Charity care in Texas: who gets free or discounted care

Texas has a state charity-care law, but it does not set one income limit: each hospital's policy decides who gets free or discounted care.

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 Texas

The law

Nonprofit hospital community benefits and charity care law

Law: Texas Health and Safety Code chapter 311, subchapter D; Tex. Health & Safety Code 311.031(7), (11), (13); Tex. Health & Safety Code 311.042; Tex. Health & Safety Code 311.043; Tex. Health & Safety Code 311.045; Tex. Health & Safety Code 311.046(d); Tex. Health & Safety Code 324.101(a), (c), (i); Tex. Health & Safety Code 324.102

Which hospitals

Nonprofit hospitals and nonprofit hospital systems (hospitals that are tax-exempt or eligible for tax-exempt bonds and organized as a nonprofit or charitable trust). For-profit hospitals are not covered by this rule.

Who can get help

People the hospital classifies as "financially indigent" (uninsured or underinsured people accepted for free or discounted care under the hospital's eligibility system) or "medically indigent" (your hospital or medical bills left after insurance are more than a share of your yearly income set by the hospital, and you can't pay them). Each nonprofit hospital sets its own income levels, tied to the federal poverty guidelines. For financially indigent patients, the hospital's income level may not be set higher than 200% of the poverty guidelines or lower than the level counties must use for county indigent health care.

Savings and other assets

The law says each hospital's eligibility system must use income levels and means testing tied to the federal poverty guidelines. Each hospital sets the details.

Law: Tex. Health & Safety Code 311.031(7), (11), (13); Tex. Health & Safety Code 311.042; Tex. Health & Safety Code 311.043; Tex. Health & Safety Code 311.045; Tex. Health & Safety Code 311.046(d); Tex. Health & Safety Code 324.101(a), (c), (i); Tex. Health & Safety Code 324.102

How to apply in Texas

Deadline to apply

No state deadline. A hospital may decide that you are financially or medically indigent after you get care.

Notice you must get

Each hospital covered by the charity care law must tell every person who seeks care about its charity care program, its eligibility rules and how to apply, in appropriate languages if possible, and must post the notice in the general and emergency waiting areas and the business office. Hospitals, surgery centers, birthing centers and freestanding emergency rooms must also have written billing policies that cover discounts for uninsured patients and for low-income patients under a sliding fee scale or charity care policy, and must post a notice in waiting, registration, admission and business office areas that these policies are available.

If you disagree

Each facility must have a complaint process and try to resolve your complaint informally. If it can't, it must tell you that you can complain to the state health agency and give you the address and phone number.

Refunds

If you overpay a hospital or other covered facility, it must refund the overpayment within 30 days after it determines you overpaid.

Other providers

Counties must run an indigent health care program for eligible low-income residents who do not live in the area of a public hospital or hospital district.

Law: Texas Health and Safety Code chapter 61; Tex. Health & Safety Code 311.031(7), (11), (13); Tex. Health & Safety Code 311.042; Tex. Health & Safety Code 311.043; Tex. Health & Safety Code 311.045; Tex. Health & Safety Code 311.046(d); Tex. Health & Safety Code 324.101(a), (c), (i); Tex. Health & Safety Code 324.102

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 Texas law.

Free tools, letters and checklist

Where to complain in Texas

Health insurance: Texas Department of Insurance · 1-800-252-3439
A state-regulated health plan denied a claim, or you got a surprise bill or out-of-network ambulance bill the state law protects you from.
Hospital licensing: Texas Health and Human Services Commission, Health Care Facilities Regulation (complaint hotline) · 1-800-458-9858
A hospital or other licensed facility did not follow state billing rules, such as the itemized bill rules.
Attorney general: Texas Attorney General, Consumer Protection Division
A debt collector or business used unfair or deceptive practices.

Questions about medical bills in Texas

Does Texas require hospitals to give free or discounted care?

Texas has a state charity-care law, but it does not set one income limit: each hospital's policy decides who gets free or discounted care.

Nearby states

National rules that apply in every state

Nonprofit hospitals (federal rules)

Each nonprofit hospital must have a written financial assistance policy (FAP).

Law: 26 U.S.C. 501(r)(4); 26 CFR 1.501(r)-4

Before any ECA, the hospital must tell you about financial assistance and wait at least 120 days from the first bill sent after you left the hospital.

Law: 26 CFR 1.501(r)-6(c)(3)

You can apply for at least 240 days from the first bill sent after you left the hospital.

Law: 26 CFR 1.501(r)-1(b)(3)

If you apply during the application period, even with an incomplete application, the hospital and its collectors must stop starting or continuing ECAs until the hospital decides, or until you fail to send requested information within a reasonable time.

Law: 26 CFR 1.501(r)-6(c)(8)

Once you are found eligible, the hospital cannot charge you more than the amounts generally billed (AGB) to people with insurance for emergency or other medically necessary care, and must charge less than its full gross charges for other covered care.

Law: 26 U.S.C. 501(r)(5); 26 CFR 1.501(r)-5

Surprise bills (No Surprises Act)

With most private health plans (job-based plans, Marketplace and other individual plans), you are protected from surprise out-of-network bills for emergency care, for non-emergency care at an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services.

Law: 42 U.S.C. 300gg-111, 300gg-131, 300gg-132, 300gg-135

For protected services, you can't be charged more than your in-network cost-sharing (copay, coinsurance, deductible).

Law: 42 U.S.C. 300gg-131, 300gg-132

Ground ambulance services are generally not covered by these federal protections, unless a state law has different rules.

Law: CMS, Know your rights when using insurance

If you don't have insurance or won't use it, providers and facilities must usually give you a written good faith estimate.

Law: 42 U.S.C. 300gg-136; 45 CFR 149.610

If one provider's or facility's bill is at least $400 more than its good faith estimate, you can use the federal patient-provider dispute resolution process.

Law: 45 CFR 149.620(a)(2)(ii), (c)(1)

Credit reports

A collection account generally cannot be reported for more than 7 years.

Law: 15 U.S.C. 1681c(a)(4), (c)(1)

For a veteran's medical debt (care authorized by the VA from a non-VA provider, or a bill the VA charged in error), nationwide credit bureaus may not report it until 1 year after the care, and may not report it once it is fully paid or settled, when they know it is a veteran's medical debt.

Law: 15 U.S.C. 1681c(a)(7), (8); 15 U.S.C. 1681a

If a medical debt on your credit report is wrong, you can dispute it with the credit bureau for free.

Law: 15 U.S.C. 1681i(a)(1)

Debt collectors

A debt collector must give you validation information about the debt, including the amount and how to dispute it.

Law: 12 CFR 1006.34

If you dispute the debt in writing within the validation period, the collector must stop collecting the disputed amount until it sends you verification of the debt.

Law: 12 CFR 1006.38(c), (d)(2)

A debt collector must not sue or threaten to sue you on a time-barred debt, meaning a debt whose statute of limitations has run out.

Law: 12 CFR 1006.26(b)

Itemized bills and price lists

Your medical and billing records kept by a health care provider are part of your 'designated record set'.

Law: 45 CFR 164.501 (designated record set); 45 CFR 164.524(b)(2)

If Medicare paid for an item or service, you can ask the provider in writing for an itemized statement.

Law: 42 U.S.C. 1395b-7(b)

Every hospital must post online a machine-readable file of all its standard charges, and a consumer-friendly list of at least 300 shoppable services (or an online price estimator tool).

Law: 45 CFR 180.40, 180.50, 180.60

Medicaid and Medicare

If you qualify for Medicaid, it can pay for covered care you got up to 3 months before the month you applied, if you were eligible then.

Law: 42 U.S.C. 1396a(a)(34), 1396d(a); Pub. L. 119-21, sec. 71112 (July 4, 2025)

If you are in the Qualified Medicare Beneficiary (QMB) program, Medicare providers may not bill you for Medicare deductibles, coinsurance or copays for Medicare-covered care.

Law: 42 U.S.C. 1396a(n)(3)(B); CMS

If your health plan denies a claim

You must file an internal appeal within 180 days (6 months) of the notice that your claim was denied.

Law: 45 CFR 147.136(b); HealthCare.gov

After a final denial, you can ask for an external review by an independent reviewer within 4 months.

Law: 45 CFR 147.136(c), (d); HealthCare.gov

National help