North Carolina

Process / partial

Not a universal statute for every clinic, but North Carolina’s acute-care hospitals opted into a charity-care compact: typically 50–100% discounts at or below 300% FPL, with automatic qualification if the household receives SNAP, WIC, or Medicaid. Screening before collections is expected. Medicaid expanded in 2023.

NCDHHS Medical Debt Relief Incentive Program (participating acute-care hospitals; not a statute) · compiled October 2026

Rule	This state
Free-care floor	300% FPL
Discount / eligibility floor	300% FPL
Covers insured patients	Yes, if they otherwise qualify
Which hospitals	Some hospitals / programs only
Medicaid expansion	Yes — adults to 138% FPL
Screen before collections	Yes
Credit reports	No state law. Hospitals in the NCDHHS Medical Debt Relief Incentive Program stopped reporting medical debt to credit bureaus. Dispute any medical collection on a credit report.
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	No extra state waiting period
Lawsuit clock	3 years · N.C. Gen. Stat. § 1-52

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 If anyone in the house is on SNAP, WIC, or Medicaid, say so — many NC hospitals must treat that as automatic qualification.
02 300% FPL is the usual acute-care discount line. Apply even if you are insured with a leftover balance.
03 Three-year lawsuit window.
04 Medicaid expansion is recent — ask about retroactive coverage around the date of service.

Appeals

Federal No Surprises Act.

Insurance: North Carolina Department of Insurance — external review

Medicaid: DHHS fair hearing.

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

Cite this in a letter

I request charity care under this hospital’s North Carolina charity-care policy, including the 300% FPL discount band and automatic qualification if this household receives SNAP, WIC, or Medicaid. Please screen before any collection action.

Put a North Carolina bill in the machine.

The estimate will use this state’s floors. The letters will cite NCDHHS Medical Debt Relief Incentive Program (participating acute-care hospitals; not a statute).

Start a North Carolina case

North Carolina 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.
Official source
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.
Official source
FDCPA
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 source
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.
Official source
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.
Official source
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.
Official source

Sources

Official government sources for the North Carolina information on this page. UNDUE does not represent any government entity.