On October 1, a D.C. Hospital Payment Plan Maxes Out at 3% of Your Monthly Income. Your Hospital Already Owes You the Application.

If you get care in Washington, D.C. and the bill comes back bigger than your month, October 1 changes what the hospital is allowed to do to you. And if you live anywhere else, keep reading, because the most useful thing in this law is a form your own hospital is already required to hand you.

The Medical Debt Mitigation Amendment Act of 2026 became D.C. Law 26-172 on August 20, without the mayor’s signature. Its teeth were held back by a funding clause until the District’s budget act cleared it, and the substantive provisions start October 1.

What they do is specific. Covered facilities have to give free medically necessary care to households at or below 200% of the federal poverty line and discounted care up to 500%. Payment plans for eligible patients are capped at 3% of monthly household income. Interest on medical debt is capped at 3% a year. No collection activity until 180 days after your first posted bill, with 90 days’ notice before it starts. No lien on your primary residence. No wage garnishment under 500% of poverty. A hospital’s claim on an injury settlement tops out at 33% of the award.

Then there is the provision that tells you what has been going on.

Providers can no longer help you fill out a medical credit card application, pitch those products to a sedated patient, or demand a credit card pre-authorization before emergency care.

Somebody had to write that down. In a statute.

What the numbers actually mean

The 2026 poverty guidelines put a household of four at $33,000. So 200% is $66,000 and 500% is $165,000. For one person, $31,920 and $79,800.

Take a family of four at $82,500, which is 250% of poverty. That is $6,875 a month. Three percent is about $206. Under this law, $206 a month is the ceiling on what the hospital’s payment plan can demand, no matter what the bill says. Not a negotiation. A cap.

That is a good law. Plainly.

The part that travels

Here is what nobody tells you outside D.C. Section 501(r)(4) of the tax code already requires every tax-exempt hospital in the country to keep a written financial assistance policy, post the whole thing on its website free of charge, stock paper copies in the emergency room and admissions area, and actively publicize it. Most hospitals in America are tax-exempt.

The hospital picks its own income thresholds, which is the weak spot. D.C. just took that discretion away from D.C. hospitals. Everywhere else, the discount exists and the application exists and almost nobody asks.

Do this before you pay

Call the billing number on the statement and ask for two things by name: an itemized bill, and the financial assistance policy application. Ask to be screened. Do it before the account leaves the hospital, because once it is sold to a collector your leverage drops to whatever the collector feels like.

If a bill is already in collections and showing up on your report, read our piece on what a Texas ruling did to state medical-debt credit reporting bans first. And put the real payment, not the one the hospital opened with, into our budget planner so you know what you can actually hold for 24 months.

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