Hospital Charity Care: Who Gets Free or Discounted Care

Hospital charity care, which hospitals usually call financial assistance, is free or discounted care for patients who cannot pay their bills. Federal tax rules require every nonprofit hospital organization recognized under section 501(c)(3) to have a written financial assistance policy covering all emergency and other medically necessary care (26 CFR 1.501(r)-4), and some states go further by setting the income levels at which care must be free or discounted.

The hospital decides each application under its own policy and any state law that applies. This guide covers what the federal rules require, the deadlines that protect you while you apply, the state laws that set income levels, and how to work out where your household income falls against the poverty guidelines.

Information last verified on October 20, 2026. This article has not been reviewed by a licensed lawyer.

Jurisdiction scope: This guide covers the federal financial assistance rules for nonprofit hospitals in the IRS section 501(r) regulations (26 CFR 1.501(r)-1 to 1.501(r)-6) and the hospital charity care laws of the 50 states and the District of Columbia. It does not cover Medicaid eligibility, surprise-billing protections for insured patients, or local and county indigent-care programs except where a state law named here creates one.

Hospital financial assistance check

See your income as a share of the federal poverty guidelines next to your state’s charity care rules.

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Source: 26 CFR 1.501(r)-4; 91 FR 1797 (Jan. 15, 2026)

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What hospital charity care is

Charity care is the everyday name for a hospital's financial assistance policy, which the federal rules call a FAP. The policy must state its eligibility criteria and whether the help it gives is free care, discounted care, or both (26 CFR 1.501(r)-4).

Under the federal rules it applies to emergency and other medically necessary care. It is not insurance, and some state laws, described below, also cover insured patients whose plans leave them with a bill they cannot pay.

It sits alongside the other medical bill protections. If you are uninsured and scheduling care, a good faith estimate gives you a price in advance; if you are insured and got a surprise out-of-network bill, the No Surprises Act may limit what you owe. Our medical bills guide sorts out which rule fits which bill.

Which hospitals must offer financial assistance

The federal rule applies to a "hospital organization," which the regulation defines as an organization "recognized (or seeking to be recognized) as described in section 501(c)(3) that operates one or more hospital facilities" (26 CFR 1.501(r)-1). For-profit hospitals, and public hospitals without 501(c)(3) status, are outside it.

State law fills part of that gap, and its reach varies by state:

• Every hospital in the state. Oklahoma requires every hospital to run a discount program for self-pay patients (63 Okla. Stat. 1-723.2). New York's rule covers all hospitals licensed by its Department of Health (N.Y. Pub. Health Law 2807-k(9-a)).
• Nonprofit hospitals only. Oregon's free and discounted care rules bind nonprofit hospitals and their nonprofit affiliated clinics, not for-profit hospitals (ORS 442.614).
• Public county hospitals. Iowa county public hospitals must provide free care to indigent residents of the county, with the hospital's board deciding who is indigent (Iowa Code 347.16), and Wyoming county memorial hospitals must provide care free to county residents who have no means to pay (Wyo. Stat. 18-8-106).

What a nonprofit hospital's policy must say

Under 26 CFR 1.501(r)-4, a nonprofit hospital's financial assistance policy must:

• apply to all emergency and other medically necessary care the hospital facility provides;
• state the eligibility criteria and whether the assistance is free or discounted care;
• state the basis for calculating the amounts charged to patients;
• explain the method for applying;
• describe the actions the hospital may take if a bill is not paid, unless a separate billing and collections policy does that; and
• list which other providers working in the hospital, such as doctors who bill separately, are covered by the policy and which are not.

The hospital writes the eligibility criteria; the federal rule requires that the policy state them. The policy must also be "widely publicized." The hospital must post the policy, the application form and a plain language summary on a website, and must make free paper copies available on request, by mail and in public places in the hospital, including at least the emergency room (if it has one) and the admissions areas.

That gives you a practical first step: ask the billing office, the admissions desk or the hospital's website for all three documents before you do anything else.

The limit on what an eligible patient can be charged

Once you are eligible under a nonprofit hospital's policy, the hospital may charge you no more than the "amounts generally billed to individuals who have insurance covering such care," known as AGB, for emergency or other medically necessary care (26 CFR 1.501(r)-5). For any other care the policy covers, the charge must be less than gross charges.

So even a partial discount has a ceiling: an eligible patient is not billed the full list price that an uninsured patient might otherwise see.

Deadlines that protect you while you apply

The federal rules give patients at nonprofit hospitals a set of timelines. All of them are counted from the first billing statement the hospital sends after discharge, so note the date on that bill.

"Extraordinary collection actions" include selling the debt (with exceptions), reporting adverse information to credit bureaus, deferring or denying care because of unpaid bills, and legal actions such as liens, foreclosure, seizing bank accounts, lawsuits, arrest or body attachment, and wage garnishment (26 CFR 1.501(r)-6). Deferring or denying care over a past unpaid bill follows a separate notice rule and is not covered by the 120-day wait or the application pause. Our guide to medical debt on your credit report explains what this means for credit reporting.

Watch out: a state deadline can be shorter than the federal window. The Illinois discount for uninsured residents requires you to apply within 90 days of discharge, service, screening or a public-coverage denial (210 ILCS 89/10). Other states give more time: New Jersey allows an application within one year of the date of service, and the District of Columbia allows one up to 240 days after the first bill or at any time while the bill is in collections.

State charity care laws

The table lists the states whose laws set an income level, measured as a percentage of the HHS poverty guidelines, at which hospital care must be free, discounted or price-limited. Where a state uses different levels for different hospitals, each group has its own row. The hospital still decides whether you meet the conditions.

Read the table with these conditions from each state's law:

• Michigan sets a price limit, not a free or discount program you apply to: a hospital in Michigan's Medicaid program must accept 115% of Medicare rates as payment in full from an uninsured patient with income up to 250% of the poverty guidelines.
• Connecticut limits what a hospital may collect from an uninsured patient at or below 250% who applied for and was denied Medicaid to the hospital's cost of care. It is a price cap, not free care.
• California and Colorado set discount programs with no state free tier. California caps discounted bills at the greater of what Medicare or Medi-Cal would pay. Colorado sets the rates and caps payments at 4% of monthly household income per facility bill and 2% per professional bill, and you must attest that you live in Colorado.
• Massachusetts runs the state Health Safety Net, which pays acute hospitals and community health centers for eligible services to Massachusetts residents. At or below 150% of the poverty level there is no deductible; from 150% to 300% you pay an annual deductible. You apply through the MassHealth or Health Connector application.
• Maine's statute sets the 200% level from July 1, 2026, but the health department's rule in force (10-144 CMR ch. 150) still uses 150%; a replacement at 200% was proposed in August 2026 and had not been adopted by October 2026. Patients up to 400% must be offered a payment plan capped at 4% of monthly family income not protected from garnishment.
• New York's free tier is below 200%, not at 200%, and covers underinsured patients whose paid medical costs in the last 12 months exceeded 10% of income. Hospitals may not consider assets or immigration status.
• Illinois covers uninsured Illinois residents only (a high-deductible plan counts as insurance), on medically necessary charges over $150 per visit ($300 at rural and critical access hospitals), and caps the total collected in 12 months at 20% of family income.
• Maryland covers uninsured patients and insured patients whose coverage does not pay the full bill, with reductions of at least 75% at 201-250% and 60% at 251-300%, and you have 240 days after the first bill to apply.
• Vermont and Washington cover insured patients too. Vermont waives all out-of-pocket costs for insured patients at or below 250%, and Washington covers the patient responsibility portion of hospital charges whether or not you are insured.
• New Jersey applies to residents with no coverage or coverage that pays only part of the bill who are not eligible for Medicaid or other assistance, with asset limits of $7,500 (individual) or $15,000 (family) and spend-down allowed. Private doctor fees are separate.
• Ohio requires free basic, medically necessary hospital services at hospitals receiving Hospital Care Assurance Program funds for Ohio residents who are not on Medicaid and have income at or below the poverty line.

Two changes are on the way. Starting January 1, 2027, Delaware hospitals must give Delaware residents free care at or below 300% of the poverty guidelines, at least 75% off up to 350%, and at least 50% off up to 400%, regardless of insurance (16 Del. C. 9962). Starting July 1, 2027, California hospitals must screen patients and presumptively treat those enrolled in programs such as CalFresh, CalWORKs or WIC as eligible for charity care or discounts, subject to verification (Cal. Health & Safety Code 127406).

States with charity care rules but no income level

Many other states regulate how hospitals handle financial assistance without setting an income level. Examples:

• Florida: hospitals must post their financial assistance and charity care policies and may not take extraordinary collection actions before screening the patient under that policy (Fla. Stat. 395.301; 395.3011).
• Texas: hospitals must have a charity care eligibility system with income levels tied to the poverty guidelines, but the law sets no level at which care must be free or discounted. Since September 1, 2025, a patient not enrolled in a health plan who asks within 60 days of the bill can be charged no more than 25% above amounts generally billed, or 50% above the hospital's lowest contracted rate (Tex. Health & Safety Code 311.031(11), 311.006).
• Minnesota: hospitals must screen uninsured patients for charity care under their own policies and hold off collections until the charity-care decision. For uninsured care, a hospital may not charge a patient with household income under $125,000 more than its lowest private-insurer rate (Minn. Stat. 144.587, 144.589).
• Tennessee: hospitals, surgery centers and outpatient diagnostic centers may not require a patient with no insurance or other payer to pay more than 175% of the cost of the services (Tenn. Code Ann. 68-11-262).
• Nevada: private hospitals with 200 or more beds must cut the bill by at least 30% for uninsured inpatients who do not qualify for public coverage and arrange payment within 30 days of the notice (NRS 439B.260).
• New Hampshire: hospitals must accept from uninsured self-pay patients no more than the amount generally billed to insured patients, and must tell you this in writing (RSA 151:12-b).
• New Mexico: patients with household income at or below 200% of the poverty level may not be pursued through collection actions such as lawsuits, liens, garnishment or debt sales, although the bill itself is not erased (NMSA 1978, 57-32-1 to -10).
• North Carolina: hospitals and surgery centers may not send your bill to collections while your charity care or financial assistance application is pending (N.C. Gen. Stat. 131E-91(d)).

In some states, such as Kansas, Missouri and Utah, state law contains no requirement that hospitals give free or discounted care based on income; nonprofit hospitals there still follow the federal rules above. The medical bill checker shows the rule for every state, for example Maryland, New York and Texas.

2026 poverty guidelines and how to find your percentage

State laws and many hospital policies measure income as a percentage of the HHS poverty guidelines. The 2026 guidelines were published on January 15, 2026 (91 FR 1797). Alaska and Hawaii have their own, higher figures.

To find your percentage:

1. Find the guideline for your household size and location in the table.
2. Divide your household's yearly income by that figure.
3. Multiply by 100.

For example, a household of three in the contiguous states with income of $54,640 is at 200% of the guideline ($54,640 divided by $27,320 is 2.0). The tool above does this calculation for you.

Check two things in the hospital's own policy before relying on the number: which year's guidelines it uses, and how it counts income and household members. A state law or policy that says "at or below 200%" and one that says "below 200%" treat a household at exactly 200% differently.

How to apply for charity care

1. Ask for the documents. Request the financial assistance policy, the application form and the plain language summary. At a nonprofit hospital they must be on its website and available on paper for free. Check the policy's provider list for the doctors who billed you.
2. Ask for an itemized bill. Check the charges before you apply; our guide on how to dispute a medical bill explains how.
3. Apply early. File well inside the 240-day federal window and any shorter state deadline. An incomplete application filed in the window still pauses extraordinary collection actions at a nonprofit hospital, so do not wait for every document.
4. Send what the application asks for, and keep copies. Keep a copy of the application, the proof of income you sent, and a record of the date you sent it.
5. Tell any collector in writing. If the bill has already gone to a collection agency, apply anyway and send the collector a written note that your application is pending.
6. Get the decision in writing. If the hospital approves assistance, ask for a corrected bill. At a nonprofit hospital it must also refund what you paid above your new amount (unless the difference is under $5) and take all reasonably available measures to undo collection actions such as credit reporting or a court judgment (26 CFR 1.501(r)-6). If it denies the application, ask for the reason in writing and how to ask for reconsideration.

If the debt is already in collections or a lawsuit has been filed, our debt collection laws guide explains collector rules, and the guides on the statute of limitations on debt and how to stop wage garnishment cover the later stages.

Related guides

• Medical bills: your rights before you pay
• Good faith estimates and the $400 dispute rule
• Medical debt on your credit report
• How to dispute a medical bill
• Balance billing laws by state
• Medical bill checker

This article provides general legal information about federal and state hospital financial assistance rules in the United States, current as of October 20, 2026. It is not legal advice. For advice about a specific bill, contact a lawyer licensed in your state, your state's legal aid program, or the hospital's financial assistance office.

Last updated: October 20, 2026.

Frequently Asked Questions

What is hospital charity care?

It is free or discounted care for patients who cannot pay their hospital bills. Nonprofit hospitals call it financial assistance, and federal rules require them to have a written financial assistance policy covering emergency and other medically necessary care (26 CFR 1.501(r)-4).

Who is eligible for hospital charity care?

Each hospital sets its eligibility criteria in its financial assistance policy, and some state laws set income floors. For example, Maryland hospitals must provide free medically necessary care at or below 200% of the federal poverty level, and Oregon nonprofit hospitals must cover 100% of costs at household income up to 200%.

Do for-profit hospitals have to offer charity care?

The federal financial assistance rules apply only to 501(c)(3) hospital organizations, so they do not reach for-profit hospitals. State law can: Oklahoma requires every hospital in the state to run a discount program for self-pay patients up to 300% of the poverty guidelines, and New York applies its rule to all hospitals licensed by its Department of Health.

How long do I have to apply for financial assistance?

At a nonprofit hospital the federal application period starts on the date of care and ends no earlier than the 240th day after the first billing statement sent after discharge (26 CFR 1.501(r)-1). State deadlines can be shorter: the Illinois uninsured discount requires an application within 90 days of discharge, service, screening or a public-coverage denial.

Can a hospital send my bill to collections while I apply?

A nonprofit hospital must wait at least 120 days after the first billing statement before extraordinary collection actions such as credit reporting or lawsuits, and an application filed within the application period pauses those actions until it decides (26 CFR 1.501(r)-6). North Carolina law separately bars hospitals from sending a bill to collections while a charity care application is pending.

Can I get charity care if I have insurance?

Sometimes. Several state laws cover insured patients: Maryland covers insured patients whose coverage does not pay the full bill, Vermont waives out-of-pocket costs for insured patients at or below 250% of the poverty level, and Washington covers the patient responsibility portion whether or not you are insured.

What is the 2026 poverty guideline for a family of four?

It is $33,000 in the 48 contiguous states and D.C., $41,250 in Alaska and $37,950 in Hawaii, under the HHS guidelines published January 15, 2026 (91 FR 1797).