50-state desk · VA
Virginia
Process / partialHospitals must screen for financial assistance and public coverage. There is no statewide FPL write-off floor. Medicaid expanded in 2019. Virginia restricts furnishers from reporting medical debt. Home liens for medical debt are limited.
Va. Code § 32.1-137.01 (screening); medical-debt credit furnishing limits · compiled September 2026
| Rule | This state |
|---|---|
| Free-care floor | — |
| Discount / eligibility floor | — |
| 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 | 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 | 5 years · Va. Code § 8.01-246 (written contracts, 5 years) |
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 Virginia requires screening, not a 200% write-off. Apply to the hospital FAP and Medicaid.
- 02 Medical debt generally should not be furnished from a Virginia provider to a bureau.
- 03 Home liens for medical debt are limited. Do not sign a new one.
- 04 Five-year written-contract window.
Appeals
Federal No Surprises Act.
Insurance: Virginia Bureau of Insurance — external review
Medicaid: DMAS fair hearing.
Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.
Cite this in a letter
I request screening for financial assistance and public coverage under Va. Code § 32.1-137.01, and a FAP determination under Internal Revenue Code section 501(r). Please do not furnish this account to a consumer reporting agency.
Put a Virginia bill in the machine.
The estimate will use this state’s floors. The letters will cite Va. Code § 32.1-137.01 (screening); medical-debt credit furnishing limits.
Start a Virginia 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.