Charity care, in plain words
That's all charity care is. "Charity" is the old word; the current one is a financial assistance policy — a written document every nonprofit hospital must keep, saying exactly who gets free care, who gets a discount, and how to apply. Section 501(r) of the federal tax code is the rule that forces it to exist. Most patients never see the document. This page is the document, translated.
A nonprofit hospital pays no income tax and can issue tax-free bonds — a public subsidy worth billions across the industry. In exchange, the law asks for community benefit, and since the Affordable Care Act added section 501(r), part of that benefit is specific and enforceable: a written financial assistance policy, publicized; charges capped for eligible patients; and strict limits on how hard the hospital may collect before you have had a fair chance to apply. A hospital that ignores 501(r) risks its tax exemption — which is why an IRS Form 13909 complaint (the kit walks it) gets attention.
Section 501(r) binds nonprofit (tax-exempt) hospitals only. Government hospitals (county, university, public systems) run their own mandated programs. For-profit hospitals owe no federal FAP — but many publish assistance policies anyway, and several states (California, Washington, New York, New Jersey, Maryland, Maine, Colorado, Illinois) wrote their own laws reaching all hospitals. Never assume; check your state and ask for the policy by name.
Some states (California from July 2027, Delaware, Illinois, Maryland, North Carolina, Oregon) make hospitals screen patients who look eligible — benefit enrollment, homelessness, income databases — and grant help without a form. Wonderful when it works. Two gaps: screens miss people (wrong address, new poverty, income the database can't see), and a screen-based denial leaves you nothing to appeal. The written application creates a record, a decision, and duties. Why we teach: always file.
The honest free alternative: Dollar For is a national nonprofit that helps patients apply for hospital financial assistance free of charge, and reports clearing over $120 million of hospital debt for 36,000+ patients. If your situation is straightforward and you have time, start there. This site and its kit exist for the people who want the whole map in their own hands — every deadline counted, every state rule cited, application, errors, negotiation, escalation — tonight.
Get the HospitalBillDecoded Kit — $49
One payment of $49. No subscription. The kit is a web page you can return to and print — the application pack, the error checklist, the scripts, the deadline tracker, and the escalation ladder.
No. Free care commonly runs to 200% of the federal poverty guidelines (about $66,000 for a family of four in 2026), and some states go much further — Washington's large hospitals give free care to 300% (about $99,000 for four), Illinois requires discounts to 600%. Working families qualify every day. They just aren't told.
Often, yes. Many policies cover the underinsured — people whose deductible and coinsurance exceed what they can pay — and several state laws (New York's, for one) define eligibility to include anyone whose medical costs passed 10% of income. A bill you cannot pay is the test, not the absence of an insurance card.
Neither. It is the hospital's own write-off, required as a condition of the tax exemption nonprofit hospitals enjoy. No repayment, no interest, no effect on immigration status where state law says so (New York's law bars using it as a criterion).
Screening ('presumptive eligibility') is the hospital checking databases instead of asking you. It helps many people — in Oregon most assisted patients never filed a form — but the federal duties, including returning money you already paid, are written around a submitted application. File the form anyway. It takes an afternoon; the protections last.