# Pacific Grove Hospital

Hospital in Riverside, CA. Verified from the hospital's own policy.

Pacific Grove Hospital likely gives free care to households with a yearly income up to $21,227 for 1 person, $28,781 for 2, $36,336 for 3, $43,890 for 4, $51,444 for 5 or $58,999 for 6. It likely gives a discount to households with a yearly income up to $63,840 for 1 person, $86,560 for 2, $109,280 for 3, $132,000 for 4, $154,720 for 5 or $177,440 for 6.

The hospital makes the final decision.

| Household size | Free care if yearly income is up to | Discount if yearly income is up to |
|---|---|---|
| 1 | $21,227 | $63,840 |
| 2 | $28,781 | $86,560 |
| 3 | $36,336 | $109,280 |
| 4 | $43,890 | $132,000 |
| 5 | $51,444 | $154,720 |
| 6 | $58,999 | $177,440 |

Dollar amounts use the 2026 federal poverty guidelines.

## Discount steps

- 0% to 133% of poverty level, patient pays $0 (100% discount)
- 134% to 150% of poverty level, patient pays 75% discount on total charges
- 151% to 200% of poverty level, patient pays 50% discount on total charges
- 201% to 400% of poverty level, patient pays 25% discount on total charges, and never more than the higher of Medicare or Medi-Cal payment

## How to apply

- Call (951) 275-8400 and ask for financial assistance.
- [Application form](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=4527de63-1ec0-4929-a50e-1fb7254741cb)
- [ACHC.BO.0160 Financial Assistance (Acadia Healthcare; last reviewed/revised 10/30/2025)](https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603)
- We do not have the deadline yet. Apply as soon as you get a bill, and ask the billing office to pause collections while you apply.
- Bring Financial Disclosure Form, one income proof, such as a recent tax return, recent pay stubs, Social Security or SSI letter, bank statement, unemployment vouchers, or a letter from a shelter or group home.
- Very large bills. Medically indigent patients, who have severe or catastrophic medical costs they cannot pay without selling off assets they need to live on or causing undue hardship, can get help. No dollar or income threshold is given.

## If you have insurance

Insured patients can also apply for help with deductibles and copays.
Keep your insurance. Financial assistance covers bills from this one place only.

## What is covered

Covered. Hospital services at Pacific Grove Hospital. Insured patients with large out-of-pocket costs can also get help.

## State program in California

### Hospital Fair Pricing Act (Health and Safety Code 127400 et seq.)

Every licensed general acute care, acute psychiatric, and special hospital in California must have a charity care policy and a discount payment policy. A patient can ask for help if they are uninsured (self-pay) or have high medical costs, and their family income is not more than 400% of the federal poverty level. Hospitals may choose to help people with higher incomes. With a discount, the bill is capped at about what Medicare or Medi-Cal would pay, whichever is greater. You can apply at any time, even after a bill goes to collections. Immigration status does not affect eligibility.

Income levels in the program are discount up to 400% of poverty level.

Applies to each licensed general acute care hospital, acute psychiatric hospital, and special hospital in California.

How to apply. Apply to the hospital's financial assistance office. Each hospital's policies and applications are posted on its website and on HCAI's Hospital Fair Pricing Policy Lookup (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-fair-pricing-policy-lookup/).

> Is a self-pay patient OR a patient with high medical costs; AND Patient's family income is not more than 400 percent of the federal poverty

Source https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/frequently-asked-questions/, checked 2026-11-10

### Hospital Bill Complaint Program (HCAI)

A free state program at HCAI. If a hospital wrongly denied you financial assistance, did not tell you about its programs, or sent you to collections the wrong way, you can file a complaint online (English and Spanish) or by mail (many languages). You must have applied to the hospital first for HCAI to review an eligibility decision. If HCAI finds you paid too much, the hospital must refund you within 30 days. It covers problems on or after January 1, 2022. It does not handle general billing disputes, price transparency, Good Faith Estimates, or bills from emergency room doctors.

Applies to complaints about any hospital covered by the Hospital Fair Pricing Act.

How to apply. File online through the Patient Complaint Portal (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/should-i-file-a-complaint/) or mail the Patient Complaint Form to Department of Health Care Access and Information, Hospital Bill Complaint Program, 2020 West El Camino Avenue, Suite 1101, Sacramento, CA 95833.

> If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.

Source https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/, checked 2026-11-10

### Emergency physician discount rule

Most hospital policies cover only the hospital's own bill. Emergency room doctors often bill separately. California law also requires an emergency physician to give discounts to uninsured patients and patients with high medical costs whose family income is at or below 400% of the federal poverty level. Ask the doctor group's billing office for its discount policy. HCAI's complaint program does not handle emergency doctor bills.

Income levels in the program are discount up to 400% of poverty level.

Applies to emergency physicians who provide emergency medical services in a California hospital that provides emergency care.

How to apply. Ask the emergency physician group named on the bill for its discount payment policy.

> an emergency physician who provides emergency medical services in a hospital that provides emergency care is also required by law to provide discounted care

Source https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=c7bdd7eb-bcc0-4a84-bcab-a21b5e578d9c, checked 2026-11-10

## Notes

This is the company-wide Acadia Healthcare policy with a scale for Pacific Grove Hospital. The scale, labeled 2022, gives free care at or below 133% of the poverty level, 75% off from 134% to 150%, 50% off from 151% to 200%, and 25% off from 201% to 400%. Above 400% there is no discount. At or below 400%, you never pay more than Medicare or Medi-Cal would pay, whichever is higher. The same policy also says that in California the Pacific Grove scale is a 100% discount up to 400% of the poverty level, subject to that payment limit. These two parts disagree. We show the lower free care limit from the scale. Ask the hospital whether free care goes up to 400%. Approval is decided by the hospital CFO or CEO, who also review disputes. The hospital may pull a credit report. Overpayments over $5 are refunded with interest within 30 days. The application form allows Medicaid-pending approvals and the hospital may help pay COBRA premiums. Neither file prints a phone number. Medicare lists the hospital's main number as (951) 275-8400.

## Sources

- Free care level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603
  > Equal to or less than 133% of FPG 100%
- Discount level https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603
  > at or below 400% of the federal poverty level is limited to the amount of payment the facility would expect to receive
- Discount steps https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603
  > 201% - 400% of FPG 25%
- Insured patients https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603
  > federal health assistance or for whom the out of pocket expenses are significant.
- Very large bills https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603
  > Medically Indigent is defined as those patients who incur severe or catastrophic medical expenses but are unable to pay
- Deadline https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603
  > Eligibility for financial assistance may be determined at any time the facility is in receipt of documentation for income verification.
- Documents https://api.hdc.hcai.ca.gov/Public/Extract/Attachment?id=dd08b643-09ae-4182-8a72-fb3b7445c603
  > To complete Income Verification, the facility will accept one of the following:

Last checked 2026-11-10.

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