Charity care requirements and how to apply

Charity care, also called financial assistance, is free or discounted hospital care for patients who meet the hospital's own criteria. Hospitals recognized as tax-exempt under section 501(c)(3), often called nonprofit hospitals, must have a written policy for it, and some state laws cover others too. Our free financial assistance letter asks for the policy and form.

Each hospital sets its own limit. Of the 38 systems we read, 16 set free care at exactly 200% of the poverty guidelines (two more set it lower) and 30 offer some discount up to 400% or higher (hospital financial assistance income limits by health system).

Free care may be available up to 600% of the poverty guidelines at NYU Langone Health, 400% at Stanford Health Care, and 400% at Cedars-Sinai, each for eligible patients under its own policy.

Who decides

The hospital decides, under its written policy. Federal rules require a nonprofit hospital's policy to state who is eligible and what help it gives, but set no income level. Some states require screening first, and Colorado allows an appeal to the state.

Have insurance? Many policies allow help, and the federal charge limit applies either way. Try the charity care check.

State rules from official sources (checked October 11, 2026)

Each row is the minimum a law sets for the hospital's policy; a hospital may give more. Income means household income as a percentage of the federal poverty guidelines. We have not checked every state.

State and federal charity care minimums
Where and which hospitals	What the policy must give	Source
California: licensed general acute care, acute psychiatric and special hospitals, except those run by the state departments of State Hospitals, Developmental Services, and Corrections and Rehabilitation	The charity care or discount payment policy must cover uninsured patients, and patients with high medical costs (yearly out-of-pocket costs at that hospital, or documented out-of-pocket medical expenses paid anywhere in the past 12 months, above 10% of family income, as the law defines them), at or below 400%. Under the discount policy, the hospital expects no more than Medicare or Medi-Cal would pay, whichever is more. Rural hospitals may set a lower level. There is no time limit to apply, savings and other monetary assets are not counted (a narrow exception applies when the hospital waives Medicare cost sharing), and proof of income is limited to recent pay stubs or tax returns. The state's policy lookup has hospitals' policies and applications.	Health and Safety Code 127405 and 127400
Colorado: general acute care and critical access hospitals, freestanding emergency departments, and the health care professionals who provide services there	At or below 250%: charges are limited under Hospital Discounted Care (rates near 100% of Medicare or Medicaid, whichever is more), with a payment plan based on income. Generally for Colorado residents; patients do not have to be lawfully present in the US. Insured patients may ask to be screened by asking for financial assistance, and are screened within 45 days of asking. Hospitals must accept a request to be screened until at least the 181st day after the date of service or discharge, whichever is later. A patient may appeal a decision to the hospital within 30 days, then to the state agency within 15 days of the hospital's new decision.	Colorado HCPF: Hospital Discounted Care, questions and patient rights notice
Maryland: acute and chronic care hospitals under the jurisdiction of the state's Health Services Cost Review Commission	For patients with no coverage, or coverage that does not pay the full bill: free medically necessary care at or below 200%; 75% off from 201 to 250% and 60% off above 250 to 300%. Below 500%, when medical debt over 12 months is more than 25% of family income: reduced cost on a scale from 75% off down to 35% off. Free care is presumed for patients not eligible for Maryland's Medicaid or children's health program who get SNAP, WIC, energy assistance or benefits from another program the state names, or who live with a child in the free and reduced-cost meal program because of household income.	Health-General 19-214.1
New Jersey: all acute care hospitals	For New Jersey residents with no coverage, or coverage that pays only part of the bill, who are not eligible for Medicaid or other medical assistance and meet income and asset limits: the patient's share of the hospital bill is 0% at 200% or below, then 20%, 40%, 60% or 80% in steps up to 300%. Between 200% and 300%, when out-of-pocket medical expenses are more than 30% of gross yearly income, the amount above that may also be covered. Proof of New Jersey residency at the time of service is required; the state says non-residents may get help in some cases. Apply within one year of the date of service. Fees billed separately, such as private doctors' fees, may not be eligible for a reduction.	New Jersey Department of Health: Charity Care
New York: general hospitals	For patients who are uninsured or underinsured, or whose insurance benefits have run out: below 200%, all charges waived; 200 to 300%, at most 10% of what Medicaid would pay (for underinsured patients, 10% of their insurance cost sharing); 301 to 400%, at most 20%. Emergency care for New York residents; other medically necessary care for residents of the hospital's primary service area. Immigration status is not a criterion. Decision within 30 days of a complete application.	Public Health Law 2807-k, subdivision 9-a
Oregon: nonprofit hospitals and their nonprofit affiliated clinics (the discount levels); hospitals licensed in Oregon (the screening)	At nonprofit hospitals, the patient's share after insurance is reduced by 100% up to 200%, at least 75% above 200 to 300%, at least 50% above 300 to 350%, and at least 25% above 350 to 400%, for all medically necessary services and supplies. The policy may not require applying for Medicaid first. Every licensed hospital must screen patients who are uninsured, on the state medical assistance program, or owe more than a set amount for one hospital visit or stay, before sending a bill and without asking for documents.	ORS 442.614 and 442.615 and the screening rule, as published by the Oregon Health Authority
Washington: licensed hospitals, including behavioral health hospitals	The patient's share after insurance is free at or below 300%, 75% off from 301 to 350% and 50% off from 351 to 400% at hospitals in systems with three or more acute hospitals and some large hospitals; at other hospitals, free at or below 200%, 75% off from 201 to 250% and 50% off from 251 to 300%. A hospital may reduce the partial discounts for some assets.	RCW 70.170.060 and 70.170.020
Every state: nonprofit hospitals (those recognized as tax-exempt under section 501(c)(3), including government hospitals with that status)	No federal income level: the hospital's written policy sets its own criteria. The policy or its application form must list the documents the hospital may ask for, and the hospital may accept other evidence or a signed statement from the applicant. For patients it finds eligible, charges for emergency and other medically necessary care are limited to the amounts generally billed to people with insurance. At least 240 days to apply, counted from the first bill sent after you leave.	IRS: section 501(r)(4), 501(r)(5), 501(r)(6) and the 2014 rules

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The federal poverty figures behind the percentages

2026 HHS poverty guidelines, yearly household income
People in household	100%	200%	250%	300%	350%	400%
1	$15,960	$31,920	$39,900	$47,880	$55,860	$63,840
2	$21,640	$43,280	$54,100	$64,920	$75,740	$86,560
3	$27,320	$54,640	$68,300	$81,960	$95,620	$109,280
4	$33,000	$66,000	$82,500	$99,000	$115,500	$132,000
5	$38,680	$77,360	$96,700	$116,040	$135,380	$154,720
6	$44,360	$88,720	$110,900	$133,080	$155,260	$177,440
7	$50,040	$100,080	$125,100	$150,120	$175,140	$200,160
8	$55,720	$111,440	$139,300	$167,160	$195,020	$222,880
Each extra person	+$5,680	+$11,360	+$14,200	+$17,040	+$19,880	+$22,720

Figures for the 48 contiguous states and Washington, DC, from the US Department of Health and Human Services (Federal Register, January 15, 2026). Alaska and Hawaii have their own, higher figures (HHS poverty guidelines).

The hospital and any state rules decide how income and the household are counted and when figures start (Colorado: April 1).

What to have ready

A nonprofit hospital's policy or form must list the papers it may ask for, and it may not turn you down for leaving out anything else. Expect proof of household income. Some programs also ask about assets or residence, as New Jersey does.

How to apply

Look for the notice on your bill. Nonprofit hospitals must print one, with a phone number and web address.
Ask for the policy, the application form and the plain language summary. Our free letter asks for all three.
Send back the hospital's own form soon, with what it asks for, and keep copies.
Ask whether the doctors who billed you separately are covered. The policy, or a list it points to, must say which are.
Ask for the decision in writing. If you are turned down, ask why and how to appeal or reapply.

Nonprofit hospitals must accept applications for at least 240 days after the first bill sent after you leave. Already paid? Read refund after hospital financial assistance.

Other discounts and free help

Ask too about self-pay or prompt-pay discounts, which hospitals may offer outside the policy. Dollar For, a nonprofit, helps people apply for hospital financial assistance for free (dollarfor.org). California's Hospital Fair Billing Program takes complaints from people denied financial assistance, and Maryland's Health Education and Advocacy Unit can help you ask a hospital to reconsider.

Check the bill itself

Charity care may lower what you owe, but it does not check the charges. Open your bill in MedBillCheckup: it is read free on your device. The free check shows how many things are worth asking about, and the largest amount worth asking about, if any. The full list, which is paid, shows every item, why, and the exact question to ask.

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