Charity care in Massachusetts: who gets free or discounted care
Massachusetts has a law that requires hospitals to give free or discounted care to people with income up to 300% of the federal poverty level.
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 Massachusetts
| Income (% of poverty level) | What you get | Details |
|---|---|---|
| Up to 150% | Free care | If your household income (counted the MassHealth way) is at or below 150% of the federal poverty level, the Health Safety Net pays for eligible services at the hospital or health center, with no deductible. You may still owe small copays for some services such as pharmacy. |
| 150% to 300% | Discount | If your household income is above 150% and up to 300% of the federal poverty level, you are 'Health Safety Net - Partial': you pay a yearly deductible first (the greater of the lowest ConnectorCare premium, adjusted for family size, or 40% of the difference between your family's income and 200% of the poverty level), and the Health Safety Net pays for eligible services above it. |
These are the income levels written in the law. Each hospital decides using its own policy.
- The law
Health Safety Net
Law: 101 CMR 613.00; 101 CMR 613.02, 613.04, 613.05, 613.08 (M.G.L. c. 118E)
- Which hospitals
All acute care hospitals and community health centers that are paid by the Health Safety Net, including for-profit hospitals. Hospital-licensed health centers and satellite clinics are included.
- Who can get help
Massachusetts residents. Uninsured people can get Health Safety Net - Primary and people with other insurance can get Health Safety Net - Secondary. You apply through the MassHealth application. People who were found eligible for MassHealth but did not enroll, or whose coverage ended for not paying premiums, cannot qualify. Any resident with very high medical bills compared to income may also apply for one-time Medical Hardship help.
- The most you can be charged
If you are a Low Income Patient, the hospital or health center may not bill you for Health Safety Net-covered services from your eligibility period except copays and deductibles. Under Medical Hardship, you pay only a set share of your income (10% to 40% depending on income), and the provider may not collect more than that share.
- Savings and other assets
Health Safety Net uses MassHealth income rules. An asset check may apply only when MassHealth asks for one under its own rules (for example for some older applicants).
- Who counts as your family
Household size and income are counted using the MassHealth MAGI household rules (or Medical Hardship family rules).
Law: 101 CMR 613.02, 613.04, 613.05, 613.08 (M.G.L. c. 118E)
How to apply in Massachusetts
- Deadline to apply
Low Income Patient status lasts up to 1 year from the date it is approved and covers services from that date on. A Medical Hardship application can include bills from the 12 months before you apply.
- Screening for help
Hospitals and health centers must tell you about financial assistance, MassHealth, ConnectorCare and Medical Hardship when you first register, on every bill, and when they learn your coverage changed. A provider may also find you presumptively eligible for a short time based on what you tell it.
Law: 101 CMR 613.04(4), 613.08(1)(e); 101 CMR 613.02, 613.04, 613.05, 613.08 (M.G.L. c. 118E)
- Applying for coverage first
You apply for Health Safety Net through the MassHealth application, and MassHealth decides whether you get MassHealth, Marketplace help or Health Safety Net. If you can get affordable insurance (including through an employer), you cannot get Health Safety Net - Primary.
- Notice you must get
Hospitals and health centers must notify you about financial assistance at registration, on all bills and in all written collection notices, post signs in admitting, emergency, clinic and business office areas (translated into any language that is the main language of 10% or more of residents in the service area), and post their credit and collection policy on their website.
- If you disagree
You can ask the Health Safety Net Office to review a decision on your Low Income Patient status, a provider's compliance with the rules, or a Medical Hardship decision (within 6 months, if circumstances outside your control affected it). Send a written request with documents; the Office gives a first response within 30 days.
Source: within 30 days of the notice
- Other providers
Community health centers are covered. Acute hospitals must keep a list of affiliated doctors and groups that work in the hospital and say which of their services the Health Safety Net covers.
Law: 101 CMR 613.02, 613.04, 613.05, 613.08 (M.G.L. c. 118E)
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 Massachusetts law.
Free tools, letters and checklist
Where to complain in Massachusetts
- Hospital bills and financial assistance: Health Safety Net Office (Executive Office of Health and Human Services) · 1-877-910-2100
You disagree with a Health Safety Net or Medical Hardship decision, or a hospital or health center billed you when the rules say it should not. - Attorney general: Massachusetts Attorney General, Health Care Division Helpline · 617-963-2100
Problems with medical bills, health insurance or health care providers. - Health insurance: Massachusetts Division of Insurance, Consumer Services Unit · 1-877-563-4467
Problems with a Massachusetts-regulated health insurance plan. - Debt collectors: Massachusetts Attorney General, Consumer Advocacy and Response Division · 617-727-8400
A debt collector broke state debt collection rules.
Questions about medical bills in Massachusetts
Does Massachusetts require hospitals to give free or discounted care?
Massachusetts has a law that requires hospitals to give free or discounted care to people with income up to 300% of the federal poverty level.
Who counts as family for charity care in Massachusetts?
Household size and income are counted using the MassHealth MAGI household rules (or Medical Hardship family rules).