Who Qualifies for Financial Assistance for Medical Bills: Hospital Charity Care, Medicaid, and Income Tiers

Who qualifies for financial assistance for medical bills

There is no single national program that pays medical bills for everyone below a set income. Instead, help comes from several places, and each has its own rules. The most common ones are:

• The hospital itself. Nonprofit hospitals must offer financial assistance under a written policy. Many public and for-profit hospitals offer it too, and some states require it of all hospitals.
• Medicaid. If your income is low enough, Medicaid may pay for current care and some recent bills.
• Community health centers. Federally funded health centers charge on a sliding scale based on income.
• Older programs and charities. A small number of facilities still owe free care under the Hill-Burton program, and some disease-specific charities help with costs.

Across all of these, three things decide most cases: your household income, the number of people in your household, and sometimes your savings or other assets. Where you live matters as well, because some states set stronger rules than federal law does. Your citizenship status usually does not matter for hospital charity care, though it does matter for Medicaid.

Nonprofit hospital financial assistance policies

To keep their federal tax exemption, nonprofit hospitals must follow section 501(r) of the tax code. The IRS rules on financial assistance policies require each hospital facility to have a written FAP that covers all emergency and other medically necessary care. The policy must spell out:

• Who is eligible and for what level of help, such as free care or a percentage discount.
• How the hospital calculates what you owe after the discount.
• How to apply, what papers it may ask for, and who to contact.
• Which doctors and outside groups working in the hospital are covered by the policy and which are not.

The hospital must post the full policy, the application form, and a plain-language summary on its website, where anyone can download them without an account or fee. Paper copies must be free in the emergency room and admissions areas, and billing statements must include a notice that help is available. Translations are required for larger language groups in the community.

The limit on what you can be charged

Under the IRS limitation on charges, a person who qualifies under the FAP can't be charged more than the "amounts generally billed" (AGB) to people with insurance for emergency or medically necessary care. Hospitals figure AGB either from what Medicare and private insurers actually paid in a past year or from what Medicare or Medicaid would allow. In plain terms, even a partial discount should bring your bill down to roughly what an insurer would pay, not the full list price.

Physicians may bill separately

Emergency doctors, anesthesiologists, and radiologists are often separate companies. Check the FAP's provider list. If a doctor group is not covered, ask that group directly whether it has its own discount program.

Typical income tiers in dollars

Federal law does not set income limits for hospital charity care. Each hospital chooses its own, and many tie them to the HHS poverty guidelines. For 2026 the guideline is $15,960 for one person plus $5,680 for each added person. Common cutoffs look like the examples below, but your hospital's policy is the only thing that counts.

Hospitals may update to new guidelines each year, usually in the spring. Many also offer a separate "catastrophic" or "medical hardship" discount when bills are large compared with income, even if your income is above the normal tiers. Ask about it by name.

States with charity care laws

Some states go further than federal rules and set minimum tiers that hospitals must follow, including for-profit hospitals. Three examples we checked against official state sources:

Sources: New Jersey Department of Health charity care overview, Washington RCW 70.170.060, and California HCAI Hospital Fair Billing Program. Other states, including Colorado, Illinois, Maryland, New York, and Oregon, have their own hospital discount or charity care laws. We have not listed their tiers here because we have not verified current figures; check your state health department or attorney general's website. Texas residents can see our guide to medical hardship grants in Texas.

Collection limits while you apply

Federal rules also limit how hard a nonprofit hospital can push for payment before it checks whether you qualify. According to the IRS billing and collections rules:

• The 240-day application period starts with the first billing statement after discharge. The hospital must process applications you send in during that time, and it may accept them later.
• 120-day wait. The hospital can't start "extraordinary collection actions" until at least 120 days after that first bill.
• 30-day notice. Before those actions, it must send a written notice saying help is available, list what it may do, and give a deadline at least 30 days away.

Extraordinary collection actions include selling your debt, reporting it to credit bureaus, suing you, placing a lien, garnishing wages, and refusing or delaying needed care because of an old unpaid bill. Once you turn in a complete application, the hospital must pause these actions until it decides. If you are approved, it must refund anything you overpaid (unless the amount is under $5) and take reasonable steps to undo collection actions, such as removing credit reporting.

If you are already in collections on a bill from a nonprofit hospital, you can still ask whether you are inside the application window. Many people find they are.

Medicaid and its retroactive coverage

Medicaid is often the biggest help for people with very low income, and hospitals often ask you to apply for Medicaid first. In states that expanded Medicaid, most adults under 65 qualify with income up to 138% of poverty; our Medicaid guide covers the full rules and state differences.

The feature that matters most for old bills is retroactive coverage. Today, Medicaid can generally pay for covered care you received in the three months before the month you applied, if you would have qualified then. That window is set to shrink for new applicants on January 1, 2027, under the 2025 federal budget law: to one month before applying for expansion adults and two months for others. If you had a hospital stay recently and your income was low at the time, applying soon may matter. You can apply at HealthCare.gov or through your state Medicaid agency, and it costs nothing.

Some states also run a "medically needy" or "spend-down" program. It lets people whose income is a bit too high qualify once their medical bills bring their countable income down to a set level. Not every state has one, so ask your state agency.

Hill-Burton free care today

The Hill-Burton program dates back to 1946, when federal grants helped build hospitals in exchange for a promise to provide some free or reduced-cost care. The program stopped funding new projects in 1997, and most facilities have finished their obligations. HRSA has reported that only about 127 facilities nationwide are still obligated, so this is a narrow option.

At those facilities, HRSA says care may be free if your income is at or below the poverty guidelines, and reduced-cost care may be available up to twice the guidelines (three times for nursing home care). You must apply at the facility's admissions or business office, and Hill-Burton does not cover bills already paid by Medicare or Medicaid. Check the HRSA list of obligated Hill-Burton facilities by state, or call HRSA's Hill-Burton line at 1-800-638-0742.

Health centers and other low-cost care

For care going forward, federally funded community health centers are one of the most reliable options. They serve people regardless of ability to pay and charge on a sliding fee scale based on income and family size. People at or below the poverty guideline usually pay only a small nominal fee. Find one with the HRSA Find a Health Center tool.

Other sources worth asking about include:

• Disease-specific foundations that help with copays for cancer, kidney disease, and other conditions. Funds open and close during the year.
• Drug company patient assistance programs for expensive prescriptions.
• Hospital social workers or financial counselors, who know the local charities and can start an application while you are still admitted.
• 211, the free referral line, for local medical bill funds run by churches or community groups.

Our healthcare help guide lists more low-cost care options by need.

Does insurance rule you out?

No. Most hospital FAPs cover the part of the bill you owe after insurance, such as a deductible or coinsurance, if your income is within their tiers. The IRS price cap applies to everyone who qualifies under the FAP, whether or not they have insurance. Washington's law, for example, applies its tiers to the patient's share after other coverage.

Some hospitals do require you to use any insurance first, or to apply for Medicaid if you look eligible, before they decide. If you are insured and the bill looks wrong or higher than expected, see our separate guide on help with medical bills after insurance, which covers claim errors, appeals, and surprise billing rules.

What a hospital application asks for

Each hospital's form is different, but most FAP applications ask for some or all of the following. A hospital can't deny you for leaving out something its own policy or form didn't ask for.

• Names and ages of everyone in your household.
• Proof of income: recent pay stubs, your last tax return, Social Security or unemployment letters, or a signed statement if you have no income.
• Bank statements, but only if the policy counts assets.
• A Medicaid decision letter, if the hospital asked you to apply.
• The account numbers of the bills you want reviewed.

Keep copies of everything you send and write down the date. For a general list of papers that many aid programs ask for, see our documents checklist.

Checking your eligibility step by step

1. Find out what kind of hospital billed you. Search the hospital's name with "financial assistance policy." Nonprofit hospitals must post it.
2. Work out your household income as a percentage of poverty. Divide your yearly income by the guideline for your household size and multiply by 100.
3. Read the tiers in the plain-language summary. Look for free care, discount levels, and any asset test or hardship discount.
4. Check your state's rules. If your state has a charity care law, the hospital must meet at least that standard.
5. Apply even if you are unsure. Applying is free, and a complete application pauses most collection steps at nonprofit hospitals.
6. Apply for Medicaid at the same time if your income is low, so retroactive coverage can pick up recent bills.
7. Get the decision in writing. If you are approved for a discount, ask for a new bill that shows how the amount was figured.

If a nonprofit hospital refuses to give you its policy or ignores a complete application, you can report it to the IRS using Form 13909, and in California you can file a complaint with the Hospital Fair Billing Program.

Related guides

• Help with medical bills after insurance
• How to apply for Medicaid
• Medicare benefits explained
• Scam warnings

Frequently asked questions

This guide is general information, not legal or tax advice. Each hospital sets its own financial assistance policy within federal and state rules. National Relief Program is an independent website and is not affiliated with any hospital or government agency.