Financial Assistance Program Notice
Mainelaw requires that financial assistance be provided toMaineresidents with income less than 150% of the Federal Poverty Level. Mercy Health System of Maine provides financial assistance toMaineresidents based on the following guidelines:
- Family income 200% or less of the Federal Poverty Level will receive 100% financial assistance
- Family income greater than 201% but less than or equal to 250% of the Federal Poverty Level will receive 50% financial assistance
| Family Size | 2013 Povery Level & DHS Guidelines |
200% Poverty Level: MHSM 100% Financial Assistance |
250% Poverty Level: MHSM 50% Financial Assistance |
| 1 | $11,490 | Up to $22,980 | $22,981 – $28,725 |
| 2 | $15,510 | Up to $31,020 | $31,021 – $38,725 |
| 3 | $19.530 | Up to $39,060 | $39,061 – $48,825 |
| 4 | $23,550 | Up to $47,100 | $47,101 – $58,875 |
| 5 | $27,570 | Up to $55,140 | $55,141 – $68,925 |
| 6 | $31,590 | Up to $63,180 | $63,181 – $78,975 |
| 7 | $35,610 | Up to $71,220 | $71,221 – $89,025 |
| 8 | $39,630 | Up to $79,260 | $79,261 – $99,075 |
| Each Additional Person | $4,020 | $8,040 | $10,050 |
- Uninsured patients with family income greater than 250% of the Federal Poverty Level will receive 20% discount from charge
If you believe you might be eligible for financial assistance contact a Financial Counselor at 207-553-6209 or toll free within Maine at 1-800-293-6583, extension 6209. Or, you may visit our Financial Assistance offices at our State Street Hospital located at 144 State Street Portland, ME
Financial Assistance is provided only for services that are medically necessary.
The Financial Counselor will ask for information about your income, health insurance, or other supplemental income, such as government subsidy.
If it has been determined that you do not qualify for financial assistance, you may ask for a fair hearing. The Financial Counselor will provide you instructions on how to apply for a fair hearing.



