Hospital charity care in California

Since January 1, 2025, California law requires that any uninsured patient — or any patient with "high medical costs," meaning their bill exceeds what they'd otherwise pay with third-party coverage — be eligible to apply for charity care or a discount payment policy if their family income is at or below 400% of the federal poverty level. Before 2025, the line was 350%. Hospitals remain free to set a more generous cutoff for higher incomes, and rural hospitals are allowed to set a lower threshold than 400% if needed to protect their financial and operational integrity.

That 400% line is the ceiling for who must be allowed to apply — it isn't automatically a promise of 100% free care. Individual hospitals still set their own tiers below that line; for example, some hospitals offer full free care up to roughly 200–300% of FPL and a sliding-scale discount from there up to 400%. Always check the specific hospital's published policy for its tiers.

A package of 2025 amendments added patient protections that go well beyond the federal 501(r) floor. As of January 1, 2025, California hospitals and emergency physicians are prohibited from:

• Considering monetary assets

  Eligibility must be based on income — though a hospital may still consider whether you have funds available in a Health Savings Account.

  Banned

• Imposing application deadlines

  Hospitals can't set a cutoff date by which you must apply for charity care or a discount.

  Banned

• Denying based on application timing

  You can't be turned down solely because of when you submitted your application.

  Banned

• Reporting you to credit bureaus

  Hospitals and emergency physicians can't report adverse information about your hospital debt to a consumer credit reporting agency.

  Banned

• Placing liens on your home

  Real-property liens can no longer be used as a method of collecting unpaid hospital or ER physician bills.

  Banned

Debt sales are also restricted: a hospital generally can't sell your unpaid bill to a debt buyer unless it has already determined you're ineligible for financial assistance, or you haven't responded to billing and assistance outreach for at least 180 days. That same 180-day mark — up from 150 days under the prior law — is now the earliest point a hospital can report adverse information or begin a civil action over an unpaid bill. Debt collectors must also certify that you were screened for public coverage programs and financial assistance before they can file a lawsuit against you.

HCAI (formerly OSHPD) collects a copy of every licensed hospital's charity care policy, discount payment policy, eligibility procedures, review process, and application form, and makes them publicly available through its Hospital Fair Billing Program. That's the most reliable way to confirm a specific hospital's actual income tiers rather than relying on general statewide ranges.