Texas

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.

What to do

1. 01 Texas has no 400% statute. Download that nonprofit’s charity-care policy — Chapter 311 requires them to have one.
2. 02 If you are a childless adult under poverty, you are likely in the Medicaid gap. FAP is the path.
3. 03 Itemize and ask for the self-pay schedule in writing.
4. 04 Four-year lawsuit window. Debt buyers cannot easily revive time-barred debt. Homestead is well protected — do not put the house on a payment plan.

Appeals

Texas surprise-billing / mediation (TDI) plus the No Surprises Act.

Insurance: Texas Department of Insurance — surprise billing / external review

Medicaid: HHSC fair hearing. Adult coverage is categorical — there is a coverage gap.

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

Cite this in a letter

If you are a nonprofit hospital, I request charity care under your policy adopted to satisfy Texas Health and Safety Code Chapter 311, and a FAP determination under Internal Revenue Code section 501(r).

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 Texas information on this page. UNDUE does not represent any government entity.

• Tex. Health & Safety Code ch. 311 (charity care / community benefits, §§ 311.041–311.048)
• Tex. Civ. Prac. & Rem. Code ch. 16, § 16.004 (lawsuit clock, 4 years)
• Tex. Fin. Code ch. 392, § 392.307 (debt buyer limits on time-barred debt)
• Tex. Ins. Code ch. 1467 (out-of-network surprise billing, mediation/IDR)
• Texas Department of Insurance: how to get help with a surprise bill
• Texas HHSC Medicaid fair hearings
• HHSC Texas Works Handbook B-1030 (appeals procedure, fair hearings)
• Texas Attorney General (file a consumer complaint)
• 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)