US HB7478

Hospitals participating in Medicare must establish charity care/financial assistance policies with public eligibility requirements and screen patients for eligibility beginning January 1, 2028, with eligibility determinations required at least 30 days before payment is due

Hospitals are prohibited from placing liens on homes, foreclosing, or garnishing wages to collect medical debt, and cannot sell debt to collectors until 1 year has passed and the patient has missed 4+ consecutive payments under a repayment program capped at 4% of monthly income

Patients with household income at or below 250% of the federal poverty line cannot be charged interest on medical debt and their debt cannot be sold to debt collectors

Noncompliant hospitals face civil monetary penalties up to $1,000,000 per instance, with the Secretary required to conduct annual compliance audits beginning January 1, 2029 and establish an online portal for patients to report violations

Authorizes $100,000,000 for fiscal year 2027 to establish a grant program allowing one nonprofit organization to acquire and discharge medical debt for individuals whose debt equals 5%+ of their income or who have household income at or below 400% of the poverty line