New York has some of the strongest hospital financial assistance laws in the country. Under Public Health Law Section 2807-k, which was significantly expanded in October 2024, every New York hospital must offer free or reduced-cost care based on income, with protections extending to families earning up to 400% of the federal poverty level (FPL). Many major systems, including NYC Health + Hospitals, go further by voluntarily extending sliding-scale discounts to 500% FPL and beyond.
Quick Answer: New York law (effective October 20, 2024) requires all hospitals to waive charges for patients below 200% FPL, cap bills at 10% of Medicaid rates for patients at 200-300% FPL, and cap bills at 20% of Medicaid rates for patients at 301-400% FPL. Hospitals cannot sue patients earning under 400% FPL. Medical debt cannot appear on your credit report in New York. Some large hospital systems voluntarily extend discounts to 500% FPL.
If you have a hospital bill in front of you right now, the CoveredUSA Bill Analyzer can compare each line item against Medicare rates and flag potential overcharges or charity care opportunities in about 30 seconds.
What the New York Hospital Financial Assistance Law Requires
New York's Hospital Financial Assistance Program (HFAP), governed by Public Health Law Section 2807-k, was substantially strengthened as part of the 2024-2025 State Budget. Before October 2024, only hospitals participating in the State Indigent Care Pool had to comply. Now every hospital in New York must follow these rules for emergency and medically necessary services.
The law creates three tiers of protection based on household income:
Tier 1 (Below 200% FPL): Free care. Hospitals must waive all charges. No nominal payment required, no questions about immigration status, no asset test.
Tier 2 (200-300% FPL): Maximum 10% of Medicaid rate. The hospital can collect no more than 10% of what Medicaid would have paid for the same service. For a procedure Medicaid reimburses at $1,000, your maximum bill is $100.
Tier 3 (301-400% FPL): Maximum 20% of Medicaid rate. The hospital can collect no more than 20% of the Medicaid rate for the service.
These caps apply to both uninsured patients and "underinsured" patients, defined as anyone whose out-of-pocket medical costs over the past 12 months exceed 10% of their gross annual income.
NYC Health + Hospitals: Voluntary 500% FPL Extension
NYC Health + Hospitals, which operates 11 public hospitals including Bellevue, Lincoln, and Kings County, extends financial assistance beyond what state law requires. Their sliding scale covers patients earning up to 500% of the 2026 FPL. Several large academic medical centers and non-profit health systems in New York have adopted similar voluntary policies, though the specific percentages and tiers vary by institution.
If your income is between 400% and 500% FPL, you should ask the hospital's financial counseling office whether they offer extended charity care. The state law does not require it, but many hospitals comply voluntarily.
2026 Income Limits: What You Qualify For
These tables use 2026 Federal Poverty Guidelines published by HHS for the 48 contiguous states.
New York Hospital Financial Assistance Income Limits, 2026 (Mandatory Under State Law)
| Household Size | 200% FPL (Free Care) | 300% FPL (10% Cap) | 400% FPL (20% Cap) |
|---|
| 1 | $31,920 | $47,880 | $63,840 |
| 2 | $43,280 | $64,920 | $86,560 |
| 3 | $54,640 | $81,960 | $109,280 |
| 4 | $66,000 | $99,000 | $132,000 |
| 5 | $77,360 | $116,040 | $154,720 |
| 6 | $88,720 | $133,080 | $177,440 |
| 7 | $100,080 | $150,120 | $200,160 |
| 8 | $111,440 | $167,160 | $222,880 |
| Each additional | +$11,360 | +$17,040 | +$22,720 |
Based on 2026 HHS Poverty Guidelines. Figures are annual gross income thresholds.
Voluntary 500% FPL Extension (NYC Health + Hospitals and Select Systems)
| Household Size | 500% FPL (Voluntary Sliding Scale) |
|---|
| 1 | $79,800 |
| 2 | $108,200 |
| 3 | $136,600 |
| 4 | $165,000 |
| 5 | $193,400 |
| 6 | $221,800 |
| 7 | $250,200 |
| 8 | $278,600 |
Contact your hospital's financial assistance office to confirm whether they offer extended discounts above 400% FPL. Discount amounts above 400% FPL vary by institution.
Medical Debt Protections That Took Effect in October 2024
The 2024 law did more than set income-based caps. These protections apply to all New York residents as of October 20, 2024:
No lawsuits below 400% FPL. Hospitals cannot file a lawsuit to collect unpaid bills from patients earning under 400% of the federal poverty level, according to the New York State Department of Health.
180-day collection freeze. Hospitals must wait at least 180 days after sending the first post-service bill before starting any collection activity. This gives you roughly six months to apply for financial assistance or set up a payment plan.
No medical debt on credit reports. New York prohibits hospitals, health care professionals, and ambulance services from reporting medical debt to credit agencies. A hospital bill cannot hurt your credit score in New York.
No debt sales to collectors. Hospitals may only sell patient debt to a third party if that purchaser agrees to forgive the debt entirely. Hospitals cannot sell your debt to a traditional collection agency.
Payment plan limits. If you do owe a balance, your monthly installment payments cannot exceed 5% of your gross monthly income. Interest is capped at 2% annually.
No denial of care for unpaid bills. Hospitals cannot refuse to admit or treat a patient because of outstanding medical debt.
No immigration status test. Eligibility for financial assistance cannot be based on citizenship or immigration status.
Apply at any time. You can apply for financial assistance at any point during the billing or collection process. There is no longer a 90-day application deadline.
How to Apply for Hospital Financial Assistance in New York
Applying for charity care or the sliding-scale discount takes most people under an hour. Here are the steps:
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Ask for the financial assistance application immediately. Every New York hospital is required to make its financial assistance policy available in writing. Ask the billing department, social work office, or financial counseling office. You can apply during your visit or after discharge.
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Gather your income documentation. You will typically need recent pay stubs (last 30-90 days), most recent federal tax return (or W-2), Social Security award letter if applicable, and proof of any other income sources. If you are self-employed, bring bank statements.
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Complete and submit the application. Fill out the hospital's financial assistance application form. Include every household member's income. Submit in person, by mail, or through the hospital's patient portal.
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Request a billing hold. While your application is under review, ask the billing department to pause collection activity. The 2024 law gives hospitals 30 days to process applications.
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Get the determination in writing. The hospital must notify you in writing of its decision. If approved, you receive a revised bill showing the adjusted amount.
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Appeal if denied. If your application is denied, you can appeal. Contact the New York State Department of Health at (800) 342-3009 or file a complaint through health.ny.gov if you believe the hospital violated the financial assistance law.
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Contact Community Health Advocates if you need help. Community Health Advocates (CHA) provides free assistance navigating hospital billing disputes in New York. Call (888) 614-5400 or visit communityhealthadvocates.org.
Documents Needed for the Application
- Government-issued photo ID
- Proof of New York address (utility bill, lease, or bank statement)
- Income documentation for all household members (pay stubs, tax return, SSI/SSDI award letters)
- Recent medical bills related to the service in question
- Insurance card and explanation of benefits (if insured)
- For self-employed individuals: most recent bank statements or profit and loss statement
Common Reasons Applications Get Denied
- Missing or incomplete income documentation
- Household income slightly above the threshold (appeal if you believe income was calculated incorrectly)
- The hospital did not classify you as "underinsured" despite high out-of-pocket costs (ask them to reconsider using the 10%-of-income test)
- Application submitted after debt was already sold (though you may still have rights if the purchaser agreed to forgive debt)
- Applying to the wrong department or not using the official application form
How to Dispute an Overcharged Hospital Bill
Even patients who do not qualify for charity care often have bills with errors. Medical billing mistakes are common, and New York's transparency laws give you tools to fight back.
Request an itemized bill. You have a right to a line-by-line itemized statement showing every charge, including the billing code (CPT code). Compare each line to what your insurer paid and what Medicare pays for the same service. Medicare rate data is publicly available through cms.gov.
Look for duplicate charges, upcoded procedures, and facility fees. These are the most common billing errors in New York hospitals. Duplicate charges appear when the same service is billed twice. Upcoding means a simpler procedure is billed as a more complex one. Facility fees can add hundreds of dollars to outpatient visits.
The CoveredUSA Bill Analyzer compares your itemized bill against Medicare benchmark rates automatically, flagging line items that look overpriced. Upload your hospital bill to get a report in about 30 seconds.
File a dispute in writing. Send a letter to the hospital's billing department listing the specific charges you are disputing and why. Keep a copy. The hospital must respond in writing.
File a complaint with the state if needed. The New York State Department of Health accepts complaints about hospital billing violations at (800) 342-3009. The Department of Financial Services (DFS) handles complaints about health insurance billing issues at (800) 342-3736.
Who Qualifies as "Underinsured" Under New York Law
This is where many insured New Yorkers leave money on the table. You do not have to be uninsured to qualify for hospital financial assistance.
Under the 2024 law, you are considered "underinsured" if your total out-of-pocket medical costs in the past 12 months exceed 10% of your gross annual income. If you earn $60,000 per year and have paid more than $6,000 in medical bills over the last year, you qualify as underinsured, regardless of what insurance you have.
Once classified as underinsured, you are entitled to the same sliding-scale caps as uninsured patients: free care below 200% FPL, maximum 10% of Medicaid rates between 200-300% FPL, and maximum 20% between 301-400% FPL.
This protection is particularly important for people with high-deductible health plans, people who had a major surgery or hospitalization, and cancer patients or anyone undergoing ongoing treatment.
Frequently Asked Questions
What is New York's hospital financial assistance law?
New York's hospital financial assistance law, Public Health Law Section 2807-k, requires every hospital in the state to offer free or reduced-cost care based on patient income. As of October 20, 2024, the law applies to all hospitals (not just those in the Indigent Care Pool) and protects patients earning up to 400% of the federal poverty level. Free care is guaranteed below 200% FPL. Patients between 200-400% FPL pay on a sliding scale based on Medicaid rates.
Does New York law cover hospital bills for insured patients?
Yes. Insured patients who qualify as "underinsured" are protected. You are underinsured if your out-of-pocket medical costs in the past 12 months exceed 10% of your gross annual income. Underinsured patients receive the same sliding-scale discounts as uninsured patients, applied to their cost-sharing amounts (deductibles, copays, coinsurance).
Can a New York hospital sue me for unpaid medical bills?
No, if your income is below 400% FPL. New York law prohibits hospitals from filing lawsuits against patients earning under 400% of the federal poverty level. In 2026, that is $63,840 for a single person and $132,000 for a family of four. Hospitals must also wait 180 days after the first bill before starting any collection activity.
Will hospital debt hurt my credit score in New York?
No. New York law prohibits hospitals, health care professionals, and ambulance providers from reporting medical debt to credit bureaus. Hospital bills cannot appear on your credit report or affect your credit score in New York, regardless of the amount owed.
What is the 500% FPL threshold mentioned in some hospital policies?
The 500% FPL threshold is a voluntary extension offered by NYC Health + Hospitals and some other large systems, not a state law requirement. New York state law mandates sliding-scale discounts only up to 400% FPL. Hospitals can voluntarily go higher, and some do. For 2026, 500% FPL is $79,800 for a single person and $165,000 for a family of four. Ask your hospital's financial counseling office whether they have a voluntary policy above 400% FPL.
How do I know if my hospital bill has errors?
Request an itemized bill listing every CPT code and charge. Then compare each line to Medicare's published reimbursement rates, which are available at cms.gov. Common errors include duplicate charges, upcoded procedure codes, and facility fees added without disclosure. The CoveredUSA Bill Analyzer can automate this comparison for you, flagging any charges that exceed Medicare benchmarks.
Can hospitals deny care because of unpaid bills in New York?
No. New York law prohibits hospitals from denying admission or treatment to patients because of prior unpaid medical debt. Emergency care must be provided regardless of financial status.
Does the financial assistance law apply to physician bills from the same hospital visit?
The state hospital financial assistance law applies specifically to hospital charges. Bills from physicians who treated you at the hospital, such as anesthesiologists, radiologists, or surgeons in private practice, may be handled separately. Some hospital systems include physician fees in their financial assistance programs; others do not. Ask the hospital's financial counseling office which providers are covered by their HFAP policy.
Upload your hospital bill to the free CoveredUSA Bill Analyzer to find errors, overcharges, and charity care options in 30 seconds.
Sources consulted:
- New York State Department of Health, Hospital Financial Assistance: health.ny.gov/facilities/hospital/financial_assist
- National Law Review, "New York Broadly Revises Hospital Financial Assistance": natlawreview.com
- Dollar For, New York Charity Care State Sheet: dollarfor.org/state_sheet/new-york
- HHS ASPE, 2026 Federal Poverty Guidelines: aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines
- New York City Bar Association, Support for Hospital Financial Assistance Law Amendments: nycbar.org
- Community Health Advocates: communityhealthadvocates.org
