

We use the DMAP priority list of medical services as a guideline for determination of covered services.


Financial assistance is secondary to all other financial resources available to the patient including insurance, government programs, third-party liability, and liquid assets. We assist persons with financial need by waiving all or part of the charges for services provided by OHSU.


Important: The statement of financial resources is for patients who have already been registered and screened for potential financial assistance. If you have not spoken to registration and been screened, please call 503-494-8505 prior to completing these forms.

Required information

Print legibly in ink.

If your discount is approved, it is not a guarantee that services will be provided.

Not all services are eligible for discounting. It is the patient's responsibility to verify, in advance, whether a requested service is eligible to be discounted. To verify, please call the doctor’s office, as registration is not able to provide this information. Excluded services include (but are not limited to):

  • Services  considered non-covered or not medically necessary by the Oregon Department of  Medical Assistance Program (DMAP)/Oregon Health Plan (OHP);
  • Services  provided to a patient who chooses to come to OHSU/OHSU Faculty Practice out of  their insurance plan network;
  • Co-payments from  insurance plans;
  • Patients who are  not responsible for the bill (i.e. Community/Agency funded support);
  • Patients who  have insurance but choose not to utilize coverage;
  • Elective cosmetic surgery procedures;
  • Other elective  procedures (examples include but are not limited to infertility services,  andrology, transplants, sterilization, (with the exception of in-house  postpartum tubal ligation patients), reversal of sterilization, circumcision,  LASIK eye surgery, routine vision exam);
  • Take home prescriptions or supplies issues by the pharmacy;
  • Medical  Equipment;
  • Access Assured membership fees.

You will receive a letter in the mail letting you know if your application has been approved.

Financial Assistance is secondary to all other financial resources.  If you appear eligible for Medicaid you will be required to apply.

There are six categories of information that you will need to provide:  

Family information

  • Please list yourself and immediate family unit members who are related to you by birth, marriage or adoption.
  • A child is considered a dependent if they are under 18, unless they are 18 and still attending high school.
  • A family unit is one of the following:

a) A legally married couple, or registered domestic partners, living together or apart. If an absent spouse contributes to the family income, include them on the application.
b) An unmarried couple with one or more children in common, if one of the common children is the patient.
c) A sponsored non-citizen, their sponsor and the sponsor's family. The sponsor is considered the financially responsible party. 

  • Unmarried couples living together with no common children are not considered a family unit. The family unit is one adult and their respective children.

Employment information

  • Include gross income for the last three full calendar months.
  • Income is counted in the month it is received, not the month it was earned.
  • If you were without income at any time during the requested months, complete the affidavit of no income 
  • If you are self-employed, complete the self employment income worksheet.
  • Do not include income earned by children under 18, or if 18 and still in high school.
  • Do not include income from student loans, scholarships or grants.

Other income information

  • Include unearned income of dependent children. For example, social security income.
  • Include income from interest or dividends if you received payments during the requested months.

Total assets information

  • List the current balance of all checking and savings accounts.
  • List the "cash value" of life insurance policies, and certificates of deposit (CD).
  • For net value of real estate or other property, subtract the amount still owing from the current market value. For real estate market value, use a recent appraisal or property tax statement.
  • For vehicles, use the blue book value.

Residence information

  • Applicants must be established residents of the state of Oregon with the intent to remain here indefinitely.
  • For services  occurring April 1, 2016 and later, financial assistance has expanded to include  the following bordering counties in the state of Washington: Benton, Clark,  Columbia, Cowlitz, Klickitat, Lewis, Pacific, Skamania, Wahkiakum, Walla Walla,  and Yakima with the intent to remain indefinitely. 
  • Include the physical address of your primary residence. Do not use a mailing address or P.O. Box.

Verification information checklist

The following verification checklist includes documents that will be required if they are applicable to your situation. If you do not include a required document, you will be contacted by a financial specialist representative by phone or mail.  Please be aware that when you send these documents, originals will not be returned.

Residency verification

  • Proof of residency. Accepted documents include utility bills in your name, rent or mortgage receipts for your residence, or a copy of your driver's license or Identification card. Additional proof of residency may be requested  depending on individual circumstances.

Income verification - include any/all of the following that apply to your situation

  • Paycheck stubs for the last three fully completed calendar  months.
  • Copies of income tax returns for most recent year filed, including any  applicable schedules (such as schedule C for self-employment income)
  • Social security, veterans, pension award letter or equivalent
  • Claims determination from the State Employment Division
  • Statement of child support and/or alimony.
  • Self - employment income worksheet or include your profit and loss statement for the last three fully completed calendar  months.
  • Verification document(s) for any other income source listed on your application,
  • including income from interest or dividends.
  • Affidavit of no income for any periods with no income

Asset verification - include any/all of the following that apply to your situation

  • Bank/credit union statements; checking and savings accounts.
  • Most current cash deposit (CD), stocks, bonds or investment account statements.
  • Financial statement confirming your business equity.
  • Documentation confirming any miscellaneous assets listed.

Return completed application and all required supporting documentation to:

Oregon Health & Sciences University
Ambulatory Registration Services, RPB07
3181 S.W. Sam Jackson Park Road
Portland, OR 97239-3098
Phone: 503-494-8551
Fax: 503-418-2377