Maryland

Statutory floor

Maryland’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 September 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	No extra state waiting period
Lawsuit clock	3 years · Md. hospital-debt limitations, Health-Gen. § 19-214.2 (3 years; no suit under $500)

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 case

Maryland 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.