Free and discounted hospital care in California

Hospital Fair Pricing Act (Health and Safety Code 127400 et seq.)

Every licensed general acute care, acute psychiatric, and special hospital in California must have a charity care policy and a discount payment policy. A patient can ask for help if they are uninsured (self-pay) or have high medical costs, and their family income is not more than 400% of the federal poverty level. Hospitals may choose to help people with higher incomes. With a discount, the bill is capped at about what Medicare or Medi-Cal would pay, whichever is greater. You can apply at any time, even after a bill goes to collections. Immigration status does not affect eligibility.

Income levels in the program are discount up to 400% of poverty level.

Applies to each licensed general acute care hospital, acute psychiatric hospital, and special hospital in California.

Apply to the hospital's financial assistance office. Each hospital's policies and applications are posted on its website and on HCAI's Hospital Fair Pricing Policy Lookup (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-fair-pricing-policy-lookup/).

Is a self-pay patient OR a patient with high medical costs; AND Patient's family income is not more than 400 percent of the federal poverty

Program source, checked 2026-11-10

Hospital Bill Complaint Program (HCAI)

A free state program at HCAI. If a hospital wrongly denied you financial assistance, did not tell you about its programs, or sent you to collections the wrong way, you can file a complaint online (English and Spanish) or by mail (many languages). You must have applied to the hospital first for HCAI to review an eligibility decision. If HCAI finds you paid too much, the hospital must refund you within 30 days. It covers problems on or after January 1, 2022. It does not handle general billing disputes, price transparency, Good Faith Estimates, or bills from emergency room doctors.

Applies to complaints about any hospital covered by the Hospital Fair Pricing Act.

File online through the Patient Complaint Portal (https://hcai.ca.gov/affordability/hospital-fair-billing-program/hospital-bill-complaint-program/should-i-file-a-complaint/) or mail the Patient Complaint Form to Department of Health Care Access and Information, Hospital Bill Complaint Program, 2020 West El Camino Avenue, Suite 1101, Sacramento, CA 95833.

If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.

Program source, checked 2026-11-10

Emergency physician discount rule

Most hospital policies cover only the hospital's own bill. Emergency room doctors often bill separately. California law also requires an emergency physician to give discounts to uninsured patients and patients with high medical costs whose family income is at or below 400% of the federal poverty level. Ask the doctor group's billing office for its discount policy. HCAI's complaint program does not handle emergency doctor bills.

Income levels in the program are discount up to 400% of poverty level.

Applies to emergency physicians who provide emergency medical services in a California hospital that provides emergency care.

Ask the emergency physician group named on the bill for its discount payment policy.

an emergency physician who provides emergency medical services in a hospital that provides emergency care is also required by law to provide discounted care

Program source, checked 2026-11-10

LA County Health Services Ability to Pay (ATP) Program

The financial assistance program for LA County residents at LA County's own hospitals and clinics (LA General, Harbor-UCLA, Olive View-UCLA, Rancho Los Amigos, and county health centers). Care is free at or below 200% of the federal poverty level. Above 200% there is no income cap, and you pay a set amount on a sliding scale, one amount per month for outpatient and ER care and one amount per inpatient stay. Uninsured, underinsured, and insured patients with high costs can apply. Assets are not counted. You can apply in person or by phone, and you can apply for past bills with no time limit. The approval lasts one year. People who live outside LA County can use the Discount Payment Program (up to 400% of poverty level).

Income levels in the program are free up to 200% of poverty level.

Applies to LA County Department of Health Services facilities only; LA County residents (out-of-county patients use the Discount Payment Program). It does not apply to for-profit hospitals.

Call 844-804-0055, option 6, or visit a Patient Financial Services office at any LA County Health Services location.

It is no cost (free) for patients with income at or under 200% Federal Poverty Level (FPL) and a reduced cost, sliding scale for those

Program source, checked 2026-11-10

AB 774 (Chapter 755, Statutes of 2006)

Created the Hospital Fair Pricing Policies, effective January 1, 2007. Required each licensed general acute care, psychiatric acute, and special hospital to publicize charity care and discounts and to standardize billing and collections.

AB 774 (Chapter 755, Statutes of 2006) established Hospital Fair Pricing Policies effective January 1, 2007.

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AB 1020 (Chapter 473, Statutes of 2021), effective January 1, 2022

Raised the income level for financial assistance from 350% to 400% of the federal poverty level. Limited the sale of patient debt. Moved the wait before adverse credit reporting or a lawsuit from 150 to 180 days after first billing. Required debt collectors to certify screening before suing. Set up a patient complaint process and penalties, with HCAI taking over enforcement from CDPH on January 1, 2024.

Effective January 1, 2022, AB 532 and AB 1020 update financial aid, disclosure, and debt collection requirements for GACHs.

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AB 532 (Chapter 465, Statutes of 2021), effective January 1, 2022

Requires hospitals to give uninsured and self-pay patients the written financial assistance and charity care forms at the time of service, or at discharge, or by mail within 72 hours. Before sending a bill to collections or selling it, the hospital must send the dates of service, who is getting the debt, how to get an itemized bill, insurance on file, and a financial assistance application.

AB 532 requires the hospital to provide the written forms related to the hospital's financial assistance and charity care policies to uninsured and self-pay patients

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AB 2297 (Chapter 511, Statutes of 2024) and SB 1061 (Chapter 520, Statutes of 2024), effective January 1, 2025

Together these laws define charity care and discount payment, widen who counts as family, ban counting monetary assets, ban requiring patients to apply for other coverage before a discount, ban application deadlines, ban liens on or sale of a patient's home or other real property, and ban adverse credit reporting. HCAI lists both bills together and does not say which change comes from which bill.

Prohibits adverse credit reporting.

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AB 1312 (Chapter 450, Statutes of 2025), effective January 1, 2026

Requires hospitals to screen patients for financial assistance and make presumptive eligibility decisions starting July 1, 2027.

The new law requires hospitals to perform financial assistance screening and make presumptive eligibility determinations beginning July 1, 2027.

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HCAI program regulations (Title 22 CCR 96051 et seq.)

Program regulations took effect January 1, 2024, with small changes January 2, 2025. A proposed clean-up rulemaking was withdrawn on August 21, 2026.

Adopted Program Regulations, effective January 1, 2024 with non-substantive changes to sections 96051 and 96051.8 effective January 2, 2025

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