Cumberland County Hospital
299 Glasgow Road
Burkesville, KY  42717


If you would like to apply for assistance you can download the CCH Charity Assistance Program Application as a PDF by clicking on the Icon or link below.  The application has instructions attached and must be printed, filled out and returned by mail.
Cumberland County Hospital Charity Assistance Program Application
You can download the Application for Disproportionate Share Hospital Program (DSH) and Medicaid/KCHIP screening form as a PDF by clicking the Icon or link below.
Application for Disproportionate Share Hospital Program (DSH) and Medicaid/KCHIP screening form.
Puede descargar la Solicitud para el Programa desproporcionado Compartir el Hospital ( DSH ) y el formulario de evaluación de Medicaid / KCHIP en formato PDF haciendo clic en el icono o enlace de más abajo .


It is the policy of Cumberland County Hospital (including BF Taylor and Flowers Rural Health Clinics and Cumberland County EMS) to provide the best possible healthcare services without discrimination, to all persons in our service area without regard to sex, economic status, educational background, race, color, religion, ancestry, national origin, sexual orientation, disability, medical condition, marital status, registered domestic partner status, or source of payment for care, including screening and transfer requirements under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), while maintaining fiscal responsibility.

This is a summary of our Financial Assistance Policy. CCH accept and bill insurance and collect co-pays and coinsuranceas applicable. When appropriate, we will work with patients to set up payment arrangements, assist with applications for financial assistance and provide certain discounts for any amounts for which the patient may be responsible. Patients who are unable to pay will be referred to the Patient Financial Assistance Office to determine eligibility for enrollment in Kentucky Medicaid, DSH Program, or the CCH Charity Care Program. No person eligible for financial assistance under the FAP will be charged more for medically necessary care than amounts generally billed to individuals who have insurance covering such care (AGB). CCH determines that AGB is determined by the outpatient service reimbursement rate on the most recently received Medicare cost-report settlement letter. Patients without health insurance, or patient balances for patient responsibility portions, who pay within 30 days of the date of their first statement will be eligible for a 25% Prompt Payment discount.

Patients who are self-pay or who have self-pay portions of bills will be offered assistance with an application for the DSH and Charity Program. DSH qualification is set at 100% of the Federal Poverty Level. If determined to be eligible, 100% of the charges will be covered by DSH.Patients who do not qualify for DSH may qualify for the Charity Care Program.To qualify, a patient’s family income must be not more than 150% of the Federal Poverty Level. Patients who qualify for this program will be given a 100% discount on the charged amount, provided that those who meet this requirement attempt to apply for Medicaid (or have provided a denial letter) before any charity care is considered.

Further information on this hospitals Financial Assistance and Charity Program may be found at

Puede descargar el Hospital del Condado de Cumberland Resumen de la Política de Asistencia Financiera en formato PDF haciendo clic en el icono o enlace de abajo.

You can download the Cumberland County Hospital Patient Financial Services Financial Assistance Policy as a PDF by clicking the Icon or link below.

Where to Obtain Information.

There are several ways to obtain more information about the FAP application process or to obtain copies of the FAP policy or application form.

Download the information by clicking on the links or icons below

You can also request information by phone by calling our Patient Financial Counselors at (270-864-2511 ext 1349.

Free paper copies of the Financial Assistance Policy and the FAP Applications (DSH/KCHIP and Charity Programs) may be requested by mail by writing to:

Cumberland County Hospital 

Financial Assistance Dept.

PO Box 280

Burkesville, Ky 42717

Puede descargar la Política de Asistencia al Paciente Servicios financieros del Hospital del Condado de Cumberland en formato PDF haciendo clic en el icono o enlace de más abajo.