Charity care in Vermont: who gets free or discounted care
Vermont has a law that requires hospitals to give free or discounted care to people with income up to 400% 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 Vermont
| Income (% of poverty level) | What you get | Details |
|---|---|---|
| Up to 250% | Free care | If your household income is at or below 250% of the federal poverty level: if you are uninsured, you get a 100% discount from the amount generally billed, which means free care; if you have insurance, the facility must waive all of your out-of-pocket costs. |
| 251% to 400% | Discount | If your household income is between 250% and 400% of the federal poverty level: if you are uninsured, you get at least a 40% discount from the amount generally billed; if you have insurance, you get at least a 40% discount on your out-of-pocket costs. |
| Up to 600% | Discount | Catastrophic assistance: if your household income is at or below 600% of the federal poverty level and the facility's bills for your care are more than 20% of your household income, the facility must lower what you owe to 20% of your household income. |
These are the income levels written in the law. Each hospital decides using its own policy.
- The law
Patient Financial Assistance and Medical Debt law
Law: 18 V.S.A. chapter 221, subchapter 10; 18 V.S.A. §§ 9481-9487
- Which hospitals
All "large health care facilities": every hospital licensed in Vermont (nonprofit or for-profit), outpatient clinics and facilities affiliated with or operating under a hospital's license, and licensed ambulatory surgical centers.
- Who can get help
Vermont residents (regardless of citizenship or immigration status, including people who work or go to school in Vermont) and people living in Vermont without stable housing when they get care. Both uninsured patients and patients with insurance can qualify. A facility may require Vermont residency but may not require that you have lived in Vermont for any length of time.
- The most you can be charged
Discounts are taken from the "amount generally billed" (the federal 501(r) look-back amount). Under catastrophic assistance, what you owe the facility is capped at 20% of your household income if your income is at or below 600% of the poverty level.
- Savings and other assets
Limited. A facility does not have to use an asset test. If it does, it may count only liquid assets, not your main home, 401(k) or IRA accounts, or pensions, and the asset limit must be at least the dollar amount of 400% of the poverty level for your household size.
- Who counts as your family
Household income and household size are figured the way the federal Marketplace premium tax credit does it, with changes: domestic partners and their dependents count as one household; married people filing separately count as one household; spouses living apart while a divorce is pending do not; and income for people who don't file a tax return is figured as if they had filed.
Law: 18 V.S.A. §§ 9481-9487
How to apply in Vermont
- Deadline to apply
Vermont law does not set an application deadline. Federal 501(r) rules apply to nonprofit hospitals.
- Screening for help
Before billing you for emergency or medically necessary care, the facility must check whether you have insurance or other coverage (including auto or workers' compensation), offer to help you apply for public programs and insurance, use information it already has to see whether you qualify for free or discounted care, and offer you a free application and help filling it out. It may approve help based on information it already has, but may not deny you based only on that information.
Law: 18 V.S.A. § 9483(a), (b)(3); 18 V.S.A. §§ 9481-9487
- Applying for coverage first
The facility must offer information and help with applying for public programs and insurance. An undocumented immigrant's refusal to apply for public programs, and any patient's refusal to apply for private health insurance, cannot be a reason to deny financial assistance.
- Notice you must get
The facility must post its policy and application online and in its patient portal, give free paper copies by mail and in person (for hospitals, in reception, admissions and billing areas), offer oral and written translations on request, post notices in its offices, offer you a paper copy at your first visit (for hospitals, at intake and discharge), and print a notice on every bill, including bills from collectors, with a phone number and web address for the policy. Every attempt to collect a medical debt for care at these facilities must include information about the financial assistance policy.
- If you disagree
The facility must tell you in writing within 30 days after it gets your application whether you are approved, denied, or what is missing. If approved, it must give you a calculation and a revised bill. If denied, you can appeal to the facility within 60 days, and it must decide your appeal within 60 days. You can also complain to the Vermont Attorney General, which enforces this law.
- Other providers
The rules cover hospital-affiliated outpatient clinics and facilities and licensed ambulatory surgical centers, not only hospitals.
Law: 18 V.S.A. §§ 9481-9487
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 Vermont law.
Free tools, letters and checklist
Where to complain in Vermont
- Attorney general: Vermont Attorney General, Consumer Assistance Program · 1-800-649-2424
A hospital, clinic or surgery center did not follow the financial assistance, credit reporting or debt sale rules, or a debt collector treated you unfairly. The Attorney General enforces the financial assistance law. - Health insurance: Vermont Department of Financial Regulation, Insurance Division · 802-828-3302
Problems with a Vermont health insurance plan, including surprise bills under the No Surprises Act. - Medicaid: Green Mountain Care (Department of Vermont Health Access) · 1-855-899-9600
Questions about Medicaid eligibility or coverage.
Questions about medical bills in Vermont
Does Vermont require hospitals to give free or discounted care?
Vermont has a law that requires hospitals to give free or discounted care to people with income up to 400% of the federal poverty level (the exact level depends on the hospital and your situation).
Who counts as family for charity care in Vermont?
Household income and household size are figured the way the federal Marketplace premium tax credit does it, with changes: domestic partners and their dependents count as one household; married people filing separately count as one household; spouses living apart while a divorce is pending do not; and income for people who don't file a tax return is figured as if they had filed.