Charity care: how to ask a hospital for financial assistance

What is charity care?

Charity care is free or discounted hospital care for people who cannot afford their bill. Hospitals usually call it financial assistance. Each hospital writes down who qualifies and how much help they get in its financial assistance policy.

You can ask for it before care, while you are in the hospital or after the bill arrives.

Which hospitals have to offer it?

Every nonprofit hospital. Federal tax law (section 501(r)) sets requirements for each nonprofit hospital, including a written financial assistance policy, limits on charges and limits on collections, and a hospital that breaks them can lose its tax exemption Source 11. Most US community hospitals are nonprofits. Their share is 58% (American Hospital Association, Fast Facts on U.S. Hospitals 2026, FY2024).

The policy must cover all emergency care and other medically necessary care, say who qualifies and explain how to apply Source 33.

For-profit and government hospitals are not covered by these federal rules, though state law may still apply to them Source 11. Ask any hospital whether it offers financial assistance.

Who qualifies?

There is no national income limit. Federal law leaves the rules to each hospital, and some states set their own Source 33. Many policies cover people with low and middle incomes, so ask even if you think you earn too much.

Two states with clear rules:

• California. Hospitals must offer charity care or a discount to uninsured patients, and to patients with high medical costs, when family income is at or under a set share of the federal poverty guidelines. That share is 400% (California HCAI, Hospital Fair Billing Program, Effective January 1, 2022) State law; check the effective date and the hospital's own policy. Last checked November 2, 2026.
• Washington. Hospitals must give full charity care, and discounts above that, up to income limits that depend on the size of the hospital. At larger hospitals, the income limit for full charity care is 300% (Revised Code of Washington 70.170.060, Care from July 1, 2022) State law; check the effective date and the hospital's own policy. Last checked November 2, 2026. The law sets separate, higher limits for discounts and lower limits for smaller hospitals Source 77.

Having insurance does not always rule you out. California's rule, for example, also covers patients with high medical costs.

The federal poverty guidelines

The state rules above measure income as a share of these guidelines. If your hospital's policy does too, the table helps you see where your household stands. The hospital may use a different year or count your household differently, and it makes the final decision.

How to apply, step by step

1. Get the policy and the application. Ask the billing office or a financial counselor, or look on the hospital's website. A nonprofit hospital must post them online for free with no account needed, hand out free paper copies, give a plain-language summary when you are admitted or discharged and mention the policy on its bills Source 33.
2. Ask for your language. The hospital must translate these papers for each language group in its community that reaches a set size. A group always counts once it reaches 1,000 (IRS, published July 3, 2026). A smaller group also counts when its share of the community is at least 5% (IRS, published July 3, 2026).
3. Fill it in and attach the proof it asks for. This is usually proof of income, such as pay stubs or a tax return. Keep copies of everything.
4. Send it as soon as you can. A nonprofit hospital must accept applications for a set time after the first bill sent after you leave. That time is at least 240 days (IRS, published July 2, 2026). Many accept later ones too, and some states allow more time Source 55.
5. Ask the hospital to pause collection while it decides. Write down who you spoke with and when.

What the hospital cannot do while it decides

Once a nonprofit hospital has your complete application, it must stop extraordinary collection actions and make a decision Source 55. Those actions include selling the debt, reporting it to a credit bureau, and legal steps such as a lien, a lawsuit or a wage garnishment Source 55.

Even before you apply, a nonprofit hospital must wait after the first bill before it takes any of these actions. The wait is at least 120 days (IRS, published July 2, 2026).

Can a hospital decide I qualify without an application?

Sometimes, yes. A nonprofit hospital may decide that you qualify for financial assistance without an application, using information you did not give it, such as your enrollment in a public benefits program, or an earlier decision that you qualified. This is called presumptive eligibility. If the hospital gives you less than its most generous help this way, it must tell you why and how to apply for more, and give you a reasonable time to apply before any extraordinary collection action Source 88.

Some states go further:

• Illinois. State law has the Attorney General set, by rule, the methods hospitals use to find patients presumptively eligible, and a hospital may not bill an uninsured patient whose financial assistance screening shows a household income that qualifies for free care (210 ILCS 88/27).
• California. A state law that has not taken effect yet will require hospitals to screen patients for financial assistance and to presume that patients enrolled in certain public benefit programs qualify, as the state agency's notice to hospitals describes it (HCAI).

Ask the billing office whether it screens patients automatically and whether you were screened. If you are enrolled in a public benefits program, say so and send proof: it may be all the hospital needs.

If you qualify

• Lower charges. For emergency or medically necessary care, the hospital may not charge you more than the amounts generally billed to people with insurance Source 44.
• Money back. It must refund what you already paid above what you owe, unless the difference is less than $5 (IRS, published July 2, 2026), and take reasonable steps to undo collection actions Source 55.

If the hospital says no

Ask for the decision and the reason in writing. Check the reason against the policy, and send anything that was missing. Ask whether you qualify for a partial discount, then ask about a payment plan for what is left. Our guide on how to negotiate a medical bill covers the next steps.

Does applying affect my immigration status?

This guide doesn't answer immigration questions. Our separate guide on immigration status and medical bills will cover these questions once an immigration attorney has reviewed it. For advice about your own case, talk to an immigration attorney or a nonprofit immigration legal service; the US Department of Justice keeps a list of recognized organizations.