CA AB1020

Increases eligibility threshold for hospital charity care and discount payments from 350% to 400% of the federal poverty level, and redefines "high medical costs" to include annual out-of-pocket costs exceeding the lesser of 10% of current or prior year family income.

Prohibits hospitals from selling patient debt to debt buyers unless the patient has been found ineligible for financial assistance or has not responded to billing/assistance attempts for 180 days, and requires hospitals to send patients a notice with charity care/financial assistance application before assigning bills to collections.

Extends debt collection prohibition from 150 to 180 days after initial billing and requires debt collectors to include in first written communication a copy of the hospital's financial assistance notice; prohibits debt buyers from collecting on hospital debt without this notice.

Requires hospitals to prominently display their financial assistance policies on their internet websites with links to the full policies, and mandates Department of Health Care Access and Information to review hospital policies by January 1, 2023, and make them publicly available.

Establishes administrative penalties up to $40,000 (adjusted annually) for hospitals violating the article's requirements, effective January 1, 2024, with an appeals process; requires hospitals to refund patient overpayments within 30 days.