50-state desk · MD
Maryland
Statutory floorMaryland’s all-payer hospital system is unique. Free care at or below 200% FPL; discounted care generally to 500% FPL depending on medical hardship. Hospitals may not sue on hospital debt under $500; hospital-debt lawsuit window is 3 years. Medical debt is barred from credit reports. HSCRC publishes the uniform financial-assistance policy.
Md. Code, Health-Gen. § 19-214.1; COMAR 10.37.10.26 (HSCRC) · compiled October 2026
| Rule | This state |
|---|---|
| Free-care floor | 200% FPL |
| Discount / eligibility floor | 500% 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 | Restricted or banned |
| Home liens | Restricted or banned |
| Wage garnishment | Tighter than the federal 25% cap |
| Interest on medical debt | No special cap located |
| Collection hold | 240 days before certain extraordinary actions |
| Lawsuit clock | 3 years · Md. Code, Cts. & Jud. Proc. §§ 5-101, 5-102 |
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 | $79,800 |
| 2 | $21,640 | $43,280 | $108,200 |
| 3 | $27,320 | $54,640 | $136,600 |
| 4 | $33,000 | $66,000 | $165,000 |
| 5 | $38,680 | $77,360 | $193,400 |
| 6 | $44,360 | $88,720 | $221,800 |
What to do
- 01 Ask for the HSCRC uniform financial-assistance application — Maryland hospitals are not supposed to freestyle this.
- 02 At or under 200% FPL, free care. Sliding scale toward 500% with medical hardship.
- 03 They should not sue under $500 or sell the debt. Three-year hospital-debt clock.
- 04 Medical debt should not be on a Maryland credit report.
Appeals
All-payer rates plus the No Surprises Act. Balance billing is tightly constrained.
Insurance: Maryland Insurance Administration — external review
Medicaid: MDH fair hearing.
Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.
Cite this in a letter
I request financial assistance under Maryland Health-General § 19-214.1 and COMAR 10.37.10.26 — free care at or below 200% of FPL and discounted care on the HSCRC sliding scale. Please apply the uniform statewide policy, not an informal write-off.
Put a Maryland bill in the machine.
The estimate will use this state’s floors. The letters will cite Md. Code.
Start a Maryland 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.
Official sourceNo 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.
Official sourceFDCPA
15 U.S.C. § 1692g. Within 30 days of first collector contact, demand validation. Until it is validated, the collector should stop collecting. Partial payment can restart a state’s statute of limitations.
Official sourceEMTALA
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.
Official sourceMedicare 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.
Official sourceCredit 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.
Official source
Sources
Official government sources for the Maryland information on this page. UNDUE does not represent any government entity.
- Health-Gen. 19-214.1 (hospital financial assistance policy, free/reduced-cost care)
- COMAR 10.37.10.26 (HSCRC financial assistance regulation)
- Health-Gen. 19-214.2 (hospital debt collection: no debt sale, no home lien, no suit at or under $500, 240-day wait)
- Cts. & Jud. Proc. 5-101 (3-year general civil limitation)
- Cts. & Jud. Proc. 5-102 (excludes hospital consumer debt from the 12-year sealed-contract period)
- Com. Law 14-1213 (medical debt credit-reporting ban)
- Health-Gen. 24-2501 (medical debt collection entity definitions)
- Com. Law 15-601.1 (wage garnishment exemption)
- Maryland Office of Financial Regulation (2025 medical debt laws guidance)
- Maryland Insurance Administration (appeals and grievances, external review)
- Maryland Department of Health (Medicaid appeal / fair hearing)
- Maryland Attorney General (health billing and insurance complaints)
- 2026 federal poverty guidelines (U.S. Dept. of Health and Human Services, published on HealthCare.gov)
- Medicaid and CHIP by state (HealthCare.gov)
- 15 U.S.C. § 1673 federal wage-garnishment cap (GovInfo)