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State Financial Assistance and
Charity Care Requirements
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This tool helps mission-driven hospitals benchmark and ensure compliance with state and federal financial assistance standards. New states will be added periodically, check back for updates.
State | FAP required? | Typical/minimum income threshold (examples) | Presumptive eligibility rules | Notification & posting requirements | Notable state-specific mandate(s) | Source |
|---|---|---|---|---|---|---|
Illinois | Yes. State regs govern hospital FAPs. | No single numeric minimum in statute; many hospitals use 200%–600% FPL; state guidance enforces reporting. | State regs define presumptive eligibility criteria for non-CAH/rural hospitals. | Hospitals must publish FAP, submit forms and report data to state/AG. | Detailed administrative rules under the Fair Patient Billing Act; reporting requirements. | Justia |
Indiana | Yes. Statute requires written criteria/procedure for charity care. | Law requires income-based means testing indexed to Federal Poverty Guidelines (FPG). | Permitted; statute contemplates presumptive/financially indigent determinations. | Hospitals operating charity care programs must conspicuously post notices and application info. | State-level oversight of policy notice and application processes. | Justia Law |
Kentucky | Yes. State registers charitable health care programs and has registration/oversight. | Varies by hospital; many publish thresholds tied to %FPL. | State guidance permits presumptive eligibility procedures for some programs. | Registered charitable providers must follow state registration and program rules. | Charitable health care registration via KY Cabinet for Health. | Cabinet for Health and Family Services |
Ohio | Yes. Multiple state programs and statutes address charity care/indigent care. | Hospitals commonly use ranges (100%–400% FPL); state HCAP targets at/below FPL for certain programs. | Hospitals may implement presumptive eligibility; program design varies. | State programs (HCAP) and statute require program documentation and reporting to state agencies. | Hospital Care Assurance Program (HCAP) and related reporting rules. | Ohio Laws |
Michigan | Emerging — proposed stronger statutory FAP requirements (legislation in 2025). | Existing hospital policies vary widely; proposed law would require implemented FAPs by 1/1/2027. | Presumptive eligibility handled in local policies; legislation would standardize requirements. | Current practice varies; proposed law would standardize program requirements and implementation timelines. | 2025 bill would require hospitals to implement FAPs by Jan 1, 2027 (watch for final enactment). | Michigan Legislature |
Wisconsin | Yes. State requires hospitals to submit FAPs and report how they notify public. | No single minimum; common practice includes thresholds tied to %FPL; state requires plan submission. | Presumptive eligibility practices exist; application procedures required. | Hospitals must submit annual uncompensated care/service plans and describe notification procedures. | State reporting/submission requirement for hospital FAPs. | The Hilltop Institute |
Alabama | Yes. State admin code recognizes charity care definitions and requires policies. | Varies by provider; policies define eligibility and documentation. | Presumptive eligibility noted in administrative guidance. | Providers must have defined policies; charity care measured as revenue forgone. | Administrative code clarifies definitions and measurement. | Legal Information Institute |
Georgia | No (or limited). Historically Georgia did not require nonprofit hospitals to adopt or disseminate FAPs statewide. | Where policies exist they vary; no statewide minimum mandated. | Presumptive eligibility handled by individual hospitals when present. | No statewide posting mandate; hospitals commonly post their own FAPs voluntarily. | State lacks uniform statutory FAP mandates; practices vary by system. | The Hilltop Institute |
North Carolina | Yes — active state programs and recent policy initiatives (medical debt relief). | Hospitals’ FAP thresholds vary (examples: several health systems use 200%–300% FPL). | State initiatives promote auto-enrollment and expanded forgiveness for eligible debt. | NCDHHS tracks participating hospitals and debt relief amounts; program reporting required for participants. | First-in-nation medical debt relief initiative; active state coordination with hospitals. | NC DHHS |
Tennessee | Yes. State law requires posting of charity care statements and public access to policies. | Thresholds vary by hospital; state requires accessible policy statements. | Presumptive eligibility exists in practice; hospitals provide application resources. | Statutory requirement to post charity care policy in public locations. | Tenn. Code §68-11-268 requires public posting of charity care statements. | The Hilltop Institute |
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