Hospital · Wellsville, NY
Jones Memorial Hospital
Free care to 200% of the federal poverty level.
Up to 200% Eligible for Medicaid Rates
What the policy says
Quoted from the hospital’s own documents · read by WaiveDiscounted careMatched80% discount above 200% to 250% FPL“Total Household Income As % of Federal Poverty Level [=(Income/FPL Value)x100%] Financial Assistance Discount To Balance Up to 200% Eligible for Medicaid Rates 201-250% 80% 251-300% 60% 301-351% 40% 351-400% 20%”POLICY Jones Memorial Hospital serviced by UR Medicine Affiliate ... · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
Discounted careMatched60% discount above 250% to 300% FPL“Total Household Income As % of Federal Poverty Level [=(Income/FPL Value)x100%] Financial Assistance Discount To Balance Up to 200% Eligible for Medicaid Rates 201-250% 80% 251-300% 60% 301-351% 40% 351-400% 20%”POLICY Jones Memorial Hospital serviced by UR Medicine Affiliate ... · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
Discounted careMatched40% discount above 300% to 351% FPL“Total Household Income As % of Federal Poverty Level [=(Income/FPL Value)x100%] Financial Assistance Discount To Balance Up to 200% Eligible for Medicaid Rates 201-250% 80% 251-300% 60% 301-351% 40% 351-400% 20%”POLICY Jones Memorial Hospital serviced by UR Medicine Affiliate ... · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
Discounted careMatched20% discount above 351% to 400% FPL“Total Household Income As % of Federal Poverty Level [=(Income/FPL Value)x100%] Financial Assistance Discount To Balance Up to 200% Eligible for Medicaid Rates 201-250% 80% 251-300% 60% 301-351% 40% 351-400% 20%”POLICY Jones Memorial Hospital serviced by UR Medicine Affiliate ... · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
Documents to includeMatchedProof of income; social security letter; tax return; pay stubs“The following is a list of documents you can use to prove your income. You do not have to provide all these documents. You can also provide a statement of no household income if you have no income. You may also provide the Eligibility determination page from the NY State of Health Marketplace. If you have this document, you do not have to provide any other income information listed below to the hospital. If Household Receives: Amount per Month: Applicant May Provide: Wages $ Please provide one Paycheck Stub, or Letter from Employer on company letterhead, signed and dated, or most recently filed income tax return. Social Security Payment $ Copy of award letter/certificate, or correspondence from the U.S. Social Security Administration, or annual benefit letter. To request a copy of your Social Security benefit letter, call 1-800-772-1213 or visit www.ssa.gov. Unemployment Compensation $ Copy of award letter/certificate, or monthly benefit statement from NYS Department of Labor, or Copy of Direct Payment Card with printout, or Correspondence from the NYS Department of Labor, or Printout of recipient’s account information from the NYS Department of Labor’s website (www.labor.state.ny.us). Disability Payment $ Copy of award letter/certificate, or correspondence from Social Security Administration, or copy of annual benefit letter. To request a copy of your benefit letter, call 1-800-772-1213 or visit www.ssa.gov. Workers Compensation $ Copy of Award Letter or Check stub. Alimony/Child Support $ Copy of court order, or 3 months of cashed checks/receipts. Dividends/Interest $ Quarterly dividend statements or 1 month statements. Other $ Letter stating the amount of non-wage earnings (if any), such as rental income, cash for odd jobs, etc. No Income $0 Signed statement of no income.”[PDF] NYS Uniform Hospital Financial Assistance Application | UR Medicine · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
How to applyMatchedMail: Please submit your completed application by mail, email or fax; UR Medicine Affiliate Billing Office 73 Buffalo St, suite 100 Canandaigua, NY 14424; email: Email: URMCAffiliateFinancialAssistance@URMC.Rochester.edu; fax: Fax: 585/340-4018“Please submit your completed application by mail, email or fax; UR Medicine Affiliate Billing Office 73 Buffalo St, suite 100 Canandaigua, NY 14424 Attn: Financial Assistance Email: URMCAffiliateFinancialAssistance@URMC.Rochester.edu Fax: 585/340-4018”[PDF] NYS Uniform Hospital Financial Assistance Application | UR Medicine · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
DecisionMatched30 days“An application will be reviewed and determination made within 30 days from the receipt of the fully completed application.”POLICY Jones Memorial Hospital serviced by UR Medicine Affiliate ... · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
Before collectionsMatched180 days after the first bill“Hospitals cannot send unpaid bills to a collection agency for at least 180 days after your first bill.”[PDF] NYS Uniform Hospital Financial Assistance Application | UR Medicine · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
Presumptive eligibilityMatchedMedicaid“Note: Patients are also considered presumptively eligible for 100% financial assistance if they are eligible for Medicaid and have outstanding balances prior to being covered by Medicaid.”Financial Assistance Policy · read by Waive · urmc.rochester.edu · retrieved Oct 13, 2026
What Tender found
Allegany County · CMS · Tender’s own checksWebsiteUnverifiedNo verified websiteTender checks the price file only on a verified website
Price fileUncheckedWebsite not verified · not checkedTender’s own check · not yet checked · logged, not quoted
CMS actionNoneNo CMS penalty on fileCMS price transparency enforcement list · no notice names this hospital