Patient & Visitor Information

RGH County Charity Program

If you need help with your hospital bill and you do not qualify or have been denied by the County for the Indigent Program, you may apply for the RGH Charity Program.

Guidelines for Roosevelt General Hospital Charity Program:

1. Residents who present proof of living in Roosevelt County.

2. Residents who meet Income Criteria as follows:

Annual Guidelines

Family Size

50%

75%

85%

100%

1

10,830.00 - 14,403.89

14,403.90 - 16,424.99

16,245.00 - 18,952.49

18,952.50 - OVER

2

14,570.00 - 19,378.09

19,378.10 - 21,854.99

21,855.00 - 26,954.49

26,954.50 - OVER

3

18,310.00 - 24,352.29

24,352.30 - 27,464.99

27,465.00 - 33,873.49

33,873.50 - OVER

4

22,050.00 - 29,326.49

29326.50 - 33,075.99

33,075.00 - 40,792.49

40,792.50 - OVER

5

25,790.00 - 34,300.69

34,300.70 - 38,685.49

38,685.00 - 47,711.49

47,711.50 - OVER

6

29,530.00 - 39,274.89

39,274.90 - 44,295.49

44,295.00 - 54,630.49

54,630.50 - OVER

7

33,270.00 - 44,249.09

44,249.10 - 49,905.49

49,905.00 - 61,549.49

61,549.50 - OVER

8

37,010.00 - 49,223.29

49,223.30 - 55,515.49

55,515.00 - 68,468.49

68,468.50 - OVER

*For family units of more than 8 members, add $3,470.00 for each additional member.

Monthly Guidelines

Family Size

50%

75%

85%

100%

1

902.50 - 1,200.32

1,200.33 - 1,353.74

1,353.75 - 1,669.62

1,669.63 - OVER

2

1,214.17 - 1,614.83

1,614.84 - 1,821.35

1,821.25 - 2,246.20

2,246.21 - OVER

3

1,525.83 - 2,029.35

2,029.36 - 2,288.74

2,228.75 - 2,822.78

2,822.79 - OVER

4

1,837.50 - 2,443.87

2,443.88 - 2,756.24

2,756.25 - 3,399.37

3,399.38 - OVER

5

2,149.17 - 2,858.38

2,858.39 - 3,223.74

3,223.75 - 3,975.95

3,975.96 - OVER

6

2,460.83 - 3,272.90

3,272.91 - 3,691.24

3,691.25 - 4,552.53

4,552.54 - OVER

7

2,772.50 - 3,687.42

3,687.43 - 4,158.74

4,158.75 - 5,129.12

5,129.13 - OVER

8

3,084.17 - 4,101.93

4,101.94 - 4,626.24

4,626.25 - 5,705.70

5,705.71 - OVER

Charity Program Application Forms:

Charity Application/Signature Form
Charity Income Application Form

For more information contact:
Carol Acosta-Flores
Roosevelt General Hospital
42121 US Hwy 70
Portales, NM 88130
Phone: 575.356.3410
Fax: 575.356.9212