{
  "name": "medfrail.com hospital bill rules",
  "version": "2026-10-21",
  "note": "What a person is owed on a hospital bill, as published by the state and the IRS. Every line names its source. The hospital decides whether a person qualifies, and the state hears appeals; this file only says what the rule says. Checked 2026-10-21.",
  "poverty_guidelines_2026": {
    "what": "HHS poverty guidelines for the 48 contiguous states and DC, published in the Federal Register on 2026-01-15. Colorado's own table may differ a little: the hospital uses the state's table.",
    "by_household_size": { "1": 15960, "2": 21640, "3": 27320, "4": 33000, "5": 38680, "6": 44360, "7": 50040, "8": 55720 },
    "each_additional_person": 5680,
    "source": "https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines"
  },
  "colorado": {
    "program": "Colorado Hospital Discounted Care (HB 21-1198)",
    "who_must_follow_it": "Every Colorado general acute and critical access hospital and its off-campus locations, every freestanding emergency department, and the physicians who provide care at them.",
    "income_limit_percent_of_poverty": 250,
    "who_can_qualify": "Household income at or below 250% of the federal poverty guidelines. You can qualify even if you have insurance, and even if you are not a citizen.",
    "screening": "Hospitals must screen every uninsured patient (unless they opt out), and any insured patient who asks, for Health First Colorado (Medicaid), CHP+, Medicare, Emergency Medicaid and the discount.",
    "what_you_pay": "Bills are limited to rates the state sets. Monthly payments can be no more than 4% of monthly household income for hospital bills and 2% for physician bills (both added together when a bill has both). After 36 monthly payments, or paying the discounted amount, you owe nothing more.",
    "hospital_payment_cap_percent_of_monthly_income": 4,
    "physician_payment_cap_percent_of_monthly_income": 2,
    "payments_until_done": 36,
    "deadlines": [
      "The hospital must check whether you qualify within 45 days of your care (uninsured) or within 45 days of your asking (insured).",
      "The hospital must tell you whether you qualify within 21 days after you complete the application.",
      "Appeal to the hospital within 30 days of its decision; it must confirm it got your appeal within 3 business days.",
      "If the hospital says no again, appeal to the state (HCPF) within 15 calendar days of the hospital's decision.",
      "A biller must tell you in writing 30 days before sending a bill to collections."
    ],
    "complaints": { "who": "Colorado Department of Health Care Policy and Financing (HCPF)", "phone": "303-866-2580", "email": "hcpf_HospDiscountCare@state.co.us" },
    "sources": ["https://hcpf.colorado.gov/colorado-hospital-discounted-care", "https://hcpf.colorado.gov/hospital-discounted-care"]
  },
  "federal_nonprofit_hospitals": {
    "rule": "IRS section 501(r), for nonprofit (tax-exempt) hospitals in every state",
    "what_it_requires": [
      "A written financial assistance policy covering emergency and other medically necessary care, with its eligibility rules and how to apply.",
      "The policy, the application and a plain-language summary on the hospital's website, with no account and no fee to read or print them, and paper copies on request at no charge.",
      "A notice about the policy on billing statements, with a phone number and web address.",
      "Once you are found eligible, you cannot be charged more than the amounts the hospital generally bills people who have insurance.",
      "Reasonable efforts to find out whether you are eligible before extraordinary collection actions."
    ],
    "what_differs_by_hospital": "Each hospital sets its own income limits, so the same household can qualify at one hospital and not another.",
    "source": "https://www.irs.gov/charities-non-profits/financial-assistance-policy-and-emergency-medical-care-policy-section-501r4"
  },
  "hand_off": {
    "name": "Dollar For",
    "what": "A national nonprofit that screens a hospital bill against that hospital's assistance policy and helps with the application. It charges the patient nothing.",
    "url": "https://dollarfor.org/"
  }
}