Financial Assistance

Financial Assistance Program

If you need help in paying your bill, Graham County Hospital does offer a Financial Assistance Program. You can request an Application for Financial Assistance from our Customer Service Department or Financial Assistance Application. We will evaluate your need for help once you complete and return the form to us.

How to Apply for Financial Assistance at Graham County Hospital

To apply for financial assistance, please follow these steps:

Step 1: Gather Required Documents

You will need to provide the following:

  1. Proof of Income
    Acceptable forms include recent pay stubs, Social Security statements, unemployment benefits, or other income documentation.
  2. Copy of Most Recent Bank Statement
    Include statements for:
    • Checking accounts
    • Any other financial accounts (e.g., savings, money market)
  3. Copy of Kansas Medicaid Denial Letter
    • Must be dated within the last 6 months
  4. Copy of Last Year’s Filed Federal Income Tax Return
    • Include all pages and schedules submitted
  5. Completed Graham County Hospital Financial Assistance Application
    • Ensure all sections are filled out and signed

Step 2: Submit Your Application

Bring all the completed documents in person to:

Billing Office

Graham County Hospital

304 West Prout

Hill City, KS. 67642

Financial Assistance Policy English Version (PDF) / Versión en español (PDF)

Financial Assistance Policy Plain Language Summary English Version (PDF) / Versión en español (PDF)

Financial Assistance Provider List English Version (PDF) / Versión en español (PDF)

Collections Policy English Version (PDF)