Baltimore Hospital Financial Assistance 2026–27: Maryland's Free Care Rule, the 500% Hardship Discount, the 240-Day Window and HEAU Help
A Baltimore patient with a five-figure hospital bill may be eligible for help at income levels most people wouldn't expect. Maryland regulation COMAR 10.37.13.06 requires every hospital under the Health Services Cost Review Commission (HSCRC) to offer free medically necessary care at or below 200% of the federal poverty level, and reduced-cost care up to 300%. It also requires a financial hardship discount for families earning up to 500% whose medical debt is large compared to their income.
This guide covers the tiers, the dollar figures, automatic eligibility, the documents hospitals can ask for, your deadline to apply, and where to get help in Baltimore if a hospital says no.
Tier 1: Free Care at or Below 200% FPL
Every Maryland hospital's financial assistance policy must provide free medically necessary care to patients with family income at or below 200% of the federal poverty level.
Automatic (presumptive) eligibility. Unless you're eligible for Medicaid or CHIP, you are deemed eligible for free care if you receive:
SNAP,
WIC,
low-income household energy assistance,
benefits from a household with a child in the free or reduced-price lunch program (based on household income),
the Primary Adult Care program, or
other programs designated by the state.
If you're enrolled in one of these, say so up front.
Tier 2: Reduced-Cost Care From 201% to 300% FPL
Hospitals must cut your out-of-pocket expenses by at least:
Family income (% of FPL) | Minimum reduction |
201% to 250% | 75% |
251% to 300% | 60% |
Tier 3: Financial Hardship Up to 500% FPL
The regulations define financial hardship as medical debt incurred by a family over a 12-month period that exceeds 25% of family income. "Medical debt" here means out-of-pocket costs, such as copays, coinsurance and deductibles, for HSCRC-regulated hospital services.
If you have a financial hardship and your family income is below 500% of FPL, minimum reductions are:
Family income (% of FPL) | Minimum reduction |
201% to 250% | 75% |
251% to 300% | 60% |
301% to 350% | 50% |
351% to 400% | 45% |
401% to 450% | 40% |
451% to 500% | 35% |
Bonus protection: once you get hardship reduced-cost care, you and immediate family members living in your household stay eligible at the same hospital for 12 months from the date the care was first received. Tell the hospital so it doesn't make you reapply.
The Tiers in Dollars
The table below applies the 2026 HHS poverty guidelines. Hospitals may use the guideline in effect at your date of service, so treat these as estimates.
Household size | 200% FPL (free care) | 300% FPL | 500% FPL (hardship ceiling) |
1 | $31,920 | $47,880 | $79,800 |
2 | $43,280 | $64,920 | $108,200 |
3 | $54,640 | $81,960 | $136,600 |
4 | $66,000 | $99,000 | $165,000 |
Example: a family of four earning $90,000 has $25,000 in hospital out-of-pocket costs over 12 months. That's more than 25% of its income, which is $22,500. It's under 300% FPL, so the family should get at least a 60% reduction.
Who Is Covered
All qualified Maryland residents, regardless of citizenship or immigration status.
Residents regardless of whether they live in the hospital's service area.
Insured and uninsured patients. The policy covers patients whose insurance doesn't pay the full bill.
All medically necessary hospital services. Hospitals can't exclude non-urgent or elective care that's medically necessary.
Your Deadline: 240 Days From the First Bill
Before discharge, hospitals must give you written notice of their financial assistance policy. The notice must say you have up to 240 days after you receive the initial hospital bill to apply. If you decline to apply at discharge, you can still apply within that 240-day window.
Eligibility is calculated at the date of service, or updated for any change in your finances in the 240 days after the first bill. That protects people who lose income because of the illness or injury that put them in the hospital.
How to Apply
Get the Uniform Financial Assistance Application. HSCRC created one application that all Maryland acute care hospitals must use. It's on the HSCRC website, and hospitals must give it to anyone who asks, regardless of insurance status.
Read the hospital's own policy. HSCRC posts links to every hospital's financial assistance policy.
Submit the application directly to the hospital that billed you, not to HSCRC.
Prove income. Hospitals must accept common documents such as tax returns, pay stubs and W-2s. They may also accept your signed statement of monthly or annual income and the number of filers and dependents on your tax return, without other documentation. If they accept a statement, no further income check is required.
Assets. Hospitals may use a monetary asset test, but Maryland's definition only counts monetary assets over $100,000, and excludes tax-favored retirement accounts.
No extra paperwork. A hospital may require only the documents needed to validate the information on your application.
If You're Denied: Reconsideration and HEAU
Every hospital policy must include a way for any patient, insured or not, to ask the hospital to reconsider a denial of free or reduced-cost care. The policy must also give contact details for the Maryland Attorney General's Health Education and Advocacy Unit (HEAU), which can help you file and mediate a reconsideration request.
HEAU (Maryland Attorney General):
Hotline: 410-528-1840, Monday to Friday, 10 a.m. to 2 p.m.
En español: 410-230-1712
Toll-free: 1-877-261-8807
Fax: 410-576-6571
Address: 200 St. Paul Place, Baltimore, MD 21202
Reconsideration checklist: the denial letter, your application copy, income proof or a signed income statement, proof of SNAP, WIC, energy assistance or school meal enrollment if you have it, and a hardship worksheet showing 12 months of out-of-pocket hospital costs against family income.
The Discharge Packet: What to Look For
Under Health-General §19-214.1(e), Maryland's acute care hospitals must give discharged patients a patient information sheet. HSCRC says it must include:
a description of the hospital's financial assistance policy,
your rights and obligations for hospital billing and collection,
contact information for the hospital office that can help with your bill and explain how to apply for free and reduced-cost care,
contact information for the Maryland Medical Assistance Program (Medicaid), and
a statement that physician charges are billed separately and aren't included in the hospital bill.
That last point matters. Maryland's hospital financial assistance rules apply to HSCRC-regulated hospital services. Doctors who bill separately, such as emergency physicians, anesthesiologists or radiologists, may have their own policies. Ask each one directly about financial help, and keep the discharge sheet with your bills.
HSCRC is at 4160 Patterson Avenue, Baltimore, and can be reached at 410-764-2605. It lists links for all 42 Maryland acute care hospitals, but applications go to the hospital, not to HSCRC.
Notices You Should See
Hospitals must post notices of your right to apply in conspicuous places, including the billing office. The notices must use simplified language in at least 10-point type, in your preferred language. Billing vendors and debt collectors working for a hospital must post a notice and a link to the application on their websites and payment portals.
More Help
More help in Baltimore: Baltimore financial help guides
Related Guides
Sources
This guide gives general information, not legal advice. Check your hospital's financial assistance policy or contact HEAU for help.
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