Carilion Clinic Financial Assistance: Free Care at 200% FPL + Sliding Scale Discounts to 300% FPL (2026 Guide)
Carilion Clinic is Western Virginia's largest health system, operating 7 hospitals across the region and affiliated with the Virginia Tech Carilion School of Medicine. Their financial assistance program provides 100% free care for patients at or below 200% FPL, sliding scale discounts for patients at 201-300% FPL, and a catastrophic medical expense provision. Both insured and uninsured patients are eligible to apply.
Jump to Section
Quick Eligibility Summary
Who Qualifies for Carilion Clinic Financial Assistance?
100% Free Care (Charity Care)
Patients with household income at or below 200% of the Federal Poverty Level qualify for complete charity care at any Carilion Clinic hospital. Your entire balance is written off. For reference, 200% FPL is approximately $31,920/year for a single person or $65,600/year for a family of four in 2026.
Sliding Scale Discounts (201-300% FPL)
Patients with household income between 201% and 300% FPL qualify for discounted care on a sliding scale. The higher your income within this range, the smaller the discount, but you still receive meaningful relief. For a single person, 300% FPL is approximately $47,880/year. A financial counselor can tell you your exact discount percentage.
Catastrophic Medical Expense Provision
Carilion Clinic also offers a catastrophic medical expense provision for patients whose medical bills are overwhelming relative to their financial situation. Even if your income exceeds 300% FPL, this provision may help if you face extremely large bills from a serious illness, extended hospital stay, or complex treatment. See the section below for details.
Catastrophic Medical Expense Provision (Key Insight)
Beyond standard income-based eligibility, Carilion Clinic recognizes that medical bills can be financially devastating even for patients with higher incomes. The catastrophic medical expense provision is designed for situations where the size of your bills is simply disproportionate to your ability to pay.
This is especially important in Western Virginia, where many communities face higher rates of chronic disease and the costs of long-term care can accumulate rapidly. Patients dealing with cancer treatment, heart surgery, extended ICU stays, or other major medical events should ask about this provision.
When to use this provision:
- Your income exceeds 300% FPL but your bills are $15,000+
- You had an extended hospital stay at Carilion Roanoke Memorial or another facility
- You are managing ongoing treatment costs for a chronic condition
- A job loss or financial hardship occurred after you received care
- Your insurance left you with a large balance after meeting your out-of-pocket maximum
- You have multiple Carilion bills accumulating from separate visits
Need Help with a Carilion Clinic Bill?
CareRoute can help you understand your options, draft appeal letters, and navigate the financial assistance application process. Our tools are designed to help patients advocate for themselves effectively.
Try Bill DefenseCarilion Clinic Hospitals
Carilion operates 7 hospitals across Western Virginia. All share the same financial assistance policy. Many of these facilities serve communities with few or no alternatives for hospital care, making financial assistance access especially critical.
Carilion Roanoke Memorial Hospital
Roanoke, VA (Flagship)
Level I trauma center, 700+ beds. The region's largest hospital and academic medical center.
Carilion New River Valley Medical Center
Christiansburg, VA
Full-service hospital serving the New River Valley, including Blacksburg and Radford.
Carilion Giles Community Hospital
Pearisburg, VA
Rural community hospital serving Giles County. Limited alternatives in the area.
Carilion Tazewell Community Hospital
Tazewell, VA
Serves Tazewell County in Southwest Virginia's coal country. Critical access point for the community.
Carilion Stonewall Jackson Hospital
Lexington, VA
Community hospital serving the Lexington and Rockbridge County area.
Carilion Franklin Memorial Hospital
Rocky Mount, VA
Serves Franklin County. A vital rural hospital with limited nearby alternatives.
Carilion Rockbridge Community Hospital
Lexington, VA
Complements Stonewall Jackson Hospital in serving the Rockbridge County area.
All seven Carilion hospitals follow the same financial assistance policy. You can apply at any location and your application will be evaluated consistently across the system.
Virginia Tech Carilion: Separate Billing (Important)
Carilion Clinic is affiliated with the Virginia Tech Carilion (VTC) School of Medicine. However, VTC physicians may bill separately from Carilion hospital services. This means you could receive two different bills for the same visit: one from Carilion for hospital/facility charges and another from VTC physicians for professional services.
What this means for financial assistance:
- Carilion's financial assistance covers hospital and facility charges
- VTC physician charges may require a separate financial assistance application
- Ask your Carilion financial counselor about handling VTC physician bills
- Request an itemized bill to identify which charges are hospital vs. physician
- Apply for financial assistance with both entities if you receive separate bills
Tip: When you call Patient Financial Services, specifically ask whether any of your charges are from VTC physicians and whether those charges are covered by the same financial assistance program. Getting clarity upfront saves time and frustration.
Virginia Medical Debt Protection Act (July 2026)
Virginia is implementing the Medical Debt Protection Act, taking effect in July 2026. This law introduces significant new protections for patients dealing with medical debt across the state, including those treated at Carilion Clinic facilities.
Key protections include:
- New limits on medical debt collections practices
- Enhanced billing transparency requirements for hospitals
- Stronger patient rights when disputing medical charges
- Additional safeguards against aggressive collection tactics
These protections work alongside Carilion's financial assistance program. Even if you do not qualify for charity care, the new law gives you additional tools to manage medical debt. Review our Virginia rights guide for the full details.
Virginia Medicaid Expansion and Carilion
Virginia expanded Medicaid in 2019, extending coverage to adults with income up to 138% of the Federal Poverty Level. This is especially relevant for patients in Western Virginia, where many residents qualify but have not yet enrolled. Carilion Clinic counselors actively help patients with Medicaid enrollment.
Why this matters:
- If you qualify for Medicaid (up to 138% FPL), it covers most hospital and physician services with little or no cost to you
- Medicaid can be applied retroactively up to 3 months before your application date
- Carilion financial counselors can help you apply for Medicaid during your financial assistance consultation
- Getting Medicaid covers future care, not just the current bill, which provides ongoing protection
Important: Many Western Virginia residents qualify for Medicaid but are not enrolled. If your income is below 138% FPL (approximately $22,100/year for a single person), ask your Carilion counselor about Medicaid before applying for charity care. Medicaid provides broader and longer-lasting coverage.
Serving Appalachian Communities
Western Virginia is one of the most economically challenged regions in the state. Many of the communities served by Carilion's smaller hospitals (Giles, Tazewell, Franklin, and Rockbridge) have higher poverty rates and fewer healthcare alternatives. Understanding this context is important for patients navigating medical bills.
Key considerations for Appalachian patients:
- Higher chronic disease rates: Southwest Virginia communities face elevated rates of diabetes, heart disease, and respiratory conditions. Long-term treatment costs can accumulate quickly, making the catastrophic expense provision especially valuable.
- Limited alternatives: For patients near Carilion Giles, Tazewell, or Franklin, the next closest hospital may be 45 minutes or more away. You are not choosing to use an expensive hospital. This is your community hospital.
- Many qualify but do not apply: A significant number of Carilion patients in these communities are eligible for free care or discounts but never apply. If your household income is below $65,600/year for a family of four, you likely qualify for at least partial assistance.
West Virginia Border Patients: Additional Protections
Some Carilion patients live across the state line in West Virginia, particularly those near Carilion Giles and Carilion Tazewell. If you are a WV resident, you qualify for Carilion's financial assistance program and may also benefit from West Virginia's strong medical debt protections.
West Virginia advantages for medical debt:
- Enhanced homestead exemption: WV offers a $12,500 homestead exemption for catastrophic medical debt, compared to the standard $5,000. This protects more of your assets.
- No hospital liens: West Virginia prohibits hospitals from placing liens on your property for unpaid medical bills. This is a significant protection not available in all states.
- Dual protections: You can apply for Carilion's financial assistance program while also leveraging WV's debtor protections if collections occur.
How to Apply for Carilion Clinic Financial Assistance
Contact Patient Financial Services
Call Carilion Patient Financial Services at (540) 981-7000 or visit the financial counseling office at any Carilion hospital. Counselors can explain your options, help you understand your bills, and check whether you qualify for Virginia Medicaid.
Gather Your Documents
You will typically need: proof of income (recent pay stubs, tax returns, or a written statement of no income), proof of household size, a government-issued ID, and your Carilion medical bills or account numbers. Your counselor will confirm exactly what is required.
Complete the Application
Fill out the Carilion Clinic financial assistance application form. Your financial counselor can assist you with the process. If you are uninsured, ask about Virginia Medicaid enrollment at the same time, as Carilion counselors help with Medicaid applications.
Check for VTC Physician Bills
Ask whether any of your charges are from Virginia Tech Carilion physicians who bill separately. If so, you may need to apply for financial assistance with VTC as well. Your counselor can guide you through this process.
Submit and Follow Up
Submit your completed application with all documentation to Patient Financial Services. Keep copies of everything you submit. Follow up within 2 weeks if you have not received confirmation of receipt. If approved, the charity care or discount will be applied to your eligible bills retroactively.
If Your Application Is Denied
If Carilion Clinic denies your financial assistance application, you still have options:
- 1.Request a written explanation of the denial reason. Understanding why helps you address the issue directly.
- 2.Appeal the decision. Ask Patient Financial Services about the appeal process. Provide additional documentation that addresses the specific denial reason.
- 3.Invoke the catastrophic expense provision. If you were denied based on income alone, explain why your bills are disproportionate to your ability to pay. Document all your financial obligations.
- 4.Request a payment plan. Even without charity care approval, Carilion may offer interest-free or reduced payment plans to make your balance manageable.
- 5.Know your state rights. As a nonprofit, tax-exempt organization, Carilion must comply with IRS Section 501(r) requirements. After July 2026, the Virginia Medical Debt Protection Act provides additional safeguards. Contact the Virginia Attorney General if you believe your rights were violated.
- 6.WV residents: Remember that West Virginia prohibits hospital liens and offers enhanced homestead protections. These apply regardless of whether Carilion approves financial assistance.
Denied? Let Us Help You Appeal
CareRoute can help you draft an appeal letter, identify the right provisions to cite (including the catastrophic expense provision), and build a compelling case for why your application should be reconsidered.
Start Your Appeal with Bill DefenseContact Information
Frequently Asked Questions
Who qualifies for free care at Carilion Clinic?
Patients with household income at or below 200% of the Federal Poverty Level qualify for 100% free charity care at all Carilion Clinic hospitals. This is approximately $31,920/year for a single person or $65,600/year for a family of four in 2026. Both insured and uninsured patients can qualify.
What discounts are available between 201% and 300% FPL?
Carilion offers sliding scale discounts for patients in this income range. The exact discount percentage depends on where your income falls within the range. A financial counselor can calculate your specific discount. For a family of four, 300% FPL is approximately $98,400/year.
Does Carilion have a catastrophic medical expense provision?
Yes. Carilion Clinic offers assistance for patients whose medical bills are overwhelming relative to their financial resources, even if their income exceeds 300% FPL. This is especially important for patients with major surgeries, extended hospital stays, or ongoing treatment for chronic conditions.
Do VTC physicians bill separately from Carilion?
Virginia Tech Carilion physicians may bill separately from Carilion hospital services. This means you could receive two bills for the same visit. You may need to apply for financial assistance with both Carilion (for hospital charges) and VTC (for physician charges). Ask your financial counselor for guidance.
Do I need to be uninsured to qualify?
No. Both insured and uninsured patients can apply for Carilion Clinic financial assistance. Insured patients may receive help with out-of-pocket costs including deductibles, copays, and coinsurance. Uninsured patients should also ask about Virginia Medicaid enrollment for broader coverage.
What is the Virginia Medical Debt Protection Act?
Taking effect in July 2026, this Virginia law introduces new limits on medical debt collections, enhanced billing transparency requirements, and stronger patient rights when disputing medical charges. Carilion patients should be aware of these new protections, which apply in addition to the hospital's financial assistance program.
Can patients from West Virginia apply for Carilion financial assistance?
Yes. Carilion serves patients regardless of state of residence. WV patients should also know that West Virginia offers an enhanced $12,500 homestead exemption for catastrophic medical debt and prohibits hospital liens on your property. These protections apply in addition to any Carilion financial assistance you receive.
Which hospitals are part of Carilion Clinic?
Carilion Clinic operates 7 hospitals: Carilion Roanoke Memorial (flagship, Level I trauma, 700+ beds), Carilion New River Valley Medical Center, Carilion Giles Community Hospital, Carilion Tazewell Community Hospital, Carilion Stonewall Jackson Hospital, Carilion Franklin Memorial Hospital, and Carilion Rockbridge Community Hospital. All follow the same financial assistance policy.
Does Carilion help with Medicaid enrollment?
Yes. Carilion financial counselors help patients apply for Virginia Medicaid. Since Virginia expanded Medicaid in 2019 to cover adults up to 138% FPL, many Western Virginia residents qualify. Medicaid can be applied retroactively up to 3 months and covers future care as well, making it a valuable option alongside financial assistance.
Is Carilion Clinic a nonprofit hospital?
Yes. Carilion Clinic is a nonprofit health system. As a 501(c)(3) tax-exempt organization, Carilion is required by IRS Section 501(r) to maintain a financial assistance policy, publicize it widely, and limit charges for assistance-eligible patients. If you believe Carilion is not meeting these obligations, you can file a complaint with the Virginia Attorney General or the IRS.
Related Guides
Your state provides additional protections for medical bills. Nearby health systems may also have financial assistance programs if you receive care outside the Carilion network.
Last updated: May 2026. Information is based on publicly available Carilion Clinic financial assistance policies. Always confirm current eligibility requirements directly with Carilion Patient Financial Services at (540) 981-7000.