A revised piece of legislation working its way through Dover would significantly change how Delaware hospitals are required to help patients who struggle to pay their medical bills.
The bill, known as Substitute Senate Bill 1 for Senate Bill 13, updates both Title 6 and Title 16 of the Delaware Code to establish new minimum standards for hospital financial assistance programs and strengthen protections for patients dealing with medical debt.
Under the proposed law, hospitals would be required to provide full financial assistance to Delaware residents whose household income falls at or below 300% of the federal poverty level. Patients earning between 300% and 350% of the poverty level would receive a 75% discount on their bills, while those between 350% and 400% would qualify for a 50% discount. Additionally, every hospital would be required to maintain a medical hardship policy offering at least a 50% discount, with income eligibility extending up to at least 500% of the federal poverty level.
Hospitals that provide exclusively psychiatric services, rehabilitative services, or long-term acute care would not fall under the new financial assistance framework and would instead remain subject to existing charity care rules.
The legislation also addresses how long a patient’s eligibility determination remains valid — at least one year — and specifies that eligibility can transfer between hospitals and facility-based providers. Collection efforts would have to be paused while a financial assistance application or appeal is being processed.
On the debt collection side, the bill would prohibit medical creditors and debt collectors from pursuing aggressive collection tactics against patients who qualify — or who the creditor has reason to believe likely qualify — for financial assistance. It would also restrict collection communications, lawsuits, and debt sales when an application or appeal is known to be pending.
In civil court proceedings to collect medical debt, a patient’s eligibility for financial assistance would serve as a complete defense. Courts would also be barred from entering a default judgment in such cases unless a hospital officer submits an affidavit confirming the patient was offered financial assistance screening.
Hospitals would be required to provide notices in any language spoken by more than 5% of their service area population, screen patients for potential eligibility, and report annually to the Diamond State Hospital Cost Review Board. The Board would oversee compliance with the new rules, and the Division of Health Care Quality would have the authority to take licensure action against hospitals found to be out of compliance.
The minimum financial assistance standards outlined in the bill are scheduled to take effect on January 1, 2027. All other provisions would kick in either when the Diamond State Hospital Cost Review Board announces that final implementing regulations have been adopted in the Register of Regulations, or by July 1, 2027 — whichever comes first.
The substitute version of the bill differs from the original Senate Bill 13 in several technical ways, including alphabetized definitions, clarifications about which services and locations are covered, and adjustments to where certain enforcement powers are placed within state law.
