Hospital charity care in Maryland
Maryland operates the only all-payer hospital rate-setting system in the United States — meaning the state government, not individual hospitals or insurers, sets the prices hospitals charge everyone. This unique system also shapes charity care: hospitals must provide free care to patients under 200% FPL, enforced by the Health Services Cost Review Commission (HSCRC).
All-payer rate setting
Maryland is the only state with an all-payer system where the HSCRC sets what hospitals can charge all payers — Medicare, Medicaid, private insurance, and self-pay patients alike.
HSCRC
The Health Services Cost Review Commission reviews and approves hospital rates and enforces charity care requirements, giving Maryland's system real enforcement teeth.
Under 200% FPL
Maryland hospitals must provide free care to patients at or below 200% of the federal poverty level under HSCRC requirements.
All acute care hospitals
Maryland's all-payer system and HSCRC oversight apply to virtually all acute care hospitals in the state.
Maryland charity care income thresholds
Maryland's HSCRC sets charity care requirements that hospitals must follow as a condition of their rate approvals:
| Income level | Required benefit |
|---|---|
| Under 200% FPL (~$31,920 for 1 person) | Free care required |
| 200%–300% FPL | Sliding-scale discount — varies by hospital |
| Above 300% FPL | Depends on individual hospital policy |
For 2026, 200% FPL for a family of four is $66,000 per year. Maryland's largest systems — Johns Hopkins Medicine, MedStar Health, and University of Maryland Medical System — all maintain financial assistance programs that typically extend well above the state minimum. Check the specific hospital's published policy for exact tiers.
How Maryland's all-payer system protects patients
- Enforced
HSCRC enforcement
Unlike most states where charity care obligations are self-reported, Maryland's HSCRC actively reviews hospital compliance as part of rate-setting oversight.
- Standardized
Uniform billing standards
Maryland's all-payer system means self-pay patients are charged the same rate as insured patients — preventing the inflated 'chargemaster' rates common elsewhere.
- Required
Free care under 200% FPL
HSCRC requirements mandate free care for patients at or below 200% FPL at all participating hospitals.
- Federal right
240-day federal window
Nonprofit hospitals must also observe the federal 240-day window before collections or adverse credit reporting.
Maryland Medicaid (HealthChoice) first
Maryland expanded Medicaid under the ACA through its HealthChoice managed care program. Before applying for charity care, check if you qualify for Maryland Medicaid — especially if you have children, are pregnant, or are over 65. If you qualify, HealthChoice will cover your bills more comprehensively than charity care.
How to look up a specific hospital's rules
The Maryland HSCRC publishes hospital financial data and oversees charity care compliance at hscrc.maryland.gov. To find your specific hospital's Financial Assistance Policy, search the hospital name plus "financial assistance policy" online. For Johns Hopkins, MedStar, or UMMS, their financial assistance pages are easy to find on their respective websites. You can also call the hospital billing department and ask for the "financial assistance application" or "charity care application."
Where this page's claims come from
- 1.Maryland HSCRC — Health Services Cost Review Commission — hscrc.maryland.gov
- 2.HSCRC, Uncompensated Care and Charity Care Policy — hscrc.maryland.gov
- 3.IRS Section 501(r) Requirements for Nonprofit Hospitals — irs.gov
General information, not legal advice
State law and hospital policies change regularly. Confirm current details with your state health department or the specific hospital's financial assistance office.