Charity care in Illinois is governed by the Hospital Uninsured Patient Discount Act (HUPDA), which requires most hospitals to discount or entirely waive charges for uninsured patients whose family income falls at or below 600% of the federal poverty level. For a family of four in 2026, household income up to $198,000 qualifies for some level of discount, and income up to $66,000 qualifies for free care.1Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act2U.S. Department of Health and Human Services. 2026 Poverty Guidelines: 48 Contiguous States The law also caps how much a hospital can collect from an eligible patient in any 12-month period, and separate federal rules add protections if the hospital is a tax-exempt nonprofit.
Who Qualifies
HUPDA covers uninsured patients only. If you carry any form of health insurance, including a high-deductible plan, the statute does not apply to your bill. Illinois residency is required, and the hospital can ask you to document it.
Eligibility then depends on the hospital type. At a standard (non-rural) hospital, family income at or below 200% of the federal poverty level qualifies you for a 100% charitable discount on medically necessary services above $150 per inpatient stay or outpatient visit. In 2026 that’s $31,920 for a single person and $66,000 for a family of four.1Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act2U.S. Department of Health and Human Services. 2026 Poverty Guidelines: 48 Contiguous States Income between 200% and 600% of poverty (up to $95,760 for a single person or $198,000 for a family of four) qualifies you for a mandatory discount, though not full forgiveness.
Rural and Critical Access hospitals use tighter thresholds. Free care kicks in only at or below 125% of poverty, and discounted care extends up to 300%. The minimum charge that triggers the discount is also higher at $300 per visit.1Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act
What About Assets
Hospitals can exclude a patient from the annual collection cap if the patient owns assets exceeding the applicable income threshold. But the statute shields your primary residence, personal property that would be exempt from a court judgment under the Illinois Code of Civil Procedure, and money held in pension or retirement plans. Distributions you actually take from a retirement plan can still count as income.1Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act
What You’ll Actually Pay
If your income puts you in the discount tier rather than the free-care tier, the hospital cannot collect more than its charges minus the statutory “uninsured discount.” That discount is calculated from the hospital’s cost-to-charge ratio in its most recent Medicare cost report, multiplied by 1.35. In practical terms, eligible uninsured patients pay roughly what it costs the hospital to provide the service, plus up to 35%.1Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act3Illinois Hospital Report Card. Hospital Uninsured Patient Discount Act
On top of that per-visit discount, the law caps what a hospital can collect from an eligible patient in any 12-month period at 20% of the patient’s family income.1Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act Even if you’re admitted several times in one year, the hospital cannot collect more than that ceiling as long as you remain eligible.
How to Apply
You have to ask. Hospitals are not required to grant HUPDA discounts automatically, and the statute gives you 90 days from the date of discharge, date of service, or completion of the eligibility screening process to submit an application.4Illinois General Assembly. 210 ILCS 89/15 Missing that window is one of the most common ways eligible patients lose access to charity care. Treat it as a hard deadline.
The hospital can ask you to document your income and Illinois residency. If you don’t provide the requested documents within 30 days, the hospital’s obligation to offer the discount ends.3Illinois Hospital Report Card. Hospital Uninsured Patient Discount Act Gather pay stubs, tax returns, or other income verification before you start.
Every bill, invoice, or summary of charges a hospital sends an uninsured patient must include a prominent statement that discounts may be available and explain how to apply.1Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act If your bill doesn’t include that notice, the hospital is already out of compliance. Apply anyway.
If Your Hospital Is a Nonprofit, Ask About Its Own Policy
Most Illinois hospitals are tax-exempt nonprofits, and federal law layers additional financial assistance rules on top of HUPDA. Section 501(r) of the Internal Revenue Code requires every tax-exempt hospital to maintain a written Financial Assistance Policy (FAP) covering all emergency and medically necessary care. The FAP has to spell out who qualifies for free or discounted care, how charges are calculated, how to apply, and what collection actions the hospital may take.5Internal Revenue Service. Financial Assistance Policies (FAPs)
The hospital must “widely publicize” the FAP by posting it online, providing free paper copies on request, and placing copies in admissions areas and the emergency department.5Internal Revenue Service. Financial Assistance Policies (FAPs) Many hospital FAPs set higher income thresholds than HUPDA requires. If HUPDA denies you at 600% of poverty, the hospital’s own FAP may still cover you. Ask for it in writing.
Protections While Your Bill Is Pending
Federal law limits what a tax-exempt hospital can do to collect on your bill before determining whether you qualify for financial assistance. Under Section 501(r)(6), the hospital must make reasonable efforts to assess your FAP eligibility before taking any “extraordinary collection actions.”6Internal Revenue Service. Billing and Collections – Section 501(r)(6)
Extraordinary collection actions include selling your debt to a collection agency, reporting the debt to credit bureaus, placing a lien on your property, garnishing wages, filing a lawsuit, and refusing medically necessary care because of an unpaid bill from a prior visit. The hospital is also on the hook if a third-party debt collector does any of these on its behalf.6Internal Revenue Service. Billing and Collections – Section 501(r)(6) If a nonprofit hospital sent your bill to collections or reported it before giving you a real chance to apply for financial assistance, that is a federal violation worth raising with the billing department or the IRS.
On credit reporting more broadly: a 2024 Consumer Financial Protection Bureau rule that would have removed medical debt from credit reports was struck down by a federal court in July 2025.7Consumer Financial Protection Bureau. CFPB Finalizes Rule to Remove Medical Bills From Credit Reports Medical debt can still appear on credit reports, though the entry cannot identify your specific provider or the nature of the services. The practical move is to apply promptly and stay in contact with the billing department while your application is pending.
If You’re Denied or the Bill Looks Wrong
If a hospital denies your HUPDA application or your bill doesn’t reflect the required discount, start by asking the hospital’s financial assistance or billing department for a written explanation. HUPDA itself does not set up a formal internal appeal with specific response deadlines, so reconsideration procedures vary by hospital.
If that doesn’t resolve it, the Illinois Attorney General’s Health Care Bureau handles complaints about HUPDA violations and hospital billing disputes. You can reach the bureau at 1-877-305-5145, use the 7-1-1 relay service for hearing or speech accessibility, or file a complaint online through the Attorney General’s website. Bureau mediators will collect information from you and then contact the hospital to try to work out a resolution.8Illinois Attorney General. Health Care – Consumer Protection The Attorney General enforces HUPDA and can seek injunctive relief and civil penalties of up to $500 per knowing violation.9Illinois General Assembly. 210 ILCS 89 – Hospital Uninsured Patient Discount Act
There’s a separate federal route for scheduled care. If you’re uninsured or paying out of pocket, the No Surprises Act entitles you to a written “good faith estimate” before a non-emergency procedure, listing expected charges by provider and service code.10Centers for Medicare & Medicaid Services. No Surprises: What’s a Good Faith Estimate? If the final bill exceeds that estimate by $400 or more, you can start the federal patient-provider dispute resolution process regardless of your income.11eCFR. 45 CFR 149.620 – Requirements for the Patient-Provider Dispute Resolution Process
A Note on Emergency Care
Charity care rules govern the bill, not access to emergency treatment. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), any hospital with a Medicare-participating emergency department must provide a medical screening examination to anyone who comes in requesting evaluation, and must stabilize an emergency condition before discharge or transfer, regardless of insurance status or ability to pay.12Office of the Law Revision Counsel. 42 USC 1395dd – Examination and Treatment for Emergency Medical Conditions EMTALA does not eliminate the bill. It just ensures you get treated first. HUPDA and the hospital’s FAP then determine how much of that bill you actually owe.