DelawareSS 1 for SB 13153rd General Assembly (2024–2026)SenateWALLET

AN ACT TO AMEND TITLE 6 AND TITLE 16 OF THE DELAWARE CODE RELATING TO HOSPITAL CHARITY CARE AND FINANCIAL ASSISTANCE.

Sponsored By: Marie Pinkney (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 7 benefits, 0 costs, 0 mixed.

Stronger medical debt protections for patients

Providers aware of a completed assistance or coverage application under review cannot report the charges to credit bureaus or pursue collections. They also cannot sell or assign the debt, sue, or start arbitration while review is pending. Hospitals must tell patients in writing that bills received during this period are not due. Creditors and collectors aware of a pending assistance decision or appeal cannot sue, start arbitration, or refer or sell the debt. Their collection messages are barred unless written messages explain that patients are not responsible during review. Creditors and collectors also cannot take extraordinary collection actions against patients they know qualify or likely qualify for assistance. Eligibility or a hospital or covered provider's failure to follow assistance rules is a complete defense in medical debt lawsuits. Before a hospital gets a default judgment, an officer must file an affidavit confirming screening was offered before suit. It must also confirm that the patient was found ineligible or did not respond.

Lower hospital bills for Delaware patients

Beginning January 1, 2027, Delaware residents who qualify get minimum discounts on their share of medically necessary hospital bills. Care is free at household income up to 300% of the federal poverty level. The minimum discount is 75% above 300% through 350%, and 50% above 350% through 400%. Hospitals may offer help above 400%. Covered care includes inpatient, emergency, observation, outpatient, and certain affiliated off-campus services, subject to the law's exclusions. Assistance covers the patient's share after insurance payments or adjustments; hospitals and covered hospital-based providers can still bill insurers. They cannot require prior payment, a payment plan, or use of all other billing remedies before granting standard-tier assistance. Hospitals providing only psychiatric, rehabilitation, or long-term acute care remain under prior charity-care rules.

Faster assistance decisions and patient refunds

Hospitals must help patients apply through multiple methods using the state's standard application and approved income documents. They must allow reasonable time to supply missing items and issue written decisions within 21 days of completed applications. Patients can appeal, apply during collections even after debt transfer, and reapply after financial changes or added medical expenses. Approval through an application lasts at least one year. Written notices must state the eligibility category, household income, effective dates, and supporting documents. Covered hospital-based providers must honor these notices; hospitals and providers must also honor valid notices from another hospital. Hospitals must refund covered payments, waive covered debt, and pay reasonable costs of obtaining assistance after required screening failures or incorrect denials. If transferred debt is invalid because the patient qualifies, the hospital must notify the debt holder or collector.

Hospital discounts for patients facing hardship

The law requires hospitals to offer hardship assistance to patients above the standard income limits. Hospital costs for one visit, including deductibles, must equal at least 10% of annual household income. The minimum discount is 50%, and any hospital-set income ceiling cannot be below 500% of the federal poverty level. The minimum assistance standards begin January 1, 2027. A documented hardship approval lasts one year and covers hospital services provided during that year. Patients previously denied under standard income limits must apply and provide added documents showing hardship.

Hospitals must help patients find assistance

Hospitals must post assistance notices and explain at registration or admission how patients can apply and get staff help. They must offer screening and applications to uninsured patients, patients paying any share themselves, and patients owing at least $500 after insurance. Written payment requests to these patients must include an assistance notice and application. Notices, policies, and applications must be available in languages spoken by more than 5% of the service-area population. Hospitals must also post policies and applications online. Patients meeting the state's presumptive eligibility criteria get assistance without a full application for at least 180 days. They may apply for one-year approval, and hospitals cannot demand documents beyond state requirements.

Patient help while public coverage is reviewed

Possible Medicaid or other public coverage does not by itself justify denying or delaying hospital assistance. Hospitals must screen using available information, make reasonable enrollment efforts, and record whether the patient appears eligible before relying on possible coverage. Patients legally barred from that coverage cannot be required to undergo screening for it. Hospitals may give temporary assistance while coverage is reviewed, generally for up to 180 days after the assistance decision. That period can continue if the coverage application remains pending and the hospital documents it. Hospitals must reconcile assistance within 30 days after learning whether coverage was approved or denied. They cannot bill or send covered amounts to collections during reconciliation and must refund overpayments within 30 days afterward.

State oversight protects hospital financial help

The Diamond State Hospital Cost Review Board sets assistance standards, forms, screening methods, and regulations. Hospitals must report annually on application outcomes and reasons, presumptive approvals, decision times, and assistance costs and operating-expense shares. The Board must post hospital policies and reports within 30 days of receiving them, alongside patient-rights information and required documents. Complaints, unusual reporting patterns, missing notices, and other warning signs can trigger compliance reviews. The Board must refer hospital violations to the Division of Health Care Quality, which can impose civil fines and take license-related action. Assistance duties follow the hospital license when owners or operators change. Providers subject to a Delaware Certificate of Public Review must provide and accept charity care as the Board directs for eligible patients. The Department of Health and Social Services enforces that requirement; exclusively psychiatric, rehabilitation, and long-term acute care hospitals retain prior charity-care rules. Except for minimum assistance standards beginning January 1, 2027, the law's rules begin when final regulations are announced or July 1, 2027, whichever is earlier.

Sponsors & Cosponsors

Sponsor

Marie Pinkney
Democratic • Senate

Cosponsors

Nnamdi O. Chukwuocha
Democratic • House
Daniel Cruce
Democratic • Senate
Kerri Evelyn Harris
Democratic • House
Larry Lambert
Democratic • House
Melissa Minor-Brown
Democratic • House
Nicole Poore
Democratic • Senate
Melanie Ross Levin
Democratic • House
Bryan Townsend
Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 44 • No: 16

House vote • 6/23/2026

Passed (SM required)

Yes: 27 • No: 13

Senate vote • 6/11/2026