“Medical debt is not a choice, and it’s monumental to have North Carolina hospitals committing to be part of eliminating medical debt for their patients,” said Governor Cooper. “By joining this first-in-the-nation solution they are raising the bar for health care, and together we will make a life-changing difference for our families and our economy.”

The list of participating hospitals includes the largest hospital systems in North Carolina. While medical debt occurs in places other than hospitals, they are the source of the most debt. By signing on to this program, North Carolina hospitals are leading the way in relieving debt and centering the well-being of their communities. The estimated total impact of the medical debt relief incentive program is approximately $4 billion. Nearly 2 million low- and middle-income North Carolinians will have more than a decade of existing medical debt relieved.

“This is big, sweeping change that will benefit our health care system and the health and well-being of millions of North Carolinians,” said Secretary Kinsley. “It is an innovative approach that was thoughtfully developed with feedback from hospitals and national experts and gets more value from federal dollars. We are leading the way here in North Carolina with a powerful roadmap for other states to improve the health of Americans.”

Hospitals that opt into the plan now have a series of deadlines to begin implementing the program that relieves past debt and puts in place forward-looking policies that mitigate the accumulation of debt. By Jan. 1, 2025, patients who are enrolled in public benefit programs such as WIC and SNAP, enrolled in Medicaid, or who are experiencing homelessness will automatically qualify for charity care. By July 1, 2025, hospitals will forgive past debt of individuals on Medicaid and will also have policies in place to ensure medical debt does not impact a person’s credit rating and to curb aggressive debt collection practices for low-income patients, such as debt sales, excessive interest rates and home foreclosures. Hospitals are required to meet and report on these and other milestones, as well as publicly post debt relief policies.

“This multi-faceted, state-wide medical debt relief initiative is truly groundbreaking. North Carolina’s approach stands out for its breadth in size and scope, benefiting North Carolinians across the entire state AND impressively, addressing medical debt both pro- and retrospectively,” said Undue Medical Debt CEO and president, Allison Sesso. “It is heartening to see so many hospitals engaged and ready to join the state in this pioneering endeavor to address this problem head on. It cannot be overstated what a huge win this is.”

North Carolina’s medical debt relief incentive program is a first-of-its-kind initiative to leverage the state Medicaid program and federal dollars through the Healthcare Access and Stabilization Program (HASP) to encourage hospitals to relieve medical debt and prevent the accrual of debt in the future. By participating, hospitals will receive enhanced HASP payments that will bring an estimated $4 billion into the state this fiscal year and a projected $6.3 billion in the next year.

By signing on to the plan, hospitals have committed to relieve medical debt dating back to Jan. 1, 2014, for all Medicaid beneficiaries, as well as medical debt deemed uncollectible for all patients whose income is at or below at least 350% of the federal poverty level. Past medical debt that exceeds 5% of a person’s annual income will also be relieved.

Participating hospitals will work with NCDHHS and Undue Medical Debt or other non-profit partners over the next two years to fully implement medical debt relief and debt mitigation policies. Patients do not need to take any action to benefit from the program. 

The goal is for eligible North Carolinians to begin to see relief for existing medical debt within the next two years. For additional information, refer to the updated Frequently Asked Questions on North Carolina’s efforts to relieve medical debt.