District of ColumbiaB26-0438Council Period 26 (2025-2026)HouseWALLET

Medical Debt Mitigation Amendment Act of 2025

Sponsored By: Christina Henderson (Democratic)

Became Law

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Bill Overview

Analyzed Economic Effects

11 provisions identified: 11 benefits, 0 costs, 0 mixed.

Free and discounted care for patients

Covered facilities must provide financial help for medically necessary care to eligible patients living in their service areas. Care is free for households earning at or below 200% of the federal poverty level. Eligible out-of-pocket costs fall 75% for incomes above 200% through 300%, 60% above 300% through 400%, and 40% above 400% through 500%. Discounts use the federal amounts-generally-billed standard, and facilities can offer more help. Written policies must explain eligibility, charges, applications, appeals, billing, and collection, without discrimination based on insurance, immigration, citizenship, or assets.

Limits on reporting patients’ medical debt

Providers and debt collectors cannot report the amount or existence of a patient’s medical debt to consumer reporting agencies. This does not stop an agency from reporting debt it independently knows about. The law therefore limits medical-debt reporting without guaranteeing removal of all medical debt from credit reports.

Lower interest and safer repayment terms

Medical debt interest is capped at 3% a year. Debt for covered-facility care carries no interest while the patient receives financial assistance and has not defaulted. Facilities and collection entities cannot demand the full balance or declare default before three consecutive months of missed payments and three reasonable contact attempts. They must provide written notice and a chance to renegotiate, making a good-faith effort if the patient asks. Lawsuits for nonpayment must wait at least 90 days after the plan is declared in default.

Medical debt safeguards homes and wages

Providers and collectors cannot place a medical-debt lien on a patient’s primary home. They cannot take wages for medical debt when annual household income is below 500% of the federal poverty level. Hospital liens on recovery awards are capped at 33% of the award. For insured accident patients, the limit is the patient’s insurance responsibility when the claim is paid. When the claim is unpaid, the limit is the amount negotiated with the insurer.

More time before medical debt collection

Providers and collectors must wait 180 days after receipt of the first posted medical bill before starting collection. Patients must receive at least 90 days’ notice; covered-facility notices must explain free or discounted care and applications. Covered facilities and their collectors cannot collect from assistance-eligible patients unless they refused help or defaulted on a discounted-care payment plan. For debt based on an insurance appeal, collection contacts, lawsuits, arbitration, and transfers to debt buyers are barred. That pause lasts while the appeal is pending and for 90 days afterward, when the provider or collector knows or should know about it.

Patients gain protections against medical loans

Providers cannot complete or help complete medical lending applications, or promote medical credit while patients are sedated or receiving treatment. Promotion in treatment areas is also barred unless no separate area exists on site. At covered facilities, providers must offer or conduct financial-assistance screening before offering medical loans or other credit. Providers cannot charge a medical lending product before the procedure or costs are incurred. For insured services, charges are limited to copays, deductibles, or coinsurance. Emergency care cannot require a credit-card hold or a card on file. Violations are enforceable as unfair or deceptive trade practices.

Relief from medical debt court judgments

Courts cannot revive old judgments used to collect medical debt covered by the law. A facility or collector must seek a court remedy when an unscreened patient with a judgment later qualifies for assistance. Remedies include canceling the judgment and attempting a payment plan, or reducing or partially satisfying it to the assistance-adjusted balance. Collection under a reduced judgment pauses while the patient follows the plan. Another remedy clears the judgment and refunds payments above the amount owed.

Affordable payment plans for discounted care

Patients approved for reduced-cost care must be offered monthly payments capped at 3% of monthly household income. Higher payments are allowed at the patient’s written request or through an existing higher-percentage plan in the same health system. The first payment cannot be due until at least 30 days after discharge or treatment ends. Eligible patients receive an itemized bill, written plan information, and a chance to discuss a plan before discharge. They have 45 days after receiving the first statement to choose a plan. Facilities must send written debt, installment, payoff, and penalty terms within 21 days of agreement; those terms survive a debt sale.

Easier access to medical bill help

Before non-emergency medically necessary care, covered facilities must offer screening to uninsured patients and patients meeting listed public-assistance or homelessness criteria. Qualifying household members also trigger screening; patients who apply and document a qualifying criterion are deemed eligible. Prior approval counts for six months only if income and insurance status remain unchanged; other patients can request screening. You can apply within 240 days after the first posted bill, or anytime once collection starts. Collection pauses during review, payment is not required while an application is pending, and complete applications receive decisions within 30 days. Approval notices must explain reductions, balances, and further help; denials must explain appeals. Refusing initial screening cannot lead to denial of medically necessary care or later assistance. Facilities must post policies and plain-language summaries online and provide notices on bills and at intake, registration, and discharge, with required language access.

Patients get estimates before medical care

Covered facilities must provide a good-faith cost estimate before medically necessary care, except in emergencies. Uninsured patients receive an estimate of the service’s cost. Insured patients receive an estimate of their expected share under their health plan.

Stronger oversight of patient financial help

Covered facilities must maintain financial-assistance policies to keep their certificate-of-need approvals in good standing. They must report annual assistance, medical-debt, collection, and resale data to the Department of Health. The Department must publish reports, corrective action plans, and fines, and review patient complaints within 30 days. It must provide requested information to the Attorney General’s office within 30 days; assistance-rule violations are subject to enforcement. The law applies six months after the Chief Financial Officer certifies that its fiscal effect is included in an approved budget and financial plan. Its effective-date requirements include mayoral approval or a veto override and a 30-day congressional review period. The Budget Director publishes the certification, and the Mayor must adopt implementing rules by the applicability date, with provider and patient-advocate input.

Sponsors & Cosponsors

Sponsor

Christina Henderson
Democratic • House

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 26 • No: 0

House vote • 6/2/2026

Final Reading, CC

Yes: 13 • No: 0

House vote • 5/5/2026

First Reading, CC