California

Statutory floor

Every general acute-care hospital must make uninsured patients and insured patients with high medical costs at or below 400% of FPL eligible for charity care or discounted payment. Rural hospitals may set a lower line. Discounted payment is typically capped near Medicare. Screening and collections waiting periods apply (including AB 1020). HCAI enforces.

Cal. Health & Safety Code §§ 127400–127446 (Hospital Fair Pricing Act) · compiled September 2026

Rule	This state
Free-care floor	200% FPL
Discount / eligibility floor	400% FPL
Covers insured patients	Yes, if they otherwise qualify
Which hospitals	Generally all licensed hospitals
Medicaid expansion	Yes — adults to 138% FPL
Screen before collections	Yes
Credit reports	Statewide ban (FCRA-preemption fights ongoing)
Debt sales	Not banned
Home liens	Not banned
Wage garnishment	Tighter than the federal 25% cap
Interest on medical debt	No special cap located
Collection hold	180 days before certain extraordinary actions
Lawsuit clock	4 years · Cal. Civ. Proc. Code § 337

2026 poverty line here

Alaska and Hawaii use their own HHS tables. Everyone else uses the 48-state and D.C. figures, effective January 2026.

Household	100%	Free floor	Discount floor
1	$15,960	$31,920	$63,840
2	$21,640	$43,280	$86,560
3	$27,320	$54,640	$109,280
4	$33,000	$66,000	$132,000
5	$38,680	$77,360	$154,720
6	$44,360	$88,720	$177,440

What to do

01 Ask for the charity-care policy and the discount-payment policy — California requires both to be written and understandable.
02 If household income is at or under 400% FPL (or medical costs are high relative to income), you are eligible. That is a statute, not a favor.
03 Demand an itemized bill. Collections generally cannot race ahead of a pending application.
04 Medical debt should not be on a California credit report. Dispute furnishers and the bureaus if it appears.

Appeals

California’s state balance-billing prohibitions sit on top of the No Surprises Act for emergency and many out-of-network facility bills.

Insurance: California Department of Insurance / DMHC Independent Medical Review

Medicaid: DHCS state fair hearing (Medi-Cal).

Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.

Cite this in a letter

I request screening and charity care or discounted payment under the Hospital Fair Pricing Act, California Health and Safety Code §§ 127400–127446, including the 400% FPL eligibility floor for uninsured patients and patients with high medical costs. Please hold extraordinary collection actions while this application is pending.

Put a California bill in the machine.

The estimate will use this state’s floors. The letters will cite Cal. Health & Safety Code §§ 127400–127446 (Hospital Fair Pricing Act).

Start a California case

California Attorney General

Federal overlay — every state

501(r)
501(c)(3) hospital organizations must publish a Financial Assistance Policy, a plain-language summary, and generally may not take extraordinary collection actions (selling the debt, reporting it, liens, lawsuits) until they have made reasonable efforts to determine FAP eligibility.
No Surprises Act
Emergency services, air ambulance, and many out-of-network clinicians at in-network facilities cannot balance-bill beyond in-network cost-sharing. Independent dispute resolution is between the plan and the provider — not a reason to pay the sticker rate.
FDCPA
15 U.S.C. § 1692g. Within 30 days of first collector contact, demand validation. Until validated, collection and credit reporting should stop. Partial payment can restart a state’s statute of limitations.
EMTALA
Emergency departments must screen and stabilize regardless of ability to pay. An ER bill is not an agreement that chargemaster rates are the cash price.
Medicare appeals
Five levels: redetermination (MAC, 120 days), reconsideration (QIC), ALJ at OMHA, Medicare Appeals Council, then federal district court. A remaining patient balance is often a claim the provider still needs to work.
Credit bureaus
The CFPB’s 2025 medical-debt reporting rule was vacated in July 2025. Industry practice still generally omits paid medical collections and unpaid balances under $500. Unpaid medical debt over $500 can appear after a delay unless a state ban applies. FCRA-preemption fights over those state bans are ongoing.