50-state desk · MA
Massachusetts
Statutory floorThe Health Safety Net covers eligible uninsured and underinsured patients, generally with full HSN coverage at or below 300% FPL (partial for some higher-income medical-hardship cases). Hospitals must help patients apply. Massachusetts also limits certain collection lawsuits.
Health Safety Net, 101 CMR 613.00; M.G.L. hospital billing rules · compiled September 2026
| Rule | This state |
|---|---|
| Free-care floor | 300% FPL |
| Discount / eligibility floor | 300% 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 | No state ban |
| Debt sales | Not banned |
| Home liens | Not banned |
| Wage garnishment | Federal CCPA cap (typically 25%) |
| Interest on medical debt | No special cap located |
| Collection hold | No extra state waiting period |
| Lawsuit clock | 6 years · M.G.L. c. 260, § 2 |
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 | $47,880 | $47,880 |
| 2 | $21,640 | $64,920 | $64,920 |
| 3 | $27,320 | $81,960 | $81,960 |
| 4 | $33,000 | $99,000 | $99,000 |
| 5 | $38,680 | $116,040 | $116,040 |
| 6 | $44,360 | $133,080 | $133,080 |
What to do
- 01 Ask the counselor to submit the bill to the Health Safety Net. That is a Massachusetts program, not a hospital favor.
- 02 At or under 300% FPL, HSN is the primary lever. Also apply for MassHealth if you might qualify.
- 03 Itemize. Professional fees (physicians) may bill separately from the facility.
- 04 If the plan denied, use Office of Patient Protection external review.
Appeals
Massachusetts surprise-billing / HSN rules plus the No Surprises Act.
Insurance: Massachusetts DOI — external review; Office of Patient Protection
Medicaid: MassHealth fair hearing.
Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.
Cite this in a letter
I request Health Safety Net screening and coverage under 101 CMR 613.00, and a hospital FAP determination. If household income is at or below 300% of FPL, please submit this account to HSN rather than collecting chargemaster rates.
Put a Massachusetts bill in the machine.
The estimate will use this state’s floors. The letters will cite Health Safety Net.
Start a Massachusetts 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.