{
 "_meta": {
  "source": "State statutes/regulations researched per-state Jun 10, 2026 (legislature texts, state health dept pages, Hilltop Institute Community Benefit State Law Profiles, Dollar For state sheets, Healthcare Value Hub profiles)",
  "researched_on": "2026-06-10",
  "fields": "free_pct / disc_pct = max income as % of Federal Poverty Guidelines for mandated FREE care / any mandated discount (null = statute sets no FPL threshold); confidence per state; federal 501(r) baseline applies everywhere",
  "derived_family4_2026": {
   "fpl4_contig_usd": 33000,
   "wa_free_300pct_usd": 99000,
   "il_discount_600pct_usd": 198000,
   "note": "Dollar conversions of free_pct/disc_pct at the 2026 federal poverty guideline for a family of 4 (48 contiguous + DC, fpl_guidelines.json). RE-DERIVE when the FPL rolls each January."
  }
 },
 "states": {
  "alabama": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; nonprofit hospitals must follow the federal 501(r) financial-assistance rules, so free or discounted care depends on each hospital's own policy.",
   "sum_es": "No hay mandato estatal de atención caritativa; los hospitales sin fines de lucro deben seguir las reglas federales 501(r) de asistencia financiera, así que la atención gratis o con descuento depende de la política de cada hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/alabama/"
   ],
   "confidence": "secondary-source-only"
  },
  "alaska": {
   "has_state_law": false,
   "sum_en": "No state charity-care law; only the federal 501(r) financial-assistance rules apply to nonprofit hospitals, with eligibility terms set by each hospital's own policy.",
   "sum_es": "No hay ley estatal de atención caritativa; solo aplican las reglas federales 501(r) a los hospitales sin fines de lucro, con términos de elegibilidad fijados por la política de cada hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/alaska/"
   ],
   "confidence": "secondary-source-only"
  },
  "arizona": {
   "has_state_law": false,
   "sum_en": "No state law regulates hospital charity care; nonprofit hospitals follow the federal 501(r) rules and must publicize their own financial-assistance policies, whose income limits vary by hospital.",
   "sum_es": "Ninguna ley estatal regula la atención caritativa hospitalaria; los hospitales sin fines de lucro siguen las reglas federales 501(r) y deben publicar sus propias políticas de asistencia financiera, cuyos límites de ingreso varían por hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/arizona/"
   ],
   "confidence": "secondary-source-only"
  },
  "arkansas": {
   "has_state_law": false,
   "sum_en": "No state charity-care or hospital financial-assistance law; only the federal 501(r) rules for nonprofit hospitals apply, so assistance terms are set by each hospital's own policy.",
   "sum_es": "No hay ley estatal de atención caritativa ni de asistencia financiera hospitalaria; solo aplican las reglas federales 501(r) a los hospitales sin fines de lucro, así que los términos los fija la política de cada hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/arkansas/"
   ],
   "confidence": "secondary-source-only"
  },
  "california": {
   "has_state_law": true,
   "law": "Hospital Fair Pricing Act (AB 774, expanded by AB 1020 in 2021)",
   "citation": "Cal. Health & Safety Code §127400 et seq.",
   "covers": "all licensed hospitals",
   "free_pct": null,
   "disc_pct": 400,
   "sum_en": "Uninsured patients (and insured patients with high medical costs) at or below 400% FPL must get charity care or discounted payment, and cannot be charged more than the hospital's Medicare or Medi-Cal rate, whichever is greater.",
   "sum_es": "Pacientes sin seguro (y asegurados con gastos médicos altos) con ingreso igual o menor al 400% del FPL deben recibir atención caritativa o pago con descuento, y no se les puede cobrar más que la tarifa de Medicare o Medi-Cal del hospital, la que sea mayor.",
   "note_en": "The statute sets no fixed free-care line; each hospital's policy decides free vs. discounted within the 400% cap.",
   "note_es": "La ley no fija una línea de atención gratis; la política de cada hospital decide entre gratis y descuento dentro del tope de 400%.",
   "sources": [
    "https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=HSC&sectionNum=127405",
    "https://hcai.ca.gov/affordability/hospital-fair-billing-program/"
   ],
   "confidence": "verified"
  },
  "colorado": {
   "has_state_law": true,
   "law": "Hospital Discounted Care (HB 21-1198)",
   "citation": "C.R.S. §25.5-3-501 et seq.",
   "covers": "all licensed general hospitals and freestanding ERs",
   "free_pct": null,
   "disc_pct": 250,
   "sum_en": "Hospitals must screen every uninsured patient; Colorado residents at or below 250% FPL get state-set discounted rates, payment plans capped at 4% (hospital) / 2% (professional) of monthly income, and after 36 monthly payments the bill is deemed paid in full.",
   "sum_es": "Los hospitales deben evaluar a todo paciente sin seguro; los residentes de Colorado con ingreso igual o menor al 250% del FPL reciben tarifas con descuento fijadas por el estado, planes de pago con tope del 4% (hospital) / 2% (profesional) del ingreso mensual, y tras 36 pagos mensuales la cuenta se considera pagada por completo.",
   "note_en": "Mandates discounts rather than free care; effective September 1, 2022.",
   "note_es": "Exige descuentos, no atención gratis; vigente desde el 1 de septiembre de 2022.",
   "sources": [
    "https://hcpf.colorado.gov/colorado-hospital-discounted-care",
    "https://leg.colorado.gov/bills/hb21-1198"
   ],
   "confidence": "verified"
  },
  "connecticut": {
   "has_state_law": true,
   "law": "Hospital collections limits for uninsured patients",
   "citation": "Conn. Gen. Stat. §19a-673, §19a-673b",
   "covers": "all hospitals",
   "free_pct": null,
   "disc_pct": 250,
   "sum_en": "Hospitals cannot collect from uninsured patients with income at or below 250% of the federal poverty guidelines more than the actual cost of services, must check hospital bed-fund (charity) eligibility before any collections, and cannot report medical debt to credit bureaus.",
   "sum_es": "Los hospitales no pueden cobrar a pacientes sin seguro con ingreso igual o menor al 250% de las pautas federales de pobreza más que el costo real de los servicios, deben revisar la elegibilidad para fondos caritativos antes de cualquier cobranza, y no pueden reportar deudas médicas a los burós de crédito.",
   "note_en": "A charge/collections cap rather than a free-care entitlement.",
   "note_es": "Es un tope de cobro/cobranza, no un derecho a atención gratis.",
   "sources": [
    "https://law.justia.com/codes/connecticut/title-19a/chapter-368z/section-19a-673/"
   ],
   "confidence": "verified"
  },
  "delaware": {
   "has_state_law": true,
   "law": "Charity care condition of the Certificate of Public Review",
   "citation": "16 Del. C. §9311",
   "covers": "hospitals subject to Certificate of Public Review",
   "free_pct": null,
   "disc_pct": 350,
   "sum_en": "Hospitals must provide charity care as a condition of their Certificate of Public Review; under Board criteria, patients at or below 350% FPL can qualify for free or discounted care, with amounts set by the Health Resources Board each year.",
   "sum_es": "Los hospitales deben dar atención caritativa como condición de su Certificate of Public Review; según criterios de la junta, pacientes con ingreso igual o menor al 350% del FPL pueden calificar para atención gratis o con descuento, con montos fijados cada año por el Health Resources Board.",
   "note_en": "The 350% figure comes from Board criteria, not statute text; a bill to mandate free care below 300% FPL (SB 13) was pending in June 2026.",
   "note_es": "El 350% proviene de criterios de la junta, no del texto de la ley; en junio de 2026 estaba pendiente un proyecto (SB 13) para exigir atención gratis bajo el 300% del FPL.",
   "sources": [
    "https://delcode.delaware.gov/title16/c093/index.html",
    "https://dollarfor.org/state_sheet/delaware/"
   ],
   "confidence": "secondary-source-only"
  },
  "district-of-columbia": {
   "has_state_law": true,
   "law": "Uncompensated-care obligation under the DC Certificate of Need program",
   "citation": "22-B DCMR §4400–4406",
   "covers": "facilities holding a Certificate of Need (includes hospitals)",
   "free_pct": null,
   "disc_pct": 200,
   "sum_en": "Facilities with a Certificate of Need must provide uncompensated care (free or reduced-charge) worth at least 3% of operating expenses minus Medicare/Medicaid payments; patients with income at or below 200% of the federal poverty level are eligible.",
   "sum_es": "Las instalaciones con Certificate of Need deben dar atención no compensada (gratis o con cargo reducido) por al menos el 3% de sus gastos operativos menos pagos de Medicare/Medicaid; son elegibles los pacientes con ingreso igual o menor al 200% del nivel federal de pobreza.",
   "note_en": "A facility-level volume obligation, not an individual entitlement.",
   "note_es": "Es una obligación de volumen del centro, no un derecho individual.",
   "sources": [
    "http://dcrules.elaws.us/dcmr/22-b4406"
   ],
   "confidence": "verified"
  },
  "florida": {
   "has_state_law": false,
   "sum_en": "No state law mandates free or discounted hospital care at set income levels; nonprofit hospitals follow the federal 501(r) rules. Since July 2024 (HB 7089), hospitals cannot sue, garnish wages, or place liens until financial-assistance eligibility is decided, and collections are limited to 3 years.",
   "sum_es": "Ninguna ley estatal exige atención hospitalaria gratis o con descuento a niveles de ingreso fijos; los hospitales sin fines de lucro siguen las reglas federales 501(r). Desde julio de 2024 (HB 7089), los hospitales no pueden demandar, embargar salarios ni imponer gravámenes hasta decidir la elegibilidad de asistencia financiera, y la cobranza se limita a 3 años.",
   "sources": [
    "https://www.flsenate.gov/Committees/BillSummaries/2024/html/7089"
   ],
   "confidence": "verified"
  },
  "georgia": {
   "has_state_law": true,
   "law": "Indigent Care Trust Fund participation requirements",
   "citation": "O.C.G.A. §31-8-150 et seq.; Ga. Comp. R. & Regs. 111-3-6-.03",
   "covers": "only hospitals receiving Indigent Care Trust Fund (DSH) payments",
   "free_pct": 125,
   "disc_pct": 200,
   "sum_en": "Hospitals that take Indigent Care Trust Fund money must treat patients below 125% FPL free and offer free or sliding-scale fees between 125% and at least 200% FPL, until their indigent-care spending equals what they received from the fund.",
   "sum_es": "Los hospitales que reciben dinero del Indigent Care Trust Fund deben atender gratis a pacientes bajo el 125% del FPL y ofrecer atención gratis o con escala de tarifas entre el 125% y al menos el 200% del FPL, hasta que su gasto en atención de indigentes iguale lo recibido del fondo.",
   "note_en": "Not universal — the duty applies only at participating hospitals and is capped at their fund receipts.",
   "note_es": "No es universal: la obligación aplica solo en hospitales participantes y tiene tope en lo que reciben del fondo.",
   "sources": [
    "https://rules.sos.ga.gov/gac/111-3-6",
    "https://dch.georgia.gov/providers/provider-types/hospital-providers/indigent-care-trust-fund"
   ],
   "confidence": "verified"
  },
  "hawaii": {
   "has_state_law": false,
   "sum_en": "No state charity-care law; only the federal 501(r) rules apply to nonprofit hospitals, with income limits set by each hospital's own policy (major systems voluntarily offer free care up to about 200% FPL).",
   "sum_es": "No hay ley estatal de atención caritativa; solo aplican las reglas federales 501(r) a los hospitales sin fines de lucro, con límites de ingreso fijados por cada hospital (los sistemas grandes ofrecen voluntariamente atención gratis hasta cerca del 200% del FPL).",
   "sources": [
    "https://dollarfor.org/state_sheet/hawaii/"
   ],
   "confidence": "secondary-source-only"
  },
  "idaho": {
   "has_state_law": false,
   "sum_en": "No hospital charity-care mandate; Idaho's county indigent program and state Catastrophic Health Care Cost program were repealed in 2022 after Medicaid expansion, leaving only the federal 501(r) rules for nonprofit hospitals.",
   "sum_es": "No hay mandato de atención caritativa; el programa de indigentes por condado y el programa estatal de costos catastróficos fueron derogados en 2022 tras la expansión de Medicaid, quedando solo las reglas federales 501(r) para hospitales sin fines de lucro.",
   "sources": [
    "https://dollarfor.org/state_sheet/idaho/"
   ],
   "confidence": "secondary-source-only"
  },
  "illinois": {
   "has_state_law": true,
   "law": "Hospital Uninsured Patient Discount Act (with the Fair Patient Billing Act)",
   "citation": "210 ILCS 89; 210 ILCS 88",
   "covers": "all general acute-care hospitals (lower thresholds at rural/critical-access hospitals)",
   "free_pct": 200,
   "disc_pct": 600,
   "sum_en": "Uninsured patients under 200% FPL get medically necessary hospital care free; under 600% FPL charges are capped at 135% of cost and hospitals can collect at most 25% of family income per year. Rural/critical-access thresholds: 125% free, 300% discounted.",
   "sum_es": "Pacientes sin seguro bajo el 200% del FPL reciben gratis la atención hospitalaria médicamente necesaria; bajo el 600% del FPL los cargos tienen tope del 135% del costo y los hospitales pueden cobrar como máximo el 25% del ingreso familiar al año. En hospitales rurales/de acceso crítico: gratis hasta 125%, descuento hasta 300%.",
   "note_en": "Since 2023, patients who decline public insurance over immigration-status fears still count as uninsured; 90-day application window.",
   "note_es": "Desde 2023, quienes rechazan seguro público por temor migratorio cuentan igual como no asegurados; ventana de solicitud de 90 días.",
   "sources": [
    "https://www.ilga.gov/Legislation/ILCS/Articles?ActID=3001&ChapterID=21"
   ],
   "confidence": "verified"
  },
  "indiana": {
   "has_state_law": true,
   "law": "Nonprofit hospital charity-care policy duty + Notice of Payment Assistance law (HEA 1271, 2026 / Public Law 88-2026, signed March 4, 2026)",
   "citation": "Ind. Code 16-21-9; 16-21-9.5 (effective July 1, 2026)",
   "covers": "policy duty: nonprofit hospitals; notice duty: all hospitals",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "Nonprofit hospitals must keep charity-care criteria indexed to the federal poverty guidelines, but each hospital sets its own thresholds. From July 1, 2026, every hospital must notify patients about payment assistance and offer an application before sending any bill to collections.",
   "sum_es": "Los hospitales sin fines de lucro deben mantener criterios de atención caritativa indexados a las pautas federales de pobreza, pero cada hospital fija sus propios umbrales. Desde el 1 de julio de 2026, todo hospital debe informar sobre asistencia de pago y ofrecer una solicitud antes de enviar una factura a cobranza.",
   "sources": [
    "https://iga.in.gov/legislative/2026/bills/house/1271/details"
   ],
   "confidence": "verified"
  },
  "iowa": {
   "has_state_law": true,
   "law": "County public hospital free-care duty",
   "citation": "Iowa Code §347.16(2)",
   "covers": "county-owned public hospitals only",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "Indigent residents of a county are entitled to free care at that county's public hospital; the hospital board decides who counts as indigent. No state law covers private or nonprofit hospitals, which follow only the federal 501(r) rules.",
   "sum_es": "Los residentes indigentes de un condado tienen derecho a atención gratis en el hospital público de ese condado; la junta del hospital decide quién califica como indigente. Ninguna ley estatal cubre hospitales privados o sin fines de lucro, que siguen solo las reglas federales 501(r).",
   "sources": [
    "https://www.legis.iowa.gov/docs/code/347.16.pdf"
   ],
   "confidence": "verified"
  },
  "kansas": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; Kansas does not require hospitals to adopt financial-assistance policies, so only the federal 501(r) rules apply at nonprofit hospitals. State law does restrict wage garnishment for medical debt after illness.",
   "sum_es": "No hay mandato estatal de atención caritativa; Kansas no exige políticas de asistencia financiera, así que solo aplican las reglas federales 501(r) en hospitales sin fines de lucro. La ley estatal sí restringe el embargo de salario por deuda médica tras una enfermedad.",
   "sources": [
    "https://hilltopinstitute.org/wp-content/uploads/hcbp/hcbp_docs/HCBP_CBL_KS.pdf"
   ],
   "confidence": "verified"
  },
  "kentucky": {
   "has_state_law": false,
   "sum_en": "No state law requires Kentucky hospitals to provide free or discounted care; nonprofit hospitals must follow the federal 501(r) financial-assistance rules.",
   "sum_es": "Ninguna ley estatal exige a los hospitales de Kentucky dar atención gratis o con descuento; los hospitales sin fines de lucro deben seguir las reglas federales 501(r) de asistencia financiera.",
   "sources": [
    "https://hilltopinstitute.org/wp-content/uploads/hcbp/hcbp_docs/HCBP_CBL_KY.pdf"
   ],
   "confidence": "verified"
  },
  "louisiana": {
   "has_state_law": true,
   "law": "State charity hospital system admission law for medically indigent patients",
   "citation": "La. R.S. 46:6",
   "covers": "state-supported charity hospitals only",
   "free_pct": 200,
   "disc_pct": null,
   "sum_en": "Louisiana residents who are uninsured with income below 200% of the federal poverty guideline are 'medically indigent' and eligible for care at state-run charity hospitals. Private and nonprofit hospitals have no state charity-care mandate; only the federal 501(r) rules apply there.",
   "sum_es": "Los residentes de Louisiana sin seguro y con ingreso bajo el 200% de la pauta federal de pobreza son 'médicamente indigentes' y elegibles para atención en los hospitales caritativos estatales. Los hospitales privados y sin fines de lucro no tienen mandato estatal; allí solo aplican las reglas federales 501(r).",
   "sources": [
    "https://law.justia.com/codes/louisiana/revised-statutes/title-46/rs-46-6/"
   ],
   "confidence": "verified"
  },
  "maine": {
   "has_state_law": true,
   "law": "Maine hospital charity-care / free-care law",
   "citation": "22 M.R.S. §1716-A (effective July 1, 2026; replaces §1716)",
   "covers": "all Maine hospitals",
   "free_pct": 200,
   "disc_pct": 400,
   "sum_en": "From July 1, 2026, hospitals must give free medically necessary care to patients with family income at or below 200% of the federal poverty level (150% under the prior rule), plus payment plans capped at 4% of monthly income for patients up to 400% FPL, with written notice and appeal rights.",
   "sum_es": "Desde el 1 de julio de 2026, los hospitales deben dar atención médicamente necesaria gratis a pacientes con ingreso familiar igual o menor al 200% del nivel federal de pobreza (150% bajo la regla anterior), más planes de pago con tope del 4% del ingreso mensual hasta el 400% del FPL, con aviso escrito y derecho de apelación.",
   "sources": [
    "https://www.mainelegislature.org/legis/Statutes/22/title22sec1716-A.html"
   ],
   "confidence": "verified"
  },
  "maryland": {
   "has_state_law": true,
   "law": "Maryland hospital financial assistance law (expanded by HB 1420)",
   "citation": "Md. Code, Health-General §19-214.1",
   "covers": "all acute-care and chronic-care hospitals",
   "free_pct": 200,
   "disc_pct": 500,
   "sum_en": "Hospitals must give free medically necessary care below 200% FPL and sliding discounts (75% down to 35%) from 201% up to 500% FPL — the 301–500% tiers for patients with financial hardship. Patients have 240 days to apply; only assets over $100,000 are counted.",
   "sum_es": "Los hospitales deben dar atención médicamente necesaria gratis bajo el 200% del FPL y descuentos escalonados (de 75% a 35%) del 201% hasta el 500% del FPL — los niveles de 301–500% son para pacientes con dificultad financiera. Hay 240 días para solicitar; solo se cuentan activos sobre $100,000.",
   "note_en": "Applies regardless of immigration status.",
   "note_es": "Aplica sin importar el estatus migratorio.",
   "sources": [
    "https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg&section=19-214.1"
   ],
   "confidence": "verified"
  },
  "massachusetts": {
   "has_state_law": true,
   "law": "Health Safety Net (HSN)",
   "citation": "101 CMR 613.00",
   "covers": "all acute-care hospitals and licensed community health centers",
   "free_pct": 150,
   "disc_pct": 300,
   "sum_en": "Massachusetts residents up to 300% FPL get hospital and health-center care paid by the state Health Safety Net. Care is fully free at or below 150% FPL; some patients between 150% and 300% FPL owe an annual deductible. Apply through the MassHealth application.",
   "sum_es": "Los residentes de Massachusetts hasta el 300% del FPL reciben atención hospitalaria y de centros de salud pagada por el Health Safety Net estatal. La atención es totalmente gratis hasta el 150% del FPL; algunos pacientes entre 150% y 300% deben un deducible anual. Se solicita con la aplicación de MassHealth.",
   "sources": [
    "https://www.mass.gov/info-details/health-safety-net-for-patients"
   ],
   "confidence": "verified"
  },
  "michigan": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; Michigan does not require hospitals to adopt financial-assistance policies or limit hospital billing, so nonprofit hospitals follow only the federal 501(r) rules. Policies vary hospital by hospital.",
   "sum_es": "No hay mandato estatal de atención caritativa; Michigan no exige políticas de asistencia financiera ni limita la facturación hospitalaria, así que los hospitales sin fines de lucro siguen solo las reglas federales 501(r). Las políticas varían por hospital.",
   "sources": [
    "https://hilltopinstitute.org/wp-content/uploads/hcbp/hcbp_docs/HCBP_CBL_MI.pdf"
   ],
   "confidence": "verified"
  },
  "minnesota": {
   "has_state_law": true,
   "law": "Hospital charity-care screening law + Attorney General Hospital Agreement",
   "citation": "Minn. Stat. §144.587 (2023)",
   "covers": "hospitals statewide (AG agreement: all nonprofit hospitals)",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "Hospitals must screen uninsured patients for charity care and may not send a bill to collections, set up payment plans, or take large card payments before deciding eligibility. Income thresholds are set by each hospital's own policy, not by statute.",
   "sum_es": "Los hospitales deben evaluar a pacientes sin seguro para atención caritativa y no pueden enviar una factura a cobranza, establecer planes de pago ni tomar pagos grandes con tarjeta antes de decidir la elegibilidad. Los umbrales de ingreso los fija la política de cada hospital, no la ley.",
   "sources": [
    "https://www.revisor.mn.gov/statutes/cite/144.587"
   ],
   "confidence": "verified"
  },
  "mississippi": {
   "has_state_law": false,
   "sum_en": "No state law sets charity-care eligibility; nonprofit hospitals follow the federal 501(r) rules. Hospitals may not bill patients admitted as indigent, and nonprofit hospitals must keep a charity ward to stay property-tax exempt — but neither creates an income-based entitlement.",
   "sum_es": "Ninguna ley estatal fija elegibilidad de atención caritativa; los hospitales sin fines de lucro siguen las reglas federales 501(r). Los hospitales no pueden facturar a pacientes admitidos como indigentes, y los sin fines de lucro deben mantener una sala caritativa para su exención fiscal — pero nada de eso crea un derecho basado en ingreso.",
   "sources": [
    "https://hilltopinstitute.org/wp-content/uploads/hcbp/hcbp_docs/HCBP_CBL_MS.pdf"
   ],
   "confidence": "verified"
  },
  "missouri": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; Missouri does not require hospitals to adopt financial-assistance policies or limit billing and collections. Nonprofit hospitals must follow the federal 501(r) rules.",
   "sum_es": "No hay mandato estatal de atención caritativa; Missouri no exige políticas de asistencia financiera ni limita la facturación y cobranza. Los hospitales sin fines de lucro deben seguir las reglas federales 501(r).",
   "sources": [
    "https://www.hilltopinstitute.org/hcbpDocs/HCBP_CBL_MO.pdf"
   ],
   "confidence": "verified"
  },
  "montana": {
   "has_state_law": true,
   "law": "Hospital nondiscrimination, community benefit and financial assistance law",
   "citation": "Mont. Code Ann. §50-5-121 (as amended 2023)",
   "covers": "all hospitals (nondiscrimination); nonprofit hospitals (financial-assistance policy duty)",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "Montana hospitals may not deny or transfer patients based on ability to pay, and nonprofit hospitals must keep a public written financial-assistance policy. The statute sets no income thresholds — specific generosity is left to each hospital and the federal 501(r) rules.",
   "sum_es": "Los hospitales de Montana no pueden negar o transferir pacientes por su capacidad de pago, y los hospitales sin fines de lucro deben mantener una política pública y escrita de asistencia financiera. La ley no fija umbrales de ingreso — la generosidad concreta queda en manos de cada hospital y de las reglas federales 501(r).",
   "sources": [
    "https://mca.legmt.gov/bills/mca/title_0500/chapter_0050/part_0010/section_0210/0500-0050-0010-0210.html"
   ],
   "confidence": "verified"
  },
  "nebraska": {
   "has_state_law": false,
   "sum_en": "No state charity-care law; nonprofit hospitals must offer financial assistance under the federal 501(r) rules, with income thresholds set by each hospital's own policy.",
   "sum_es": "No hay ley estatal de atención caritativa; los hospitales sin fines de lucro deben ofrecer asistencia financiera bajo las reglas federales 501(r), con umbrales de ingreso fijados por la política de cada hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/nebraska/"
   ],
   "confidence": "secondary-source-only"
  },
  "nevada": {
   "has_state_law": true,
   "law": "Hospital billing reduction and indigent-care requirements",
   "citation": "Nev. Rev. Stat. §§439B.260, 439B.320",
   "covers": "major hospitals (200+ beds); indigent-care quota exempts hospitals with 100 or fewer beds",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "Major Nevada hospitals must cut an uninsured inpatient's bill by at least 30% if the patient isn't eligible for public coverage and arranges payment within 30 days. Larger hospitals must also provide free inpatient care to indigent patients worth 0.6% of their annual net revenue.",
   "sum_es": "Los hospitales grandes de Nevada deben reducir al menos 30% la factura de un paciente internado sin seguro si no es elegible para cobertura pública y acuerda el pago en 30 días. Los hospitales más grandes también deben dar atención hospitalaria gratis a indigentes por el 0.6% de sus ingresos netos anuales.",
   "note_en": "Eligibility for 'indigent' care uses fixed dollar amounts, not FPL percentages.",
   "note_es": "La elegibilidad como 'indigente' usa montos fijos en dólares, no porcentajes del FPL.",
   "sources": [
    "https://law.onecle.com/nevada/health/439B.260.html"
   ],
   "confidence": "verified"
  },
  "new-hampshire": {
   "has_state_law": false,
   "sum_en": "No state charity-care law; nonprofit hospitals must offer financial assistance under the federal 501(r) rules, with income thresholds set by each hospital's own policy.",
   "sum_es": "No hay ley estatal de atención caritativa; los hospitales sin fines de lucro deben ofrecer asistencia financiera bajo las reglas federales 501(r), con umbrales de ingreso fijados por la política de cada hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/new-hampshire/"
   ],
   "confidence": "secondary-source-only"
  },
  "new-jersey": {
   "has_state_law": true,
   "law": "New Jersey Charity Care Program (Hospital Care Payment Assistance Program)",
   "citation": "N.J.S.A. 26:2H-18.50 et seq.",
   "covers": "all acute-care hospitals (inpatient and outpatient)",
   "free_pct": 200,
   "disc_pct": 300,
   "sum_en": "Every NJ acute-care hospital must give uninsured patients free hospital care at or below 200% FPL and sliding-scale discounts up to 300% (patient pays 20–80%). Asset limits apply ($7,500 individual / $15,000 family); patients have one year from the date of service to apply.",
   "sum_es": "Todo hospital de cuidados agudos de NJ debe dar a pacientes sin seguro atención hospitalaria gratis hasta el 200% del FPL y descuentos escalonados hasta el 300% (el paciente paga 20–80%). Hay límites de activos ($7,500 individual / $15,000 familia); hay un año desde la fecha del servicio para solicitar.",
   "note_en": "Covers hospital charges only — separate physician fees aren't included.",
   "note_es": "Cubre solo cargos del hospital — los honorarios médicos separados no están incluidos.",
   "sources": [
    "https://www.nj.gov/health/hcf/charity-care/overview/"
   ],
   "confidence": "verified"
  },
  "new-mexico": {
   "has_state_law": true,
   "law": "Patients' Debt Collection Protection Act",
   "citation": "NMSA 1978, §§57-32-1 to 57-32-10",
   "covers": "all health-care facilities and medical-debt collectors",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "New Mexico bans all collection actions — lawsuits, wage garnishment, liens, debt sales, credit reporting — against patients with household income at or below 200% of the federal poverty guidelines. Patients can prove eligibility with a simple self-attestation form.",
   "sum_es": "Nuevo México prohíbe toda acción de cobranza — demandas, embargos de salario, gravámenes, venta de deuda, reportes de crédito — contra pacientes con ingreso del hogar igual o menor al 200% de las pautas federales de pobreza. La elegibilidad se demuestra con un formulario simple de auto-certificación.",
   "note_en": "A collections shield rather than a mandate to grant free or discounted care.",
   "note_es": "Es un escudo contra cobranzas, no un mandato de dar atención gratis o con descuento.",
   "sources": [
    "https://www.osi.state.nm.us/en/consumer-assistance/patients-debt-collection-protection-act/"
   ],
   "confidence": "verified"
  },
  "new-york": {
   "has_state_law": true,
   "law": "New York Hospital Financial Assistance Law (expanded 2024)",
   "citation": "N.Y. Public Health Law §2807-k(9-a)",
   "covers": "all general hospitals",
   "free_pct": 200,
   "disc_pct": 400,
   "sum_en": "All NY hospitals must limit patients under 200% FPL to at most nominal charges and cap bills on a sliding scale above that (max 10% of Medicaid rates at 200–300% FPL, 20% at 301–400%). Hospitals cannot sue patients under 400% FPL or consider immigration status.",
   "sum_es": "Todos los hospitales de NY deben limitar a pacientes bajo el 200% del FPL a cargos máximos nominales y poner topes escalonados por encima (máx. 10% de tarifas de Medicaid entre 200–300% del FPL, 20% entre 301–400%). Los hospitales no pueden demandar a pacientes bajo el 400% del FPL ni considerar el estatus migratorio.",
   "note_en": "Expanded to all hospitals effective October 2024; 30-day decisions; no collections while an application is pending.",
   "note_es": "Ampliada a todos los hospitales desde octubre de 2024; decisiones en 30 días; sin cobranzas mientras la solicitud está pendiente.",
   "sources": [
    "https://www.nysenate.gov/legislation/laws/PBH/2807-K"
   ],
   "confidence": "verified"
  },
  "north-carolina": {
   "has_state_law": false,
   "sum_en": "No charity-care statute, but under the 2024 Medical Debt Relief incentive program all 99 acute-care hospitals agreed to give 50–100% discounts to patients at or below 300% FPL, presumptive screening, and large-scale forgiveness of old medical debt.",
   "sum_es": "No hay ley de atención caritativa, pero bajo el programa de incentivos de alivio de deuda médica de 2024, los 99 hospitales de cuidados agudos acordaron dar descuentos de 50–100% a pacientes hasta el 300% del FPL, evaluación presuntiva y perdón masivo de deudas médicas antiguas.",
   "note_en": "Hospital duties are conditions for enhanced Medicaid payments — contractual, not statutory.",
   "note_es": "Las obligaciones son condiciones de pagos mejorados de Medicaid — contractuales, no legales.",
   "sources": [
    "https://www.ncdhhs.gov/medicaldebt"
   ],
   "confidence": "verified"
  },
  "north-dakota": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; nonprofit hospitals must offer financial assistance under the federal 501(r) rules, with income thresholds set by each hospital's own policy.",
   "sum_es": "No hay mandato estatal de atención caritativa; los hospitales sin fines de lucro deben ofrecer asistencia financiera bajo las reglas federales 501(r), con umbrales de ingreso fijados por la política de cada hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/north-dakota/"
   ],
   "confidence": "secondary-source-only"
  },
  "ohio": {
   "has_state_law": true,
   "law": "Hospital Care Assurance Program (HCAP)",
   "citation": "Ohio Rev. Code §5168.14; Ohio Admin. Code 5160-2-17",
   "covers": "all hospitals receiving HCAP payments (statewide in practice)",
   "free_pct": 100,
   "disc_pct": null,
   "sum_en": "Ohio hospitals receiving HCAP funds must provide basic, medically necessary hospital services free to Ohio residents at or below 100% of the federal poverty line who are not on Medicaid. Patients apply through the hospital where they received care.",
   "sum_es": "Los hospitales de Ohio que reciben fondos HCAP deben dar servicios hospitalarios básicos y médicamente necesarios gratis a residentes de Ohio con ingreso igual o menor al 100% de la línea federal de pobreza que no tienen Medicaid. Se solicita en el hospital donde recibió la atención.",
   "note_en": "Excludes physician professional fees and some services.",
   "note_es": "Excluye honorarios médicos profesionales y algunos servicios.",
   "sources": [
    "https://www.ohiohospitals.org/Health-Economics/Hospital-Finance/HCAP"
   ],
   "confidence": "verified"
  },
  "oklahoma": {
   "has_state_law": false,
   "sum_en": "No state charity-care law; nonprofit hospitals must offer financial assistance under the federal 501(r) rules, with income thresholds set by each hospital's own policy.",
   "sum_es": "No hay ley estatal de atención caritativa; los hospitales sin fines de lucro deben ofrecer asistencia financiera bajo las reglas federales 501(r), con umbrales de ingreso fijados por la política de cada hospital.",
   "sources": [
    "https://dollarfor.org/state_sheet/oklahoma/"
   ],
   "confidence": "secondary-source-only"
  },
  "oregon": {
   "has_state_law": true,
   "law": "Oregon hospital financial assistance law (HB 3076, 2019)",
   "citation": "ORS 442.614",
   "covers": "all nonprofit hospitals and their affiliated clinics",
   "free_pct": 200,
   "disc_pct": 400,
   "sum_en": "Oregon nonprofit hospitals must wipe out 100% of bills for households at or below 200% of the federal poverty guidelines, and discount at least 75% (200–300% FPL), 50% (300–350%), and 25% (350–400%) for all medically necessary care, including at affiliated clinics.",
   "sum_es": "Los hospitales sin fines de lucro de Oregon deben eliminar el 100% de la factura para hogares con ingreso igual o menor al 200% de las pautas federales de pobreza, y descontar al menos 75% (200–300% del FPL), 50% (300–350%) y 25% (350–400%) en toda atención médicamente necesaria, incluidas las clínicas afiliadas.",
   "note_en": "Hospitals may not require a Medicaid application first; policies must be translated.",
   "note_es": "Los hospitales no pueden exigir primero una solicitud de Medicaid; las políticas deben estar traducidas.",
   "sources": [
    "https://oregon.public.law/statutes/ors_442.614"
   ],
   "confidence": "verified"
  },
  "pennsylvania": {
   "has_state_law": false,
   "sum_en": "No state law mandates free or discounted hospital care at set income levels; nonprofit hospitals follow the federal 501(r) rules. Hospitals claiming state uncompensated-care payments must have a plan to serve the uninsured, but no income thresholds are set in state law.",
   "sum_es": "Ninguna ley estatal exige atención hospitalaria gratis o con descuento a niveles de ingreso fijos; los hospitales sin fines de lucro siguen las reglas federales 501(r). Los hospitales que reclaman pagos estatales por atención no compensada deben tener un plan para atender a los no asegurados, pero la ley estatal no fija umbrales de ingreso.",
   "sources": [
    "https://dollarfor.org/state_sheet/pennsylvania/"
   ],
   "confidence": "secondary-source-only"
  },
  "puerto-rico": {
   "has_state_law": false,
   "sum_en": "No general charity-care law; nonprofit hospitals follow the federal 501(r) rules. Puerto Rico's Patient Bill of Rights (Ley 194-2000) guarantees access to emergency care regardless of ability to pay, but does not mandate free or discounted non-emergency care.",
   "sum_es": "No hay ley general de atención caritativa; los hospitales sin fines de lucro siguen las reglas federales 501(r). La Carta de Derechos del Paciente de Puerto Rico (Ley 194-2000) garantiza acceso a atención de emergencia sin importar la capacidad de pago, pero no exige atención gratis o con descuento fuera de emergencias.",
   "sources": [
    "https://www.lexjuris.com/lexlex/leyes2000/lex2000194.htm"
   ],
   "confidence": "secondary-source-only"
  },
  "rhode-island": {
   "has_state_law": true,
   "law": "Statewide hospital charity-care standards (Hospital Conversions Act regulations)",
   "citation": "216-RICR-40-10-23 §23.14; R.I. Gen. Laws §23-17.14-15",
   "covers": "all licensed hospitals",
   "free_pct": 200,
   "disc_pct": 300,
   "sum_en": "Every Rhode Island hospital must give 100% free care to uninsured residents with income up to 200% of the federal poverty level, and sliding-scale discounts between 200% and 300% FPL, covering routinely billed inpatient and outpatient essential services.",
   "sum_es": "Todo hospital de Rhode Island debe dar atención 100% gratis a residentes sin seguro con ingreso hasta el 200% del nivel federal de pobreza, y descuentos escalonados entre el 200% y el 300% del FPL, cubriendo los servicios esenciales hospitalarios y ambulatorios de facturación rutinaria.",
   "note_en": "Hospitals may optionally apply an asset test for full free care.",
   "note_es": "Los hospitales pueden aplicar opcionalmente una prueba de activos para la atención totalmente gratis.",
   "sources": [
    "https://rules.sos.ri.gov/regulations/part/216-40-10-23"
   ],
   "confidence": "verified"
  },
  "south-carolina": {
   "has_state_law": true,
   "law": "Medically Indigent Assistance Program (MIAP)",
   "citation": "S.C. Code Ann. §44-6-150",
   "covers": "general hospitals (inpatient care for program-sponsored patients)",
   "free_pct": 100,
   "disc_pct": 200,
   "sum_en": "South Carolina has no general financial-assistance mandate, but the county-funded MIAP sponsors inpatient hospital care for low-income residents up to 200% of poverty; hospitals must admit sponsored patients, with a sliding-scale copay between 100% and 200% FPL.",
   "sum_es": "Carolina del Sur no tiene mandato general de asistencia financiera, pero el MIAP financiado por condados patrocina hospitalización para residentes de bajos ingresos hasta el 200% de la pobreza; los hospitales deben admitir a pacientes patrocinados, con copago escalonado entre el 100% y el 200% del FPL.",
   "note_en": "Citizens/lawful permanent residents only; asset limits apply; apply within 1 year of discharge.",
   "note_es": "Solo ciudadanos/residentes permanentes legales; hay límites de activos; solicite dentro de 1 año del alta.",
   "sources": [
    "https://www.scstatehouse.gov/code/t44c006.php"
   ],
   "confidence": "verified"
  },
  "south-dakota": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; nonprofit hospitals must follow the federal 501(r) rules. State law instead requires counties to assist medically indigent residents, and an unlimited homestead exemption protects homes from medical-debt foreclosure.",
   "sum_es": "No hay mandato estatal de atención caritativa; los hospitales sin fines de lucro deben seguir las reglas federales 501(r). La ley estatal en cambio obliga a los condados a asistir a residentes médicamente indigentes, y una exención de vivienda ilimitada protege las casas de ejecuciones por deuda médica.",
   "sources": [
    "https://dollarfor.org/state_sheet/south-dakota/"
   ],
   "confidence": "verified"
  },
  "tennessee": {
   "has_state_law": false,
   "sum_en": "No state law requires hospitals to give free or discounted care; nonprofit hospitals follow the federal 501(r) rules. Tennessee only requires every licensed facility to develop and publicly post a concise statement of its charity-care policy.",
   "sum_es": "Ninguna ley estatal exige a los hospitales dar atención gratis o con descuento; los hospitales sin fines de lucro siguen las reglas federales 501(r). Tennessee solo exige que cada centro licenciado desarrolle y publique un resumen claro de su política de atención caritativa.",
   "sources": [
    "https://law.justia.com/codes/tennessee/title-68/health/chapter-11/part-2/section-68-11-268/"
   ],
   "confidence": "verified"
  },
  "texas": {
   "has_state_law": true,
   "law": "Community Benefits and Charity Care Requirements (nonprofit hospital standards)",
   "citation": "Tex. Health & Safety Code §§311.043–311.045",
   "covers": "nonprofit hospitals and hospital systems",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "Texas requires nonprofit hospitals to spend minimum amounts on charity care — for example, charity plus government-sponsored indigent care of at least 4% of net patient revenue — as a condition of state tax exemption, but each hospital sets its own patient eligibility rules.",
   "sum_es": "Texas exige a los hospitales sin fines de lucro gastar montos mínimos en atención caritativa — por ejemplo, atención caritativa más atención a indigentes patrocinada por el gobierno de al menos el 4% de los ingresos netos — como condición de su exención fiscal estatal, pero cada hospital fija sus propias reglas de elegibilidad.",
   "note_en": "An institutional spending standard — the statute sets no patient income limits.",
   "note_es": "Es un estándar de gasto institucional — la ley no fija límites de ingreso del paciente.",
   "sources": [
    "https://texas.public.law/statutes/tex._health_and_safety_code_section_311.045"
   ],
   "confidence": "verified"
  },
  "utah": {
   "has_state_law": false,
   "sum_en": "No state law requires hospitals to give free or discounted care; the federal 501(r) rules govern nonprofit hospitals. Nonprofit hospitals must keep an open-access charity-care policy to retain property-tax exemption, and providers must give 45 days' written notice before sending bills to collections.",
   "sum_es": "Ninguna ley estatal exige atención gratis o con descuento; las reglas federales 501(r) rigen a los hospitales sin fines de lucro. Estos deben mantener una política de atención caritativa de acceso abierto para conservar su exención fiscal, y los proveedores deben dar aviso escrito de 45 días antes de enviar facturas a cobranza.",
   "sources": [
    "https://healthcarevaluehub.org/wp-content/uploads/Utah-Prevent-Medical-Debt.pdf"
   ],
   "confidence": "verified"
  },
  "vermont": {
   "has_state_law": true,
   "law": "Patient Financial Assistance law (Act 119 of 2022)",
   "citation": "18 V.S.A. §§9481–9482",
   "covers": "all hospitals, hospital-affiliated clinics, and ambulatory surgical centers",
   "free_pct": 250,
   "disc_pct": 400,
   "sum_en": "Vermont facilities must give 100% free care to uninsured patients at or below 250% of the federal poverty level, at least a 40% discount (including on insured patients' out-of-pocket costs) up to 400% FPL, and cap total bills at 20% of household income up to 600% FPL.",
   "sum_es": "Los centros de Vermont deben dar atención 100% gratis a pacientes sin seguro con ingreso igual o menor al 250% del nivel federal de pobreza, al menos 40% de descuento (incluyendo costos de bolsillo de asegurados) hasta el 400% del FPL, y limitar la factura total al 20% del ingreso del hogar hasta el 600% del FPL.",
   "note_en": "Standards effective July 1, 2024; an appeals process is required.",
   "note_es": "Estándares vigentes desde el 1 de julio de 2024; se exige un proceso de apelación.",
   "sources": [
    "https://legislature.vermont.gov/statutes/section/18/221/09482"
   ],
   "confidence": "verified"
  },
  "virginia": {
   "has_state_law": true,
   "law": "Hospital financial assistance, screening, and payment plan law",
   "citation": "Va. Code §32.1-137.010",
   "covers": "all hospitals",
   "free_pct": null,
   "disc_pct": null,
   "sum_en": "Every Virginia hospital must screen uninsured patients for Medicaid and financial-assistance eligibility before any debt collection, offer written payment plans based on ability to pay with capped interest and no fees, and conspicuously post its free and discounted care policies.",
   "sum_es": "Todo hospital de Virginia debe evaluar a los pacientes sin seguro para Medicaid y asistencia financiera antes de cualquier cobranza, ofrecer planes de pago escritos según la capacidad de pago con interés limitado y sin cargos, y publicar visiblemente sus políticas de atención gratis y con descuento.",
   "note_en": "The statute mandates screening and collections limits but lets each hospital's policy set income limits.",
   "note_es": "La ley exige evaluación y límites de cobranza, pero deja que cada hospital fije sus límites de ingreso.",
   "sources": [
    "https://law.lis.virginia.gov/vacode/title32.1/chapter5/section32.1-137.010/"
   ],
   "confidence": "verified"
  },
  "washington": {
   "has_state_law": true,
   "law": "Charity Care Act (expanded by SHB 1616, 2022)",
   "citation": "RCW 70.170.060",
   "covers": "all licensed hospitals, in two tiers by size/system",
   "free_pct": 300,
   "disc_pct": 400,
   "sum_en": "All Washington hospitals must give free care and discounts based only on income: large-system hospitals give 100% free care up to 300% of the federal poverty level and 50–75% discounts up to 400%; smaller independent hospitals give free care up to 200% and discounts up to 300%.",
   "sum_es": "Todos los hospitales de Washington deben dar atención gratis y descuentos según el ingreso únicamente: los hospitales de sistemas grandes dan atención 100% gratis hasta el 300% del nivel federal de pobreza y descuentos de 50–75% hasta el 400%; los hospitales independientes más pequeños dan atención gratis hasta el 200% y descuentos hasta el 300%.",
   "note_en": "Listed thresholds are the large-system tier; assets cannot be used against collections-protected patients.",
   "note_es": "Los umbrales listados son del nivel de sistemas grandes; los activos no pueden usarse contra pacientes protegidos de cobranza.",
   "sources": [
    "https://app.leg.wa.gov/rcw/default.aspx?cite=70.170.060",
    "https://www.atg.wa.gov/news/news-releases/new-law-offering-free-or-discounted-hospital-care-4-million-washingtonians"
   ],
   "confidence": "verified"
  },
  "west-virginia": {
   "has_state_law": false,
   "sum_en": "No state law sets free or discounted care requirements; the federal 501(r) rules govern nonprofit hospitals. Nonprofit hospitals claiming property-tax exemption must maintain a board-approved charity-care plan and post notices about free and below-cost care, but each hospital sets its own amounts.",
   "sum_es": "Ninguna ley estatal fija requisitos de atención gratis o con descuento; las reglas federales 501(r) rigen a los hospitales sin fines de lucro. Los que reclaman exención fiscal deben mantener un plan de atención caritativa aprobado por su junta y publicar avisos sobre atención gratis o bajo costo, pero cada hospital fija sus montos.",
   "sources": [
    "https://www.hilltopinstitute.org/wp-content/uploads/hcbp/hcbp_docs/HCBP_CBL_WV.pdf"
   ],
   "confidence": "verified"
  },
  "wisconsin": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; nonprofit hospitals must follow the federal 501(r) rules. Wisconsin does require hospitals to report uncompensated and charity care annually, and wage garnishment is barred for households below the federal poverty level.",
   "sum_es": "No hay mandato estatal de atención caritativa; los hospitales sin fines de lucro deben seguir las reglas federales 501(r). Wisconsin sí exige reportar anualmente la atención caritativa y no compensada, y el embargo de salario está prohibido para hogares bajo el nivel federal de pobreza.",
   "sources": [
    "https://dollarfor.org/state_sheet/wisconsin/"
   ],
   "confidence": "verified"
  },
  "wyoming": {
   "has_state_law": false,
   "sum_en": "No state charity-care mandate; nonprofit hospitals must follow the federal 501(r) rules, which require a written financial-assistance policy and restrict collections but set no income thresholds. For-profit hospitals face no free-care requirement.",
   "sum_es": "No hay mandato estatal de atención caritativa; los hospitales sin fines de lucro deben seguir las reglas federales 501(r), que exigen una política escrita de asistencia financiera y restringen cobranzas pero no fijan umbrales de ingreso. Los hospitales con fines de lucro no tienen requisito de atención gratis.",
   "sources": [
    "https://dollarfor.org/state_sheet/wyoming/"
   ],
   "confidence": "verified"
  }
 }
}