50-state desk · TX
Texas
Process / partialNonprofit hospitals must provide charity care and community benefits and report them — but Texas does not set a patient-level FPL write-off floor. Texas has not expanded Medicaid. Providers can lose the right to collect certain charges if they miss billing deadlines (often discussed as an 11-month claims window). Four-year lawsuit window. Homestead is strongly protected.
Tex. Health & Safety Code §§ 311.031–311.048 (charity care / community benefits) · compiled September 2026
| Rule | This state |
|---|---|
| Free-care floor | — |
| Discount / eligibility floor | — |
| Covers insured patients | Yes, if they otherwise qualify |
| Which hospitals | Nonprofit / 501(c)(3) hospitals via federal 501(r) |
| Medicaid expansion | Not adopted |
| Screen before collections | Not required by state law |
| Credit reports | No state ban |
| Debt sales | Not banned |
| Home liens | Not banned |
| Wage garnishment | Federal CCPA cap (typically 25%) |
| Interest on medical debt | No special cap located |
| Collection hold | No extra state waiting period |
| Lawsuit clock | 4 years · Tex. Civ. Prac. & Rem. Code § 16.004; debt-buyer revival limits in Tex. Fin. Code § 392.307 |
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 | — | — |
| 2 | $21,640 | — | — |
| 3 | $27,320 | — | — |
| 4 | $33,000 | — | — |
| 5 | $38,680 | — | — |
| 6 | $44,360 | — | — |
What to do
- 01 Texas has no 400% statute. Download that nonprofit’s charity-care policy — Chapter 311 requires them to have one.
- 02 If you are a childless adult under poverty, you are likely in the Medicaid gap. FAP is the path.
- 03 Ask whether they billed in time. Stale hospital claims are a real Texas defense.
- 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). Please also confirm this account was billed within any applicable timely-billing limit.
Put a Texas bill in the machine.
The estimate will use this state’s floors. The letters will cite Tex. Health & Safety Code §§ 311.031–311.048 (charity care / community benefits).
Start a Texas 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.