50-state desk · WI
Wisconsin
Process / partialNo ACA Medicaid expansion (BadgerCare covers many adults under poverty, so the classic coverage gap is smaller than in Texas or Florida). No statewide FPL write-off floor. Nonprofit FAPs and occasional AG scrutiny are the levers.
I.R.C. § 501(r); Wis. hospital / AG charity-care expectations · 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 | 6 years · Wis. Stat. § 893.43 |
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 Apply for BadgerCare if income is under poverty — Wisconsin is not a full expansion state but is not a pure gap state either.
- 02 No write-off statute. The hospital FAP is the lever.
- 03 Itemize and demand self-pay.
- 04 Six-year lawsuit window. Wisconsin treats some expired debts as extinguished — do not revive them with a payment.
Appeals
Federal No Surprises Act.
Insurance: Wisconsin OCI — external review
Medicaid: DHS fair hearing (BadgerCare).
Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.
Cite this in a letter
I request a FAP determination under Internal Revenue Code section 501(r).
Put a Wisconsin bill in the machine.
The estimate will use this state’s floors. The letters will cite I.R.C. § 501(r); Wis. hospital / AG charity-care expectations.
Start a Wisconsin 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.