Maryland Medical Bill Rights & Programs: The Only State Where Government Sets Hospital Prices
Maryland has a completely unique hospital pricing system found nowhere else in the United States. The Health Services Cost Review Commission (HSCRC) sets rates for every hospital service, and all payers (including Medicare, Medicaid, and private insurance) pay the same price at the same hospital. Combined with a ban on medical debt credit reporting, mandatory free care for low-income patients, and new protections against home liens and small-debt collections, Maryland offers some of the strongest patient billing protections in the country.
Maryland Patient Protections at a Glance
Government-Set Hospital Prices
HSCRC sets rates for ALL payers (only state in the US)
Medical Debt Off Credit Reports
Banned statewide (Fair Medical Debt Reporting Act, HB 1020)
Free Care Under 200% FPL
Required at all acute and chronic care hospitals
No Home Liens for Medical Debt
Banned on primary residences (HB 428)
Debts Under $500 Cannot Be Collected
Hospitals barred from pursuing small debts (HB 268)
3-Year Statute of Limitations
From date of service, regardless of contract terms
The All-Payer System: Why Maryland Hospital Pricing Is Unique in the US
How It Works: The HSCRC Sets Every Hospital Price
Since 1971, Maryland has operated the only all-payer hospital rate-setting system in the United States. The Health Services Cost Review Commission (HSCRC), an independent state agency, sets the price for every service at every hospital in the state. This means:
- All payers pay the same price. Medicare, Medicaid, Blue Cross, Aetna, and uninsured patients all pay the same HSCRC-approved rate at the same hospital for the same service. No other state does this.
- Hospitals cannot negotiate higher prices with private insurers or charge uninsured patients more than insured patients. The rates are fixed by the state.
- Price variation is eliminated. In other states, the same procedure can cost 3x to 10x more at one hospital than another. In Maryland, prices are transparent and regulated.
- Quality incentives are built in. Hospitals that reduce preventable complications receive rate increases. Hospitals with higher complication rates see rate decreases.
Global Budget Revenue (GBR): Capping Total Hospital Spending
Under the Total Cost of Care (TCOC) Model, each Maryland hospital receives a fixed annual revenue budget set by the HSCRC. This "global budget" caps total hospital spending regardless of how many patients are served. The HSCRC oversees approximately $22 billion per year in hospital revenue through this system.
- Hospitals are incentivized to keep people healthy rather than maximize procedures, because their revenue is capped.
- Prices adjust dynamically. If a hospital is trending above its budget, it must lower unit prices. If below, prices can rise slightly. The annual total stays the same.
- Financial stability for hospitals. During COVID-19, Maryland hospitals maintained revenue under the global budget while hospitals in other states faced financial crises from canceled elective procedures.
What This Means for You as a Patient
Because the government sets hospital rates in Maryland, you are protected from the price gouging and wild price variation that patients face in other states. An uninsured patient in Maryland pays the same HSCRC-approved rate as someone with private insurance. You can also verify any hospital charge against the publicly available HSCRC rate schedules.
Medical Debt Banned from Credit Reports
Fair Medical Debt Reporting Act (HB 1020, effective October 1, 2025)
Maryland bans medical debt from appearing on credit reports with a "double layer" of protection that applies to both providers and collection agencies:
- Medical providers cannot disclose any medical debt information to a consumer reporting agency
- Consumer reporting agencies cannot create, furnish, or maintain a report containing information they know (or should know) relates to medical debt
- Any contract between a provider and a collection agency must include a prohibition on disclosing medical debt to credit bureaus. Contracts without this provision are void and unenforceable.
Warning: Credit Card Exception
If you pay a medical bill with a general-purpose credit card (including medical credit cards like CareCredit), it becomes regular consumer debt and loses all medical debt protections, including the credit reporting ban and collection restrictions. However, if a credit card was specifically opened only to pay for medical expenses, the debt on that card is still considered medical debt under Maryland law.
Financial Assistance (Free and Reduced-Cost Care)
Maryland Hospital Financial Assistance Requirements
Maryland law requires every acute care and chronic care hospital to maintain a financial assistance policy with minimum thresholds set by the state. These are floors, not ceilings. Many hospitals offer more generous assistance.
- 240 days to apply. Patients have 240 days from the initial bill to apply for financial assistance (HB 268). During this period, the hospital cannot pursue collection.
- Automatic eligibility categories. Recipients of SNAP, free or reduced school lunch, or LIHEAP (Low Income Home Energy Assistance Program) are automatically deemed eligible for free care.
- Written notice required. Hospitals must provide written notice of their financial assistance policy before discharge and in every collection communication.
- Policies submitted to HSCRC. Each hospital must file its financial assistance policy with the HSCRC annually, ensuring state oversight.
Income-Based Sliding Scale (State Minimums):
| Income Level | What You Qualify For |
|---|---|
| At or below 200% FPL | Free medically necessary care (all charges waived) |
| 200-300% FPL | Reduced-cost medically necessary care |
| 200-500% FPL (uninsured) | Payment plans required for uninsured patients |
No Interest for Eligible Patients:
Hospitals cannot charge interest or fees on debt incurred by patients who are eligible for free or reduced-cost care. They must also notify all patients with medical debt about the availability of installment payment plans.
Lawsuit & Collection Protections
What Hospitals and Collectors Cannot Do:
- Cannot collect debts of $500 or less (HB 268, effective October 1, 2025). Small medical debts are simply uncollectable.
- Cannot file a lawsuit within 180 days of the initial bill. The hospital must wait at least 180 days before pursuing any legal action.
- Cannot collect during the 240-day financial assistance window. Patients have 240 days to apply for financial assistance, and hospitals must pause collection during this period.
- Cannot place a lien on your primary residence for medical debt (HB 428, effective October 1, 2025). Debt collectors are prohibited from using money judgments to lien your home.
- Cannot seek body attachment or arrest for medical debt. Hospitals are prohibited from obtaining arrest warrants against patients for unpaid medical bills.
- Cannot garnish wages of financial assistance-eligible patients. Hospitals may not garnish wages of patients who are eligible for free or reduced-cost care.
- Cannot claim against a deceased patient's estate under certain conditions set out in the Medical Debt Protection Act.
3-year statute of limitations: The statute of limitations to collect hospital debt in Maryland is 3 years from the date of service, regardless of any language to the contrary in a contract between the hospital and patient.
Wage garnishment limits: For patients not eligible for financial assistance, Maryland follows federal guidelines. Garnishment is limited to 25% of disposable income, and debtors must be left with at least 30 times the state minimum hourly wage per week. The first $500 in any bank account is also exempt from garnishment.
Surprise Billing Protections
How Maryland's All-Payer System Prevents Surprise Bills:
Maryland's rate-setting system provides a structural advantage against surprise billing that no other state has. Because the HSCRC sets rates for all hospital services and all payers pay the same rate, the concept of "out-of-network" hospital charges is fundamentally different. In addition to this structural protection, Maryland also has explicit surprise billing laws:
- HMO balance billing prohibition: If you are in an HMO governed by Maryland law, you cannot be balance billed for services covered by your plan, including ground ambulance services.
- Emergency services protection: For emergency care or treatment by an out-of-network provider at an in-network facility, you are limited to your in-network cost-sharing amount.
- Federal No Surprises Act also applies: For self-funded employer plans not governed by Maryland state law, the federal No Surprises Act provides baseline protections.
Patient Bill of Rights (2019 SB 301)
Maryland's Patient Bill of Rights gives you the right to receive an estimation of hospital charges before care is provided, in an accessible format. Hospitals cannot retaliate against patients for filing complaints. The Office of Health Care Quality monitors hospital compliance.
Payment Plan Protections
Maryland law requires hospitals to offer payment plans and includes several protections:
- All patients with medical debt must be notified about the availability of installment payment plans
- No interest or fees for patients eligible for free or reduced-cost care
- Uninsured patients between 200% and 500% FPL must be offered payment plans
- Hospitals must determine financial assistance eligibility at the time of service, not just after billing
Medicaid & Maryland Health Connection
Maryland Expanded Medicaid:
- • Adults: Up to 138% FPL (~$20,784/year for a single person)
- • Over 350,000 Maryland adults are covered through Medicaid expansion
- • No asset test for MAGI-based Medicaid
- • Apply through Maryland Health Connection
Maryland Health Connection (State Marketplace):
Maryland runs its own state-based health insurance marketplace, separate from HealthCare.gov. For residents earning above the Medicaid threshold:
- • Premium tax credits: Available for income between 138% and 400% FPL
- • Cost-sharing reductions: Available for income up to 250% FPL
- • Automatic transition: If you lose Medicaid eligibility, Maryland Health Connection can automatically enroll you in a marketplace plan
- • Apply at marylandhealthconnection.gov
How to Dispute a Medical Bill in Maryland (Step-by-Step)
Request an Itemized Bill
Request a detailed itemized bill from the hospital billing department. Because Maryland rates are set by the HSCRC, you can verify every charge against publicly available rate schedules posted on the HSCRC website.
1 phone call
Apply for Financial Assistance
Request the hospital's financial assistance application. You have 240 days from the initial bill to apply. If you receive SNAP, free or reduced school lunch, or LIHEAP, you are automatically eligible for free care. Collection must pause while your application is reviewed.
30-60 minutes
Review for Errors
Common issues: duplicate charges, upcoding, unbundling, services not received, and charges above HSCRC-approved rates. Compare your bill against the hospital's HSCRC-approved rate schedule.
30 minutes
File a Written Dispute
Send a certified letter to the hospital billing department. Reference Maryland's financial assistance requirements and HSCRC rate regulations. Hospitals must provide a mechanism for patients to file complaints about bill handling.
1 hour
Escalate if Needed
File a complaint with the HSCRC at [email protected] for hospital charges or financial assistance violations. Contact the Health Education and Advocacy Unit (HEAU) at 410-576-6571 for free mediation. File with the Attorney General for billing fraud.
Varies
Even with Maryland's strong protections, navigating the dispute process across hospitals, insurers, and state agencies takes time. For complete peace of mind, our Bill Defense team manages the entire process on your behalf. You pay nothing unless we reduce your bill.
Sample Dispute Letter Template:
Maryland Agencies & Help Lines
Maryland Resources for Medical Bill Help:
Health Services Cost Review Commission (HSCRC)
For: Hospital charge disputes, financial assistance violations, rate complaints
Patient complaint information →Health Education and Advocacy Unit (HEAU)
For: Free mediation for billing disputes, insurance coverage disputes, consumer protection
File complaint online →Maryland Attorney General - Consumer Protection
For: Medical billing fraud, deceptive billing practices, consumer complaints
Attorney General website →Federal No Surprises Help Desk
For: Surprise bills on self-funded employer plans, good faith estimate disputes
File complaint online →Pro Tip: When calling, write down: Date, time, representative name, reference number, and what was promised. Under Maryland's Patient Bill of Rights (2019 SB 301), you have the right to file complaints without retaliation.
Frequently Asked Questions
What makes Maryland's hospital pricing system unique?
Can medical debt appear on my credit report in Maryland?
Who qualifies for free hospital care in Maryland?
Can a Maryland hospital put a lien on my home for medical debt?
What is the statute of limitations for medical debt in Maryland?
Can a Maryland hospital collect a debt under $500?
Take Action Now
Get Professional Bill Negotiation
Expert advocates handle everything. You pay only if we reduce your bill.
Johns Hopkins Financial Assistance
Apply for charity care at Johns Hopkins Hospital and Health System
Find Hospital Financial Assistance Programs
Browse charity care and financial assistance by hospital
Related Resources:
Disclaimer: This information is for educational purposes only and is not legal advice. Laws and regulations may change. Always verify current requirements with official sources or consult with a qualified attorney for specific legal guidance. CareRoute does not provide legal services.