Sanford Health Financial Assistance: Free Care at 200% FPL + Sliding Scale to 300% FPL (2026 Guide)
Sanford Health is the largest rural health system in the United States, operating 47 hospitals and over 200 clinics across South Dakota, North Dakota, Minnesota, and parts of Nebraska and Iowa. 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 additional consideration for catastrophic medical expenses. Both insured and uninsured patients are eligible at all Sanford facilities.
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Quick Eligibility Summary
Who Qualifies for Sanford Health 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 Sanford Health. Your entire bill is written off. For a single person in 2026, 200% FPL is approximately $31,920/year. For a family of four, it is approximately $65,600/year. Both insured and uninsured patients are eligible.
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 will still pay significantly less than the full bill. Sanford financial counselors can calculate your specific discount level.
Catastrophic Medical Expenses
Sanford Health provides additional consideration for patients facing catastrophic medical expenses. If you have experienced an extended hospitalization, complex surgery, or ongoing treatment that has created bills far beyond your ability to pay, you should ask about this provision even if your income is above 300% FPL.
Special Considerations for Rural Patients
In many rural communities across South Dakota and North Dakota, Sanford Health is the only hospital. This makes their financial assistance policy especially important for rural families, because there is no alternative provider to turn to.
What rural patients should know:
- Critical Access Hospitals (CAHs): Many rural Sanford facilities are designated as Critical Access Hospitals. These facilities have different reimbursement structures, and bills from CAHs may be lower than bills from larger Sanford medical centers.
- Travel and lodging assistance: Sanford offers travel and lodging assistance for rural patients who must travel long distances for specialty care. This is separate from financial assistance for medical bills, but many patients do not know to ask about it.
- Good Samaritan Fund: Some Sanford facilities maintain Good Samaritan funds for patients who fall outside standard financial assistance criteria. Always ask if there are additional discretionary funds available at your specific facility.
- Same FA policy everywhere: Whether you receive care at a small rural Sanford clinic or the main medical center in Sioux Falls, the same financial assistance policy applies. Do not assume a smaller facility has different rules.
Tip: If you are a rural patient who was transferred to a larger Sanford facility for specialty care, ask about travel reimbursement and whether the Good Samaritan Fund can help cover lodging and transportation costs.
Need Help with a Sanford Health 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 DefenseCross-State Billing: Know Your Protections
Sanford Health operates across multiple states, and each state has different medical debt laws and patient protections. The state where you received care determines which protections apply, not the state where you live. This is critical to understand because a bill from Sanford Fargo (North Dakota) has different legal protections than a bill from Sanford Sioux Falls (South Dakota).
South Dakota
- Unlimited homestead exemption (your home is fully protected from medical debt judgments)
- No state-mandated financial assistance requirements beyond federal 501(r) rules
- 6-year statute of limitations on medical debt
North Dakota
- 90-day delinquency rule before debt collection can begin
- $150,000 homestead exemption
- 6-year statute of limitations on medical debt
Minnesota
- Strong patient protections with required charity care policies
- $450,000 homestead exemption
- 6-year statute of limitations on medical debt
Nebraska
- $60,000 homestead exemption
- 5-year statute of limitations on medical debt
- Wage garnishment limits protect essential income
Key insight: If you live in South Dakota and received care at Sanford, your home is fully protected from medical debt judgments under the state's unlimited homestead exemption. Even if your financial assistance application is denied, Sanford cannot force the sale of your home to collect on a medical debt.
Indian Health Service (IHS) Referral Patients
Sanford Health receives many referral patients from Indian Health Service facilities, particularly in South Dakota and North Dakota. If you are eligible for IHS services, there is an important billing pathway you should know about.
How IHS Purchase/Referred Care (PRC) works with Sanford:
- Get a referral first: Contact your IHS facility to obtain a Purchase/Referred Care (PRC) authorization before receiving care at Sanford, or as soon as possible afterward.
- IHS pays first: If you have a valid PRC referral, IHS should pay for your Sanford care before financial assistance is even considered.
- Emergency exceptions: If you received emergency care at Sanford without a referral, contact your IHS facility within 72 hours to request retroactive PRC authorization.
- Remaining balance: If IHS PRC does not cover the full bill, you can then apply for Sanford financial assistance for the remaining balance.
Important: Do not let a Sanford bill go to collections if you are IHS-eligible. Contact your IHS facility and Sanford Patient Financial Services simultaneously to ensure proper coordination. Tell Sanford billing that you are IHS-eligible so they can code and route the claim correctly.
Sanford Health Major Facilities by State
South Dakota
Sanford USD Medical Center
Sioux Falls (Headquarters)
Flagship hospital and Level I Trauma Center serving the region
Sanford Aberdeen Medical Center
Aberdeen
Regional hospital serving northeast South Dakota
Sanford Vermillion Medical Center
Vermillion
Critical Access Hospital serving southeast South Dakota
Sanford Chamberlain Medical Center
Chamberlain
Critical Access Hospital serving central South Dakota
North Dakota
Sanford Medical Center Fargo
Fargo
Major medical center and Level I Trauma Center
Sanford Bismarck Medical Center
Bismarck
Regional medical center serving western North Dakota
Sanford Hillsboro Medical Center
Hillsboro
Critical Access Hospital serving rural North Dakota
Sanford Mayville Medical Center
Mayville
Critical Access Hospital in the Goose River valley
Minnesota, Nebraska, and Iowa
Sanford Bemidji Medical Center
Bemidji, MN
Regional hospital serving northern Minnesota
Sanford Worthington Medical Center
Worthington, MN
Serving southwest Minnesota communities
Sanford Luverne Medical Center
Luverne, MN
Critical Access Hospital near the SD border
Additional Clinics
NE and IA locations
Sanford operates clinics in parts of Nebraska and Iowa
All Sanford Health facilities share the same financial assistance policy. Your application will be evaluated consistently regardless of which facility provided your care.
How to Apply for Sanford Health Financial Assistance
Contact Patient Financial Services
Call Sanford Patient Financial Services at (605) 328-7050 or visit the financial counseling office at your Sanford facility. You can also ask at registration, the billing department, or the emergency department. Financial assistance notices are posted in common areas.
Gather Your Documents
You will typically need: proof of income (recent pay stubs, tax returns, or a statement of no income), proof of household size, government-issued identification, and your Sanford medical bills or account numbers. If you have IHS eligibility, bring your IHS card or tribal enrollment documentation.
Complete the Application
Fill out the Sanford Health financial assistance application form. A financial counselor can help you complete it. Be thorough: include all income sources, household members, and relevant expenses. If you are requesting catastrophic expense consideration, include a summary of your total medical bills and financial obligations.
Ask About Additional Resources
While applying, ask about: the Good Samaritan Fund at your facility, travel and lodging assistance if you traveled for care, Medicaid eligibility screening, and any other programs that may help. Sanford counselors can connect you with community resources.
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. If approved, the charity care or discount will be applied to your eligible bills retroactively.
If Your Application Is Denied
If Sanford Health denies your financial assistance application, you have several options:
- 1.Request a written explanation of the denial reason. You need to understand exactly why you were denied before you can address the issue effectively.
- 2.Appeal the decision. Ask about the formal appeal process and provide additional documentation that addresses the specific denial reason.
- 3.Ask about catastrophic expense consideration. If denied based on income alone, explain why your bills are disproportionate to your ability to pay and request review under the catastrophic expense provision.
- 4.Ask about the Good Samaritan Fund. Some Sanford facilities have discretionary funds for patients who fall outside standard criteria. This is a separate resource from the main financial assistance program.
- 5.Request a payment plan. Even without charity care approval, Sanford may offer interest-free or reduced payment plans to make your balance manageable.
- 6.Know your state protections. In South Dakota, your home is fully protected from medical debt judgments (unlimited homestead exemption). In North Dakota, there is a 90-day delinquency rule. Check your state rights page for specific protections.
- 7.Contact your state Attorney General if you believe the denial violates nonprofit hospital obligations. Sanford must comply with IRS 501(r) requirements as a tax-exempt organization.
Denied? Let Us Help You Appeal
CareRoute can help you draft an appeal letter, identify the right provisions to cite (including catastrophic expense and Good Samaritan Fund options), and build a compelling case for reconsideration.
Start Your Appeal with Bill DefenseContact Information
Sanford Health has a centralized Patient Financial Services department, as well as local financial counselors at each facility.
Frequently Asked Questions
Who qualifies for free care at Sanford Health?
Patients with household income at or below 200% of the Federal Poverty Level qualify for 100% free care at all Sanford Health facilities. 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 are eligible.
What discount do patients between 201-300% FPL receive?
Patients between 201% and 300% FPL receive discounted care on a sliding scale. The exact discount depends on where your income falls within this range. Contact Sanford Patient Financial Services at (605) 328-7050 to learn what your specific discount would be.
Does Sanford offer help for catastrophic medical expenses?
Yes. Sanford Health provides additional consideration for patients with catastrophic medical expenses. If your bills are large relative to your ability to pay, you may qualify for assistance even if your income is above 300% FPL. Always mention catastrophic expenses when speaking with Patient Financial Services.
I live in a rural area where Sanford is the only hospital. What are my options?
As a nonprofit, Sanford is required to offer financial assistance under IRS 501(r) rules regardless of location. Many rural Sanford facilities are Critical Access Hospitals (CAHs) with potentially lower charges. Ask about the Good Samaritan Fund, travel and lodging assistance for specialty care referrals, and Medicaid eligibility screening. The same financial assistance policy applies at every Sanford facility, large or small.
Does Sanford Health offer travel and lodging assistance?
Yes. Sanford offers travel and lodging assistance for rural patients who must travel long distances for specialty care. This is a separate program from financial assistance for medical bills. Ask your care team or Patient Financial Services about available travel assistance before or during your visit.
How do billing protections differ across the states where Sanford operates?
Each state has different medical debt laws. South Dakota has an unlimited homestead exemption, meaning your home cannot be seized for medical debt. North Dakota has a 90-day delinquency rule before collections can begin. Minnesota has strong charity care requirements. Nebraska and Iowa have their own protections. The state where you received care determines which laws apply.
I am eligible for Indian Health Service (IHS). How does that work with Sanford?
If you are IHS-eligible, your care at Sanford may be covered through IHS Purchase/Referred Care (PRC). Contact your IHS facility to get a referral before receiving care at Sanford, or within 72 hours for emergencies. IHS pays first, and you can apply for Sanford financial assistance for any remaining balance. Always tell Sanford billing that you are IHS-eligible.
Does Sanford screen patients automatically for financial assistance?
Sanford may perform automatic screening in some cases, particularly for uninsured emergency patients. However, you should never rely on automatic screening alone. Always proactively contact Patient Financial Services and submit a formal application to ensure you receive the maximum assistance available.
What is the Good Samaritan Fund?
Some Sanford facilities maintain Good Samaritan funds, which are discretionary funds for patients who fall outside standard financial assistance criteria. These funds are facility-specific and subject to availability. If your financial assistance application is denied or you need additional help, ask your financial counselor whether a Good Samaritan Fund exists at your facility.
What is a Critical Access Hospital, and does it affect my bill?
Critical Access Hospitals (CAHs) are small, rural hospitals with a special Medicare designation. Many rural Sanford facilities are CAHs. Because CAHs have different reimbursement structures and typically lower overhead, bills from these facilities may be lower than bills from Sanford's larger medical centers. The financial assistance policy is the same regardless of facility type.
Related State Rights Guides
Your state may provide additional protections for medical bills beyond what Sanford Health offers through its financial assistance program.
Last updated: May 2026. Information is based on publicly available Sanford Health financial assistance policies. Always confirm current eligibility requirements directly with Sanford Patient Financial Services at (605) 328-7050.