50-state desk · DE
Delaware
Process / partialNo enforceable income floor today. SB 13 (16 Del. C. ch. 99) is slated for January 1, 2027. Delaware already bans interest on some medical debt and restricts credit reporting. Certificate-of-need review can weigh financial assistance.
I.R.C. § 501(r); Del. medical-debt credit reporting ban; SB 13 (charity care effective 2027) · compiled September 2026
| Rule | This state |
|---|---|
| Free-care floor | — |
| Discount / eligibility floor | — |
| Covers insured patients | Yes, if they otherwise qualify |
| Which hospitals | Nonprofit / 501(c)(3) hospitals via federal 501(r) |
| Medicaid expansion | Yes — adults to 138% FPL |
| Screen before collections | Not required by state law |
| 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 | Generally none allowed |
| Collection hold | No extra state waiting period |
| Lawsuit clock | 3 years · 10 Del. C. § 8106 |
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 | — | — |
| 2 | $21,640 | — | — |
| 3 | $27,320 | — | — |
| 4 | $33,000 | — | — |
| 5 | $38,680 | — | — |
| 6 | $44,360 | — | — |
What to do
- 01 Use the hospital FAP now. The 2027 charity-care statute is not yet the floor.
- 02 Delaware’s lawsuit window is three years — check the date of service before paying old debt.
- 03 Interest on hospital medical debt is generally not allowed. Strike it from any payoff.
- 04 Dispute medical collections on a credit report; the state ban is in force.
Appeals
Federal No Surprises Act.
Insurance: Delaware Department of Insurance — external review
Medicaid: DMMA fair hearing.
Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.
Cite this in a letter
I request a FAP determination under Internal Revenue Code section 501(r). Delaware restricts interest and credit reporting on medical debt. I ask that you not furnish this account to a consumer reporting agency.
Put a Delaware bill in the machine.
The estimate will use this state’s floors. The letters will cite I.R.C. § 501(r); Del. medical-debt credit reporting ban; SB 13 (charity care effective 2027).
Start a Delaware caseFederal 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.