A growing web of federal and state laws requires hospitals to screen patients for financial assistance and limits what unaffordable medical debt can do to people's lives. Today, most of that protection lives in paperwork, mailed notices, and manual review. AffordPath turns those rules into structured, automated data — so patients actually get the help the law already entitles them to.
Every law below was written to help patients. But eligibility screening still runs on paper applications, mailed notices, faxed pay stubs, and staff working through backlogs by hand. Patients miss deadlines they never saw. Hospitals struggle to prove compliance. Assistance that was legally required never reaches the person who needed it.
AffordPath is the enabling layer. We take the same federal and state rules, encode them, and apply them automatically to each patient — converting a slow, error-prone paper trail into a clear, instant, documented result.
Federal law sets baseline requirements for nonprofit hospitals and protects patients from surprise bills. AffordPath builds these rules directly into every screening.
Every tax-exempt hospital must maintain a written Financial Assistance Policy, publicize it (including translations for limited-English patients), limit charges for eligible patients to no more than the "Amounts Generally Billed" to insured patients, and make reasonable efforts to determine eligibility before pursuing aggressive collections like lawsuits, liens, or wage garnishment.
Since January 2022, most privately insured patients are protected from surprise out-of-network bills for emergency care and certain in-network facility care. Providers must also give uninsured and self-pay patients a good-faith estimate of expected charges, with a dispute process when the final bill is substantially higher.
Since 2014, states may authorize qualified hospitals to make temporary, presumptive Medicaid eligibility determinations — enrolling patients who appear to qualify right away, rather than leaving them to charity care alone. AffordPath's screening logic is designed to surface these coverage paths first.
Federal action on medical debt in credit reports has shifted. A 2025 federal rule that would have removed most medical debt from credit reports was vacated by a federal court in July 2025 and is not in effect. Separately, the three national credit bureaus' voluntary policies — removing paid medical collections, delaying reporting for a year, and excluding unpaid balances under $500 — remain in force nationwide.
Federal agencies have flagged concerns that high-interest medical credit cards and point-of-care financing can be pushed on patients instead of the financial assistance they're legally entitled to. AffordPath's model is to determine legally required assistance first — before any financing is ever discussed.
States regulate hospitals directly and have moved well beyond the federal floor, filling gaps that federal law leaves. Because these rules differ by state and change often, AffordPath maintains them so providers don't have to track every change in every state. Below are representative examples.
The Hospital Fair Pricing Act requires financial-assistance screening; AB 1020 raised eligibility to 400% of the Federal Poverty Level, restricted patient-debt sales, and extended the window before adverse credit reporting or a collection lawsuit.
CA HCAI — Hospital Fair BillingHospital Discounted Care requires screening every uninsured patient before billing and caps charges and payment plans by income. Colorado was the first state to ban medical debt from credit reports (HB23-1126) and caps medical-debt interest at 3%.
CO — HB23-1126The Fair Medical Debt Reporting Act bars reporting medical debt to credit bureaus. New York's Hospital Financial Assistance Law mandates a standardized application, extends eligibility to 400% FPL, and bars suing patients under that threshold.
NY AG — Medical DebtThe Hospital Uninsured Patient Discount Act requires screening for public coverage and assistance, permits collections only after screening and a reasonable payment plan, and gives patients time after discharge to apply. Illinois also bans medical debt from credit reports.
IL — 210 ILCS 89The Charity Care Act requires hospitals to identify patients who may qualify for Medicaid or charity care and bars denying emergency care based on ability to pay. Washington enacted a medical-debt credit-reporting ban effective July 2025.
WA — RCW 70.170.060HB 3320 requires screening patients for presumptive financial-assistance eligibility before direct billing in specified cases, keeps eligibility active for 12 months, and mandates an easy appeals process. A 2025 law bans medical-debt credit reporting effective January 2026.
OR — HB 3320 SummaryNonprofit hospitals must report financial-assistance and community-benefit activity to the state, and must report how many patient accounts are referred to extraordinary collections. Maryland passed medical-debt credit-reporting bans in 2025.
Commonwealth Fund — State ProtectionsEvery acute-care hospital must treat patients regardless of ability to pay. The Hospital Care Payment Assistance ("Charity Care") program grants free care up to 200% FPL and sliding-scale discounts up to 300% FPL, after screening for other coverage.
NJ DOH — Charity CareHospitals holding "bed funds" must offer assistance from them and wait at least 120 days before collections. Public Act 24-6 (July 2024) prohibits reporting any medical debt to credit agencies and voids debt that is reported anyway.
CT — Public Act 24-6Maine requires free care up to 200% FPL and affordable payment plans up to 400% FPL, with enhanced requirements taking effect in July 2026. Maine also enacted a medical-debt credit-reporting ban and unfair-collection-practice restrictions.
ME — P.L. 663The patient-protection landscape is expanding every year — which makes automated, always-current rules more valuable, not less.
Sources: Commonwealth Fund (2025), National Consumer Law Center. This page is a plain-language summary for general information and is not legal or tax advice; rules change and vary by state.
AffordPath encodes federal and state assistance rules and applies them automatically — so patients get the help the law already promises, and providers get the documentation they need.