Financial Assistance Application and Indigent Care Policy


Charity and Indigent Care Policy and Summary

As of September 1, 1994, Washington County Regional Medical Center has offered programs for Indigent and Charity Care. Those who may qualify would fall below the 125% Federal Poverty line for indigent and 150% for Charity Care.

No individual shall be denied medically necessary services (those services Georgia Medicaid would pay) based solely upon the lack of ability to pay for services. All policies shall be implemented in accordance with State and Federal rules and regulations. Individuals shall be granted impartial consideration regardless of race, creed, sex, national origin, handicap, or age. Those eligible for Indigent and Charity Care cannot be charged more than the amounts generally billed for emergency or other medically necessary care.

To apply, we must have the total number of individuals residing in your household as well as the household income for the last 12 months. Household income consist of any income that is provided by individuals other than household members to assist with expenses, food stamps, wages, child support, alimony, and self-employment income.

Applicants may be required to apply for Medicaid through the Dept. of Family and Children Services and/or the Social Security Administration. Verification of this process will be required and can be obtained from the department of Family and Children services by accessing their website at or the SSA’s website at www.SSA.GOV.

Applications are available for download here: 

Applications are available in English, a translation line is available if necessary.  

They can also be received or submitted via fax (478-240-2016), U.S. Mail (ATTN: Financial Counseling), or in person at 610 Sparta Rd., Sandersville, GA 31082.

Please contact our Financial Counseling office at 478-240-2168 for additional assistance and to request a copy of the application.

Please view our Financial Assistance Application and Charity and  Indigent Care Policy: