What is Cook Children's hardship provision?

Families whose out-of-pocket medical costs exceed 5% of their annual income may qualify for additional discounts that cap their costs at 5% to 20% of their income, depending on their FPL percentage. This protects families at any income level from catastrophic medical bills.

How do I apply for Cook Children's financial assistance?

Complete the financial evaluation form and submit it through the MyCookChildren's patient portal, by email to CBOFinancialCounselor@cookchildrens.org, or by mail to Financial Counseling, 801 7th Ave., Fort Worth, TX 76104. Applications are available in English and Spanish at cookchildrens.org/financial-assistance.

How long do I have to apply for Cook Children's charity care?

Under IRS Section 501(r), nonprofit hospitals like Cook Children's must accept financial assistance applications for 240 days from the first billing statement. Applications submitted within this window must be considered, even if the account has already been sent to collections.

Which Cook Children's locations offer financial assistance?

Financial assistance applies to all Cook Children's facilities, including Cook Children's Medical Center in Fort Worth, Cook Children's Medical Center Prosper, specialty clinics, and other locations across the DFW metroplex. Financial counselors are available at Patient Registration desks at medical centers.

Cook Children’s Financial Assistance: 100% Free Care at 400% FPL + 75% Discount to 500% FPL (2026 Guide)

Cook Children’s Health Care System offers one of the most generous pediatric financial assistance programs in Texas. Families earning up to 400% of the Federal Poverty Level qualify for completely free care, and families up to 500% FPL receive a 75% discount. A separate hardship provision caps costs for families at any income level whose medical bills exceed 5% of their annual income. This guide covers eligibility, required documents, and how to apply.

Our Bill Defense team can apply for financial assistance on your behalf, follow up with Cook Children’s, provide any additional documentation they request, and find other ways to reduce your child’s bill (billing errors, insurance disputes, negotiation). You pay $0 unless we save you money.

Quick Facts Eligibility Hardship Provision Why It Matters in Texas Locations Documents How to Apply Contacts If Denied FAQ

Quick Facts

100% Free Care

Household income at or below 400% FPL (~$124,800/yr for family of 4)

75% Discount

Household income 400-500% FPL (~$156,000/yr for family of 4)

Hardship Protection

Costs capped at 5-20% of income if bills exceed 5% of annual income

240-Day Application Window

From your first billing statement, even if sent to collections

to see income thresholds for your household size.

Eligibility and Discount Tiers

Cook Children’s determines financial assistance eligibility based on household income relative to the Federal Poverty Guidelines (FPG). Any patient can apply regardless of insurance status.

Income Level	Benefit	2026 Income Example (Family of 4)
At or below 400% FPL	100% free care	Up to ~$124,800/year
401-500% FPL	75% discount	~$124,800 to ~$156,000/year
Any income level	Hardship cap (5-20% of income)	If out-of-pocket costs exceed 5% of annual income

Key insight: Cook Children’s 400% FPL free care threshold is exceptionally generous. Many Texas hospitals set their free care cutoff at 200% FPL. A family of four earning $120,000/year would owe nothing at Cook Children’s but could face full charges at hospitals with lower thresholds. If your child needs specialty or surgical care and you fall under 400% FPL, this policy could save you tens of thousands of dollars.

Important Notes:

• Eligibility applies to both uninsured and underinsured families
• Emergency care is provided regardless of financial assistance eligibility
• Eligible patients will never be charged more than amounts generally billed to insured patients (AGB rate)
• Covers medically necessary services including emergency, specialty, and surgical care
• Families may be asked to apply for Medicaid, CHIP, or other government programs first

Hardship Provision (No Income Limit)

Cook Children’s offers a separate hardship provision that has no hard income ceiling. If your family’s out-of-pocket medical costs exceed 5% of your annual income, you may qualify for a discount that caps your total liability at 5% to 20% of your annual income, depending on your FPL percentage.

When to use the hardship provision:

Your income is above 500% FPL but your child had a major surgery, NICU stay, or extended treatment
Your insurance left large out-of-pocket costs that exceed 5% of your annual income
Your child needs ongoing specialty care with accumulating bills
You experienced a financial change (job loss, reduced hours) after incurring bills

Example: A family earning $180,000/year with $15,000 in medical bills would exceed the 5% threshold ($9,000). Under the hardship provision, their total cost could be capped at $9,000 to $36,000 depending on their FPL bracket, potentially reducing a $15,000 bill to $9,000.

Why This Matters: Texas Has Not Expanded Medicaid

Texas is one of the states that has not expanded Medicaid under the Affordable Care Act. This creates a coverage gap where many families earn too much for traditional Medicaid but too little for marketplace subsidies to make insurance affordable. For children, Texas CHIP helps fill some of this gap, but many families still face significant costs.

Cook Children’s 400% FPL free care threshold is particularly valuable in this environment. Texas has no state-level charity care law beyond federal 501(r) requirements, meaning hospital financial assistance policies are voluntary and vary widely. Cook Children’s goes far beyond the minimum.

Cook Children’s (Fort Worth)

Free care at 400% FPL, 75% discount to 500% FPL

Many Texas Hospitals

Free care at 200% FPL, limited or no discounts above

Cook Children’s also operates its own health plan (Cook Children’s Health Plan) for Medicaid and CHIP-eligible children. If your child qualifies for those programs, the health plan may be an option before or alongside financial assistance.

Need Help with a Cook Children’s Bill?

CareRoute can help you understand your options, apply for financial assistance, draft appeal letters, and navigate the process. Our tools are designed to help families advocate for themselves effectively.

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Cook Children’s Locations

Cook Children’s operates hospitals, specialty clinics, and primary care offices across the Dallas-Fort Worth metroplex and North Texas. Financial assistance applies to eligible services at all Cook Children’s locations.

Cook Children’s Medical CenterFort Worth (main campus), 801 7th Ave.

Cook Children’s Medical Center Prosper4200 W. University Dr., Prosper

Specialty ClinicsMultiple locations across DFW including Southlake, Denton, and more

Primary Care OfficesNeighborhood pediatric clinics throughout the region

Service area: Cook Children’s primary service area includes Tarrant, Johnson, Parker, Denton, Hood, and Wise counties, but they treat children from across North Texas and beyond. Financial assistance is available regardless of which county you live in.

Required Documents Checklist

Income Verification

Most recent federal income tax return
3 most recent pay stubs (or statement of no income)
Social Security or disability award letter (if applicable)

Household Information

Proof of household size
Government-issued identification
Insurance information (if applicable)

Submit copies, not originals. A financial counselor may request additional documents depending on your situation. The financial evaluation form and policy are available in both English and Spanish.

How to Apply (Step-by-Step)

Get the Financial Evaluation Form

Download the form from cookchildrens.org/financial-assistance, request one at any Patient Registration desk at a Cook Children’s medical center, or ask your financial counselor. The form is available in English and Spanish.

5 minutes

Gather Your Documents

Collect all required documents from the checklist above. Having everything ready before you submit prevents delays. If you are unsure what is needed, call 682-885-2965 (option 3) for guidance.

15 minutes

Submit Your Application

You have three options: (1) submit online through the MyCookChildren’s patient portal, (2) email to CBOFinancialCounselor@cookchildrens.org, or (3) mail to Financial Counseling, 801 7th Ave., Fort Worth, TX 76104.

10 minutes

Apply for Government Programs if Directed

Cook Children’s may ask you to apply for Medicaid, CHIP, or the Cook Children’s Health Plan if your child may be eligible. This can provide ongoing coverage beyond financial assistance for individual bills.

Varies

Follow Up

Call billing at 682-885-4432 (toll-free 888-852-6635) or financial counseling at 682-885-2965 (option 3) to confirm receipt and check your status. Respond promptly to any requests for additional information.

Ongoing

Tips for a Smooth Application

✓ Apply Within 240 Days

You have 240 days from your first billing statement to submit an application. Cook Children’s must consider applications within this window, even if the bill has gone to collections.

✓ Request a Billing Hold

Ask for a hold on your account while your application is being reviewed. This prevents collections activity and gives you time to complete the process without pressure.

✓ Mention the Hardship Provision

If your income is above 500% FPL but your bills are large, specifically ask about the hardship provision that caps costs at 5-20% of income. This is often overlooked by families who assume they will not qualify.

✓ Check Medicaid and CHIP First

If your child may qualify for Medicaid or CHIP, apply for those programs first or simultaneously. Cook Children’s operates its own health plan for these programs, which could provide ongoing coverage.

Contacts and Official Links

Billing Customer Service

Toll-free: 888-852-6635

Financial Counseling

Financial Counseling Email

Mailing Address

Official Resources

Financial Assistance Policy, Form and Documents →Billing and Insurance Information →

In-Person Assistance

Visit any Patient Registration desk at Cook Children’s Medical Center (Fort Worth or Prosper) to request help from a financial counselor.

What If You Are Denied?

Understand the Reason

Cook Children’s will notify you of the decision. If denied, ask the financial counselor to explain the specific reason, whether it was income, missing documents, or another factor. Get this in writing.

Ask About the Hardship Provision

If you were denied based on income alone, specifically ask about the hardship provision. If your out-of-pocket costs exceed 5% of your annual income, you may still qualify for assistance even if your income is above 500% FPL. Many families do not know to ask about this.

Request Reconsideration

Contact Financial Counseling at 682-885-2965 (option 3) or email CBOFinancialCounselor@cookchildrens.org to discuss the denial. If your circumstances have changed or you have additional documentation, ask them to reconsider.

Other Options

• Ask about interest-free payment plans to spread costs over time
• Request an itemized bill to verify all charges are correct
• Check if your child qualifies for Medicaid, CHIP, or Cook Children’s Health Plan
• Contact the Texas Attorney General if you believe Cook Children’s is not following its posted financial assistance policy

Denied or need more help? If your financial assistance application is denied, or your bill has other issues beyond charity care (billing errors, insurance underpayment), CareRoute’s Bill Defense team can appeal the denial, identify additional savings, and handle all communications with the hospital on your behalf.

Frequently Asked Questions

Who qualifies for free care at Cook Children’s?

Uninsured or underinsured families with household income at or below 400% of the Federal Poverty Guidelines qualify for 100% free care. For a family of four in 2026, this is approximately $124,800/year. Both uninsured and underinsured patients are eligible.

Does Cook Children’s offer discounts above 400% FPL?

Yes. Families with income above 400% but at or below 500% FPL receive a 75% discount on eligible medical bills. Additionally, the hardship provision can help families at any income level if their out-of-pocket costs exceed 5% of their annual income.

What is the hardship provision?

If your family’s out-of-pocket medical costs exceed 5% of your annual income, Cook Children’s may cap your total costs at 5% to 20% of your income, depending on your FPL percentage. This applies regardless of your income level and is separate from the standard FPL-based assistance tiers.

Can I apply if my child has insurance?

Yes. Any patient can apply regardless of insurance status. If your insurance leaves significant out-of-pocket costs (deductibles, copays, coinsurance), or if your benefits are exhausted or services are not covered, you can apply for assistance on the remaining balance.

How long do I have to apply?

Under IRS Section 501(r), nonprofit hospitals must accept financial assistance applications for 240 days from the first billing statement. Cook Children’s must consider applications submitted within this window, even if the account has already been referred to collections.

Is the application available in Spanish?

Yes. Cook Children’s provides the financial evaluation form, policy documents, and plain language summary in both English and Spanish. You can download them from cookchildrens.org/financial-assistance or request copies at any Patient Registration desk.

How does Cook Children’s compare to Texas Children’s Hospital?

Cook Children’s (Fort Worth/DFW) offers 100% free care at 400% FPL with a 75% discount to 500% FPL. Texas Children’s (Houston) uses a sliding scale from 56.5% to 100% discount. Cook Children’s also has a unique hardship provision that caps costs relative to income regardless of FPL level. Both are major pediatric systems, but Cook Children’s thresholds are among the most generous in the state.

What services are covered by financial assistance?

Financial assistance covers emergency and medically necessary services, including specialty care, surgical services, NICU stays, and other pediatric care. Emergency care is always provided regardless of financial assistance eligibility or ability to pay.

Next Steps

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Related Resources

Texas law and other DFW hospital programs may provide additional options for reducing your medical bills.

Texas Medical Bill Rights and Protections Baylor Scott and White Financial Assistance Texas Health Resources Financial Assistance Texas Children’s Hospital Financial Assistance (Houston)