California hospital financial assistance is available to uninsured patients with family income up to 400% of the federal poverty level and to insured patients whose out-of-pocket medical costs exceed 10% of family income. If you qualify, a general acute care hospital in California cannot charge you more than Medicare or Medi-Cal would pay for the same service, must offer you an interest-free payment plan, and cannot garnish your wages or put a lien on your home to collect the bill. Every hospital in the state is required to maintain both a charity care policy and a discount payment policy, and to tell you they exist.
Who Qualifies
Two groups of patients are eligible. The first is uninsured patients with family income at or below 400% of the federal poverty level. In 2026, that ceiling is roughly $63,840 for an individual and $132,000 for a family of four, based on federal poverty guidelines of $15,960 for one person and $33,000 for a family of four.1HHS ASPE. 2026 Poverty Guidelines
The second group is insured patients with high medical costs. You qualify under this path two ways. Your out-of-pocket costs at the hospital exceed 10% of your current family income (or your income over the prior 12 months, whichever is lower). Or your out-of-pocket medical expenses across all providers exceed 10% of family income, if you can document those expenses. Individual hospitals can set more generous thresholds under their own policies.2California Legislative Information. California Code HSC Division 107 Part 2 Chapter 2.5 Article 1
When a hospital screens you for eligibility, it can look at income and financial assets, but it cannot count retirement accounts, deferred compensation plans, or the first $10,000 of your other monetary assets. A modest savings cushion will not disqualify you.
What You’ll Be Charged, and How You Can Pay
If you qualify, the hospital cannot charge you more than Medicare or Medi-Cal would pay for the same service, whichever amount is higher. If neither program has an established rate, the hospital has to set an appropriate discounted price. The inflated “chargemaster” prices that uninsured patients often see on initial bills are not what you owe.3California Legislative Information. California Code Health and Safety Code HSC 127405
Hospitals must also offer eligible patients interest-free extended payment plans. The specific terms are negotiable between you and the hospital. A hospital can declare a payment plan no longer operative if you miss every consecutive payment over a 90-day stretch, but only after making a reasonable attempt to reach you by phone and in writing, and only after giving you a chance to renegotiate. While a payment plan is active, no hospital, collection agency, or debt buyer can sue you.4California Legislative Information. California Code Health and Safety Code HSC 127425
What the Hospital Has to Tell You
Hospitals have to give every patient a written notice that explains the availability of charity care and discount payment programs, lays out eligibility, and names a contact for applications. These notices must be posted in the emergency department, billing office, admissions office, and outpatient settings, and the full policy must be prominently linked on the hospital’s website.5California Legislative Information. California Code HSC 127410
Every billing statement you receive has to include a plain-language summary of the hospital’s financial assistance policy, instructions for applying, and a phone number for the office that handles applications. If you have a bill in front of you, that information should be on it. If it isn’t, ask for it before you pay.
Protections Against Collection While You Sort It Out
A hospital, any entity it assigns the debt to, a collection agency, or a debt buyer cannot report negative information to a credit bureau or file a lawsuit against you for nonpayment until at least 180 days after the initial billing date. That window exists so you can apply for assistance, negotiate a plan, or resolve an insurance dispute without credit damage piling up.4California Legislative Information. California Code Health and Safety Code HSC 127425
A hospital cannot sell your debt to a debt buyer unless it has already found you ineligible for financial assistance, or you have not responded to any billing or financial assistance outreach for 180 days. If the debt is sold, the buyer has to follow the same rules the hospital would have.
If you have a pending insurance appeal, the 180-day period is extended until that appeal reaches a final determination, provided you keep the hospital reasonably informed. This applies to grievances against health plans, independent medical reviews, Medi-Cal fair hearings, and Medicare coverage appeals.6California Legislative Information. California Code Health and Safety Code HSC 127426
No Wage Garnishment or Home Liens for Eligible Patients
If you qualify under a hospital’s charity care or discount payment policy, the hospital and any affiliate or subsidiary cannot garnish your wages or place a lien on your home. Outside collection agencies and debt buyers face the same restrictions, and they also cannot conduct a sale of any real property you own.4California Legislative Information. California Code Health and Safety Code HSC 127425
Written Notice Before Collection Starts
Before any entity begins collection activity, it must send you a written notice summarizing your rights under the California Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act, and telling you that nonprofit credit counseling may be available in your area. If the debt is passed to a new entity, that entity has to send the same notice.7California Legislative Information. California Health and Safety Code 127430
Boundaries
These rules apply to general acute care hospitals in California. They do not govern bills from independent physician groups, ambulance companies, or other providers who bill separately from the hospital, even if you were treated at the hospital.
Filing a Complaint if a Hospital Doesn’t Follow the Rules
If a hospital denies you financial assistance you should have received, charges you more than the discounted rate, or sends your account to collections without screening you, you can file a complaint with the Department of Health Care Access and Information (HCAI) through its Hospital Bill Complaint Program. HCAI handles complaints for services or issues on or after January 1, 2022; earlier issues go to the California Department of Public Health. If the investigation finds you overpaid, you may be reimbursed with interest.8California Department of Health Care Access and Information. Hospital Bill Complaint Program
What to Gather First
Before you file, collect copies of all hospital bills and itemized statements, any notices you received from the hospital or a collection agency, and records showing the dates of service. If you want someone else to help with your complaint, complete the Authorized Representative Form included with the complaint form on HCAI’s website.
How to File
The fastest route is HCAI’s online Patient Complaint Portal, which lets you upload documents and track the complaint’s status. You can also print the Patient Complaint Form and mail it with copies of your supporting documents; the mail option is available in multiple languages. HCAI will acknowledge the complaint, review your documents and the hospital’s response, and may ask for additional information or proof of household income. If the hospital appeals a finding against it, you’ll get a copy of the evidence the hospital submits and a chance to respond.8California Department of Health Care Access and Information. Hospital Bill Complaint Program