Health Care Responsibility Act (HCRA) Handbook

Table of Contents [404KB, PDF]


  1. Background and Overview [307KB, PDF]
  2. County, Hospital, and Agency Program Administration [209KB, PDF]
  3. Covered Services Emergency Care [192KB, PDF]
  4. Application Process [259KB, PDF]
  5. Eligibility Determination Process [279KB, PDF]
  6. Claims Processing [284KB, PDF]
  7. Appeal Process [174KB, PDF]


  1. Definitions [29.6KB, PDF]
  2. Monthly Caseload and Appeals Report [183KB, PDF]
  3. HCRA Quarterly Financial Report [59KB, PDF]
  4. Out-of-County Charity Care Report
    Page 1 [116KB, PDF] and
    Page 2 [44.6KB, PDF]
  5. Sample Participation Agreement [52.1KB, PDF]
  6. Notification of Eligibility, AHCA Form 5220-0002 [23.3KB, PDF]
  7. Health Care Assistance Application, AHCA Form 5220-0001 [90.0KB, XLS]
  8. UB-04 (CMS-1450) Claim Completion Instructions [47.6KB, PDF] Update: 5/31/07
    UB-04 Claim Form [262KB, PDF]
    UB-04 CMS Manual [1.80MB, PDF]
  9. Itemized Paid Claims [48.3KB, PDF]
  10. HCRA Income Limits (100% FPL) [133KB, PDF]
  11. HCRA Spend-down Provision Income Limits (150%) [131KB, PDF]