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Financial Assistance Program

A Financial Assistance program is available for qualifying Mississippi Gulf Coast residents.

Program Requirements

Singing River Health System is a public health system owned by Jackson County, Mississippi. The Financial Assistance Program procedures are designed to assist individuals who qualify for less than full coverage under available federal, state, and local medical assistance programs, but for whom residual “self-pay” balances exceed their own ability to pay.

Proof of Income

Our office will determine financial assistance eligibility using the specific document types below. Please submit the required documents for each family member, according to their type of employment, along with your application to ensure timely processing of your application.

Wage/Salary

All Required

  • A complete copy of your current and/or last year’s Federal Income Tax Return (include W2s and/or 1099)
  • If no tax return, provide last filing date letter from the IRS
  • Two (2) current pay stubs to include year-to-date wages

Unemployment Requirements

Choose One if Applicable

  • Receiving unemployment benefits: Award letter AND current bank statement
  • Not receiving unemployment benefits: Correspondence letter from Department of Labor AND letter from person(s) providing support including length of unemployment

Self-Employed

All Required

  • A complete copy of your current and/or last year’s Federal Income Tax Return with schedule C
  • If no tax return, provide last filing date letter from the IRS
  • Six (6) months of current bank statements
  • Business ledger

Other Forms of Income

All Required

(Social security, disability, alimony, child support, retirement, benefits, pension, worker’s compensation, and/or unemployment compensation)

  • Award letter indicating the amount you receive
  • Most recent bank statement reflecting deposit OR most recent 1099

Proof of Residency

To qualify for financial assistance, the patient must be a resident of Jackson, Harrison, Hancock, George, or Stone County. Please submit one (1) of the following documents as proof of residency. Residency documents must be in the applicant’s name or the applicant’s spouse’s name and contain a physical address. No post office box may be used as proof of residency.

  • Current driver’s license
  • Car tag registration
  • Mortgage papers, lease or rental agreement
  • Homestead exemption request
  • Voter registration card
  • Water bill and/or electric bill required

Proof of Dependents

Submit one (1) of the following, if applicable:

  • Copy of tax return (Form 1040) for the current tax year
  • School records
  • Legal documents
  • If separated, please provide divorce document and/or a notarized letter of separation

Application

To apply for financial assistance, patients must submit a complete application with a signed consent form allowing Singing River Health System to pull their credit report. The credit report will result in a soft hit, which has no adverse effect towards the patient’s credit score.

All information will be verified. An incomplete application will be denied. Patients have 240 days from discharge to submit an application for financial assistance.

Obtain an application form at any of our hospitals, apply online through MySingingRiver, or download the files you need below.

Download Application Files

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Doctors and Providers Covered by Financial Assistance Policy by Practice

Updated August 26, 2025

  • Behavioral Health Services
  • Center for Cardiovascular Surgery
  • East Central Medical Center RHC
  • Geriatric Medicine Clinic
  • Inpatient Physician Services
  • Singing River Anesthesia (Certified Registered Nurse Anesthetists/CRNAs only)
  • Singing River Cancer Center
  • Singing River Cardiology
  • Singing River Colorectal Surgery Clinic
  • Singing River Digestive Health
  • Singing River ENT
  • Singing River Gulfport Anesthesia
  • Singing River Health System Endocrinology Services
  • Singing River Health System Heartburn Center
  • Singing River Health System Hospice of Light
  • Singing River Health System Pulmonary Services
  • Singing River Health System Rheumatology Services
  • Singing River Infectious Disease
  • Singing River Interventional Pain Management
  • Singing River Kids & Tummies
  • Singing River Neurology
  • Singing River Orthopedics
  • Singing River Pediatrics
  • Singing River Primary Care
  • Singing River Regional Digestive Specialists
  • Singing River Surgical Services
  • Vancleave Medical Center RHC
  • Wound Care Center

Doctors and Providers Not Covered by Financial Assistance Policy by Specialty or Practice

  • Dental
  • Dermatology
  • Emergency
  • Nephrology
  • Pathology
  • Radiology
  • Urology
  • Infectious Disease
  • Obstetrics & Gynecology
  • Children’s Clinic of Pascagoula
  • Pediatric Care Center
  • Southern Mississippi Heart Center
  • Gulf Coast Heart Institute
  • Bienville Orthopedics
  • Digestive Health Center
  • Gulf Coast Gastroenterology
  • Ophthalmology
  • Jackson County Anesthesia
  • The Heart Center
  • Bay Area ENT
  • Coastal ENT Associates

If you have questions about the Financial Assistance Program or the application process, call Financial Services at (228) 762-8876.