Hill-Burton Act free care is still available at about 126 hospitals and nursing homes across the country, and you can apply before treatment, after discharge, or even after the bill has gone to a collection agency. Whether you qualify depends on your household income measured against the federal poverty guidelines, and whether the facility that treated you is one of the ones still under the obligation.
Who Qualifies
Eligibility runs off the federal poverty guidelines that HHS publishes each year. If your household income is at or below the guideline, hospital services can be fully free. If your income is up to twice the guideline, you can qualify for reduced-cost hospital care. For nursing home care, the reduced-cost ceiling is three times the guideline.1Health Resources & Services Administration. Hill-Burton Free and Reduced-Cost Health Care
For 2026, the guideline for a single person in the 48 contiguous states and Washington, D.C. is $15,960, and for a family of four it is $33,000. A single person earning up to $31,920 can therefore qualify for reduced-cost hospital care, and up to $47,880 for reduced-cost nursing home care. Alaska and Hawaii use higher thresholds: $19,950 and $18,360 respectively for one person.2Federal Register. Annual Update of the HHS Poverty Guidelines
One important limit. Hill-Burton does not layer on top of coverage you already have. If insurance, Medicare, or Medicaid pays the facility charge in full, you’re not eligible for Hill-Burton to cover the same charge.3Health Resources & Services Administration. Frequently Asked Questions But if you’re uninsured, or your coverage doesn’t reach what the facility charges, Hill-Burton can fill the gap when you meet the income rules.
What the Program Actually Pays For
Hill-Burton covers facility charges only. The hospital bill or nursing home bill, in other words. It does not cover bills from private physicians who treated you during your stay but are not employed by the facility.1Health Resources & Services Administration. Hill-Burton Free and Reduced-Cost Health Care Those bills come separately and stay your responsibility.
Each obligated facility also decides which of its own services it will provide for free or at reduced cost. Those choices are written into an allocation plan that the facility must post publicly. If the service you received isn’t in the plan, the facility can deny your Hill-Burton request.3Health Resources & Services Administration. Frequently Asked Questions Ask the admissions or business office what the plan covers before you apply.
How to Apply
Apply directly at the admissions or business office of the obligated facility. There is no filing deadline. You can apply before you get care, while you’re admitted, after you’re discharged, or even after the bill has been turned over to a collection agency.1Health Resources & Services Administration. Hill-Burton Free and Reduced-Cost Health Care If a collector is already contacting you about a hospital bill, it’s worth checking whether the facility carries the obligation.
Bring proof of your income, such as a recent pay stub. If you applied to Medicaid, Medicare, or another assistance program, bring the letter showing whether you were approved or denied. The facility can turn down your request if you don’t provide what it needs to verify eligibility, so gather the paperwork before you go.
Once you apply, the facility has to move quickly. For hospitals and outpatient facilities, a determination must come within two working days if you apply before discharge or before outpatient services. If you apply after the fact, the facility has until the end of the first full billing cycle. Nursing homes have 10 working days for pre-admission applications and two working days after admission.4Health Resources & Services Administration. Frequently Asked Questions
Finding a Facility That Still Participates
As of late 2024, roughly 126 healthcare facilities in the country still carry a Hill-Burton uncompensated care obligation.5Health Resources & Services Administration. Hill-Burton Facilities Obligated to Provide Free or Reduced-Cost Care The number shrinks each year as older obligations end. More than a dozen states have no obligated facilities at all, among them Alaska, Delaware, Indiana, Maryland, Minnesota, Nebraska, Nevada, and Ohio.
HRSA keeps a searchable list at data.hrsa.gov. Filter by state to see what’s near you. Each listing shows the facility name, address, and type. The HHS civil rights page also links to the finder and lists a helpline you can call.6HHS. Medical Treatment in Hill-Burton Funded Healthcare Facilities
What to Do If You’re Turned Down or Discriminated Against
Two different obligations can lead to two different complaints. HRSA handles complaints about uncompensated care, and the HHS Office for Civil Rights handles discrimination complaints tied to the community service requirement.6HHS. Medical Treatment in Hill-Burton Funded Healthcare Facilities
If a facility denied you care based on race, color, national origin, or creed, or refused to accept Medicare, that’s a community service issue. Discrimination complaints must be filed with HHS within 180 days of the alleged violation.7HHS. Know Your Rights – Hill-Burton Fact Sheet
On the uncompensated care side, if a facility falls short of its annual free-care level because it didn’t follow the rules, HHS can require it to make up the deficit starting the year after the noncompliance is identified.8eCFR. 42 CFR 124.503 – Compliance Level Serious violations can bring further sanctions, including termination of state assistance or court action. An eligible patient who was wrongly denied care can, after using administrative remedies, ask a court to order the facility to comply.
A Note on the Broader Community Service Rule
Every facility that ever took Hill-Burton money carries a permanent community service obligation, even those whose free-care obligation ended long ago. That rule bars discrimination and requires the facility to accept Medicare and Medicaid, but it is not itself a free-care program. If you’re looking specifically for help paying a bill, the facility must be on HRSA’s current list of about 126, not just a former Hill-Burton recipient.