New Hampshire Medical Bill Rights: "Live Free or Die" State Is Surprisingly Protective for Patients

What Collectors Can and Cannot Do:

• Cannot set up ongoing garnishment. Each trustee process attempt requires a separate court filing. Wages earned after service are completely exempt, making repeated attempts economically impractical for collectors.
• Massive homestead exemption (HB 617, eff. Jan 1, 2026). Under the updated RSA 480:1, your primary residence equity is protected up to $400,000 for an individual or $550,000 for co-owners (married couples). For medical debt arising from catastrophic or terminal illness or injury, the homestead exemption is unlimited. This is one of the most generous homestead protections in the entire country.
• Hospital liens limited to personal injury. Under RSA 448-A, hospital liens can only be placed against personal injury claims (such as auto accident settlements). A hospital cannot place a general lien on your home or property simply because you owe a medical bill.
• No income tax, including on forgiven debt. New Hampshire has no state income tax. This means if a hospital or collector forgives your medical debt and issues a 1099-C, there is zero state tax consequence. You may still owe federal tax on forgiven debt (unless you qualify for an insolvency exclusion), but NH will not tax it. This makes debt settlement and forgiveness more attractive in NH than in most states.

How RSA 358-A Protects Patients

New Hampshire's Consumer Protection Act (RSA 358-A) is a broad unfair and deceptive acts and practices (UDAP) law that applies directly to medical billing. If a hospital, billing company, or debt collector engages in unfair or deceptive practices, you have the right to sue under this law with meaningful penalties:

• Minimum $1,000 or actual damages. If you prove a violation, you are entitled to your actual damages or $1,000, whichever is greater. Even if your actual damages are small, you still get at least $1,000.
• Treble damages for willful violations. If the violation was willful or knowing, the court can award triple your damages. A $5,000 overcharge could become $15,000.
• Attorney fees and costs. If you win, the defendant must pay your attorney fees and court costs. This makes it practical for patients to bring claims even on smaller bills.
• AG enforcement. The NH Attorney General can also bring enforcement actions under RSA 358-A, potentially resulting in injunctions and civil penalties.

What New Hampshire Hospitals Must Do:

RSA 151:13-b requires New Hampshire hospitals to take specific steps to help patients who may qualify for financial assistance. These are not optional. Every licensed hospital in the state must comply:

• Written financial assistance policies required. Every hospital must maintain a written policy that describes who qualifies for financial assistance and how to apply.
• Patient screening required. Hospitals must screen patients for financial assistance eligibility. They cannot simply skip this step and send you straight to collections.
• Information before billing. Hospitals must provide information about their financial assistance programs before sending bills. This includes posting notices and making applications available.
• Federal 501(r) also applies. Nonprofit hospitals (most in NH) must additionally comply with federal tax code requirements for charity care, including making reasonable efforts to determine eligibility before pursuing collections.

Granite Advantage Eligibility and Coverage:

New Hampshire expanded Medicaid in 2014 through the Granite Advantage Health Care Program, and made it permanent through SB 313 in 2018. The program provides comprehensive health coverage to low-income adults through managed care organizations:

• • Adults ages 19-64: Up to 138% FPL (~$20,783/year for a single person in 2026)
• • Children: NH Healthy Kids covers children in families up to 318% FPL
• • Pregnant women: Up to 196% FPL
• • Managed care delivery: Services delivered through managed care organizations (MCOs)
• • No premiums for most enrollees
• • Apply through NH EASY (nheasy.nh.gov) or call NH DHHS at (603) 271-9700

Current Protections:

New Hampshire does not currently have a state-specific law banning medical debt from credit reports. However, federal protections and voluntary credit bureau policies provide significant coverage:

• The three major credit bureaus (Equifax, Experian, TransUnion) voluntarily removed all paid medical debt from credit reports in 2022
• Unpaid medical debt under $500 is no longer reported to credit bureaus
• New medical debt cannot appear on credit reports until at least 1 year after becoming delinquent
• The 3-year SOL means NH medical debt ages out of legal enforceability faster than in most states, which also limits how long it can practically affect your credit

Federal No Surprises Act (Also Active in NH):

In addition to SB 173, the federal No Surprises Act (effective January 2022) provides baseline protections for all NH patients:

• Emergency services: You can only be charged in-network cost-sharing for emergency care, even at an out-of-network facility. The provider and insurer must resolve any payment dispute without billing you the difference.
• Out-of-network providers at in-network facilities: If you receive care at an in-network hospital but are treated by an out-of-network doctor (anesthesiologist, radiologist, etc.), you are protected from balance billing.
• Air ambulance: You pay only in-network rates for air ambulance services, even if the provider is out-of-network.
• Good faith estimates: Uninsured or self-pay patients must receive a good faith cost estimate before scheduled services. If the final bill exceeds the estimate by $400 or more, you can dispute it through an independent review process.

New Hampshire Resources for Medical Bill Help: