Hospital charity care in Massachusetts
Massachusetts has some of the strongest charity care laws in the country, combining federal 501(r) requirements with a state-funded Health Safety Net program that supplements hospital charity care and requires hospitals to proactively screen all patients — not just those who ask.
Health Safety Net (HSN)
Massachusetts's Health Safety Net reimburses hospitals and community health centers for services provided to low-income uninsured and underinsured residents, supplementing standard charity care programs.
Up to 400% FPL
The HSN covers patients at or below 400% of the federal poverty level, with different benefit tiers depending on income and insurance status.
Proactive screening required
Massachusetts hospitals must screen all patients for eligibility for public programs and financial assistance — you don't have to know to ask.
All acute care hospitals
All licensed acute care hospitals in Massachusetts must participate in the Health Safety Net program.
Who qualifies for free or reduced care in Massachusetts
Massachusetts uses both the federal 501(r) framework and the state Health Safety Net to provide layered protections. The HSN has its own income tiers:
| Income level | Typical benefit |
|---|---|
| Under 100% FPL ($15,960 for 1 person) | Full coverage through HSN |
| 100%–300% FPL | Sliding-scale HSN coverage |
| 300%–400% FPL | Partial assistance, varies by hospital |
| Above 400% FPL | Depends on individual hospital policy |
The HSN is separate from — and in addition to — each hospital's own charity care program under 501(r). Patients may qualify for both, and hospitals are required to apply whichever benefit is more favorable to the patient.
How the Health Safety Net works alongside hospital charity care
- Required
Proactive patient screening
Hospitals must screen every patient for eligibility for MassHealth, ConnectorCare, and the Health Safety Net — whether or not the patient asks.
- Protected
Retroactive eligibility
Patients can apply for HSN coverage retroactively for services already received, even after a bill has been issued.
- Protected
No immigration status barrier
The Health Safety Net does not require immigration documentation for coverage — eligibility is based on income and Massachusetts residency.
- Your right
Appeal rights
Patients have the right to appeal a denial of HSN benefits through the Health Safety Net Office.
MassHealth first
Before applying for hospital charity care in Massachusetts, hospitals are required to screen you for MassHealth (Medicaid) eligibility. If you qualify for MassHealth, that covers your bills more comprehensively than charity care. The HSN then covers any remaining gaps for those who don't qualify for MassHealth.
How to look up a specific hospital's rules
The Massachusetts Health Safety Net Office, operated by the Health Policy Commission, oversees the program. You can find information at mass.gov/health-safety-net. For individual hospital charity care policies, search the hospital's name plus "financial assistance policy" — all nonprofit hospitals must post this publicly. You can also ask the hospital's financial counselor directly about both the hospital's own charity care program and HSN eligibility in a single conversation.
Where this page's claims come from
- 1.Massachusetts Health Safety Net — mass.gov — mass.gov
- 2.MA Health Policy Commission, HSN regulations — mass.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's health department or the specific hospital's financial assistance office before relying on this page for a decision.