California has the strongest self-pay patient protections of any state in the country. The Hospital Fair Pricing Act, strengthened by AB 1020 effective January 1, 2025, raised the charity care income threshold to 400% of the federal poverty level and prohibits hospitals from charging uninsured patients more than what they accept from Medicare or Medi-Cal. For a single adult in 2026, 400% FPL is roughly $60,240 per year. More than half of all Californians are estimated to qualify.
What the law requires
The California Hospital Fair Pricing Act (originally AB 774, strengthened by SB 1276 and AB 1020) imposes several requirements on California hospitals that go far beyond federal law:
| Protection | Who Qualifies | What It Means |
|---|---|---|
| Free care | Below 200% FPL | Hospital must provide care at no charge |
| Discounted care (sliding scale) | 200% - 400% FPL | Charges reduced on a sliding scale based on income |
| Price cap | All uninsured patients | Cannot be charged more than Medicare or Medi-Cal rate (whichever is higher) |
| Interest-free payment plans | All patients with medical debt | SB 1061 requires hospitals to offer interest-free payment plans |
| Credit reporting ban | All patients | AB 1526 (effective Jan 2025) bans most medical debt from California credit reports |
The income thresholds in dollars
2026 Federal Poverty Level by Household Size (California)
Approximate 2026 figures based on HHS poverty guidelines. Thresholds are slightly higher in Alaska and Hawaii.
A family of four earning up to $124,800 per year qualifies for some level of financial assistance at every nonprofit hospital in California. That covers a significant portion of the state's middle class.
How to use this law
The law does not apply automatically. You must apply for financial assistance. Here is the process:
Before the procedure, tell the hospital billing department you are uninsured or self-pay. Ask for a Good Faith Estimate and the hospital's financial assistance application. Every nonprofit hospital is required to have a written Financial Assistance Policy (FAP) and to make the application available on its website, at the billing office, and in the emergency department.
Submit the application with proof of income. This typically means recent tax returns, pay stubs, or a signed statement of income. The hospital has to process the application before sending the account to collections.
If the hospital bills you at the chargemaster rate without screening you for financial assistance, that is a violation. The California Attorney General's office enforces the Hospital Fair Pricing Act, and patients can file complaints through the AG's healthcare complaint portal.
The 240-day rule: Under federal 501(r) rules (which apply in every state, not just California), you have 240 days from the first post-discharge billing statement to apply for financial assistance. A hospital cannot send your account to collections until that window closes or your application is processed, whichever comes first. California law reinforces this with its own screening requirements.
What California law does not cover: The Hospital Fair Pricing Act applies to hospitals. It does not apply to individual physician practices, imaging centers, labs, or ambulatory surgery centers. If your surgeon has a separate professional fee billed through a private practice, that bill is not subject to the hospital's FAP. You can still negotiate, but you do not have the same statutory protection.
Related on this site
Charity care at nonprofit hospitals: how to apply under IRS 501(r) covers the federal baseline that applies in all 50 states.
State price transparency laws compares protections across all states.
Elsewhere in the network
The Waiting Room on saveonsurgery.co covers savings tactics including hospital financial assistance applications and prompt-pay discounts.