Charity care in Maryland: who gets free or discounted care
Maryland has a law that requires hospitals to give free or discounted care to people with income up to 300% of the federal poverty level (the exact level depends on the hospital and your situation).
Charity care means free or discounted care for people with low income. Hospitals also call it financial assistance.
Checked against official sources: October 30, 2026.
What the law says in Maryland
| Income (% of poverty level) | What you get | Details |
|---|---|---|
| Up to 200% | Free care | If your family income is at or below 200% of the federal poverty level, the hospital must give you medically necessary care for free. All covered hospitals |
| 201% to 250% | Discount | If your family income is from 201% to 250% of the federal poverty level, the hospital must cut what you owe out of pocket by at least 75%. All covered hospitals |
| 251% to 300% | Discount | If your family income is above 250% and up to 300% of the federal poverty level, the hospital must cut what you owe out of pocket by at least 60%. All covered hospitals |
| 301% to 350% | Discount | If you have a financial hardship (medical debt over 12 months that is more than 25% of family income) and your family income is above 300% and up to 350% of the poverty level, the hospital must cut your out-of-pocket costs by at least 50%. All covered hospitals, for patients with a financial hardship |
| 351% to 400% | Discount | With a financial hardship and family income above 350% and up to 400% of the poverty level, the cut is at least 45%. All covered hospitals, for patients with a financial hardship |
| 401% to 450% | Discount | With a financial hardship and family income above 400% and up to 450% of the poverty level, the cut is at least 40%. All covered hospitals, for patients with a financial hardship |
| 451% to 500% | Discount | With a financial hardship and family income above 450% and up to 500% of the poverty level, the cut is at least 35%. All covered hospitals, for patients with a financial hardship |
These are the income levels written in the law. Each hospital decides using its own policy.
- The law
Maryland hospital financial assistance law (free and reduced-cost care), enforced by the Health Services Cost Review Commission (HSCRC)
- Which hospitals
Every acute care hospital and chronic care hospital in Maryland under the jurisdiction of the Health Services Cost Review Commission (HSCRC), not only nonprofit hospitals. The rules cover hospital services the HSCRC regulates; doctors' bills are billed separately.
- Who can get help
Patients without health coverage, and patients whose insurance does not pay the full hospital bill. Under HSCRC rules, hospitals must give free and reduced-cost care to all qualified Maryland residents, whatever their citizenship or immigration status and even if they live outside the hospital's service area. The policy covers all medically necessary hospital care, including non-urgent or elective care that is medically necessary.
- The most you can be charged
If you qualify for free or reduced-cost care, the hospital may not collect fees or any amount above the charge for the service approved by the HSCRC.
- Savings and other assets
Limited. A hospital may count only household money assets (such as cash, bank and investment accounts) above $100,000. Retirement accounts with special tax treatment are not counted.
- Who counts as your family
For an adult, the household includes at least you, your spouse (whether or not you file taxes jointly), your biological, adopted or step children, and anyone you claim on your tax return. For a child, it includes the child, parents or stepparents or guardians, brothers and sisters (including adopted and step), and anyone the parents claim on their tax return.
Law: Md. Code, Health-General 19-214.1, 19-214.2, 19-214.3; COMAR 10.37.13.06
How to apply in Maryland
- Deadline to apply
You have up to 240 days after the day you receive the first hospital bill to apply. The hospital must also consider changes in your finances during those 240 days if you tell it before the period ends.
- Screening for help
The hospital must check whether you have insurance, whether you are presumed eligible for free care, and whether you could get public or private coverage, and use information it already has to decide if you qualify. Once you turn in a complete application, it must decide within 14 days and pause billing and collection while it decides. It may not sue you until it has decided whether you qualify.
Law: Md. Code, Health-General 19-214.1(h), 19-214.2(f)(6); Md. Code, Health-General 19-214.1, 19-214.2, 19-214.3; COMAR 10.37.13.06
- Applying for coverage first
The hospital must check whether an uninsured patient could get public or private insurance and, where practical, help you apply if you choose to. If you are eligible for Medicaid or the Maryland Children's Health Program, the presumed-eligibility rule for free care does not apply.
- Notice you must get
Before you leave the hospital, and in every collection letter, the hospital must tell you about its financial assistance policy and that you have 240 days after the first bill to apply, and must get your signed acknowledgment before discharge. It must give you a plain-language information sheet before scheduled care, before discharge, with the bill, on request and with every collection letter. Notices must be posted in the hospital, including the billing office, in simple language in your preferred language or in each language spoken by at least 5% of the local population.
- If you disagree
You can ask the hospital to reconsider a denial. The Health Education and Advocacy Unit of the Maryland Attorney General can help you file and mediate the request. You can also file a complaint with the HSCRC, alone or together with that unit.
- Refunds
If you are found eligible for free care within 240 days after the first bill, the hospital must refund amounts over $25 that it collected from you, within 30 days after deciding you are eligible. If it sued you or reported you to a credit bureau, it must try to undo the judgment or remove the report.
- Other providers
The state financial assistance rules apply to hospital services regulated by the HSCRC, not to separate doctors' bills. Maryland's ban on reporting medical debt to credit bureaus covers all medical providers, including ambulance services.
- Find a hospital's policy
Law: Md. Code, Health-General 19-214.1, 19-214.2, 19-214.3; COMAR 10.37.13.06
Check your income level
Find out what percent of the federal poverty level your household income is, and compare it with the income levels in Maryland law.
Free tools, letters and checklist
Where to complain in Maryland
- Hospital bills and financial assistance: Health Services Cost Review Commission (HSCRC) · 410-764-2605
A hospital did not follow Maryland's financial assistance, payment plan, billing or debt collection rules. Complaints go by email to hscrc.patient-complaints@maryland.gov. - Attorney general: Maryland Attorney General, Health Education and Advocacy Unit (HEAU) · 410-528-1840 (toll free 1-877-261-8807)
Help with a medical bill dispute, a financial assistance reconsideration request or a surprise bill; it can file a complaint jointly with the HSCRC and mediate. - Health insurance: Maryland Insurance Administration · 1-800-492-6116
Problems with a state-regulated health insurer or HMO, including balance bills and ambulance bills. - Debt collectors: Maryland Office of Financial Regulation · 410-230-6077
A collection agency broke Maryland collection rules.
Questions about medical bills in Maryland
Does Maryland require hospitals to give free or discounted care?
Maryland has a law that requires hospitals to give free or discounted care to people with income up to 300% of the federal poverty level (the exact level depends on the hospital and your situation).
Who counts as family for charity care in Maryland?
For an adult, the household includes at least you, your spouse (whether or not you file taxes jointly), your biological, adopted or step children, and anyone you claim on your tax return. For a child, it includes the child, parents or stepparents or guardians, brothers and sisters (including adopted and step), and anyone the parents claim on their tax return.