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On August 20, the District of Columbia’s Medical Debt Mitigation Amendment Act of 2026 became effective after being enacted without Mayor Muriel Bowser’s signature. The law establishes new requirements governing medical debt collection, credit reporting, financial assistance, payment plans, and medical financing. Although the law is effective, its substantive provisions remain subject to an applicability provision tied to funding. The District’s FY2027 Budget Support Emergency Act repeals that delay beginning October 1, 2026.
The law imposes several requirements on health care facilities, providers, and entities collecting medical debt. Specifically, the law:
- Requires financial assistance. Covered health care facilities must provide free medically necessary care to patients with household income at or below 200% of the federal poverty level and discounted care for patients with household income between 200% and 500%. Eligible patients receiving discounted care must also be offered payment plans generally capped at 3% of monthly household income.
- Restricts medical debt collection. Providers and debt collectors generally may not begin collection activity until 180 days after the first medical bill and must provide at least 90 days’ notice before beginning collection. The law also prohibits liens against a patient’s primary residence and wage garnishment for patients with household income below 500% of the federal poverty level.
- Prohibits medical debt reporting. Health care providers and debt collectors may not report the amount or existence of medical debt owed by a patient to a consumer reporting agency.
- Limits medical lending practices. Providers may not assist patients in completing applications for medical lending products and face restrictions on promoting or charging such products during treatment, before procedures occur, or before financial-assistance screening in certain circumstances.
Mayor Bowser returned the legislation unsigned, supporting several of its consumer protections but raising concerns that the financial-assistance thresholds, collection restrictions, and related administrative obligations could impose significant costs on District health care facilities.
Putting It Into Practice: D.C.’s law extends protections to collection practices and medical financing. These state measures continue to develop against a shifting federal backdrop. Health care providers, debt collectors, and medical financing providers operating in D.C. should monitor the law’s applicability and implementing rules and review their billing, collection, credit-reporting, and financing procedures accordingly.
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