50-state desk · NC
North Carolina
Process / partialNot 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.
N.C. Medical Debt Protection / HIE charity-care participation (acute-care hospitals) · 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 | Some hospitals / programs only |
| Medicaid expansion | Yes — adults to 138% FPL |
| Screen before collections | Yes |
| Credit reports | North Carolina has restricted some medical-debt furnishing. Dispute any medical collection on a credit report. |
| Debt sales | Not 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 · 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. Home liens for medical debt are limited.
- 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 N.C. Medical Debt Protection / HIE charity-care participation (acute-care hospitals).
Start a North Carolina 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.