Massachusetts Hospital Charity Care (2026): MA Eligibility, Statutes, and How to Apply
Massachusetts's Health Safety Net (HSN) covers hospital and community health center costs for residents up to 300% FPL.
Quick answer
Massachusetts eligibility floor: 200% FPL for full HSN coverage; sliding scale to 300% FPL. Statute: M.G.L. c. 118E § 64; 101 CMR 613.00 (Health Safety Net). The federal 501(r) framework also applies to every nonprofit hospital, with the 240-day retroactive window for refunds. Massachusetts's Health Safety Net is the most comprehensive state-administered hospital assistance program in the country. It covers acute hospital care, community health centers, and specialty services. Eligibility is income-only (no asset test for most patients) and applications can be backdated 10 days from receipt.
Need help applying?
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What Massachusetts Hospitals Are Required to Do
Massachusetts's Health Safety Net is the most comprehensive state-administered hospital assistance program in the country. It covers acute hospital care, community health centers, and specialty services. Eligibility is income-only (no asset test for most patients) and applications can be backdated 10 days from receipt. Patients should always check the specific hospital's posted Financial Assistance Policy for the current eligibility cutoffs and AGB rate. State and federal protections operate side-by-side; you typically benefit from whichever is more generous.
Federal IRS 501(r) sets the baseline: every nonprofit hospital must publish a Financial Assistance Policy (FAP), evaluate eligible patients without charging more than "Amounts Generally Billed" (AGB), and accept retroactive applications up to 240 days after the first post-discharge bill. Massachusetts state law layers on top of 501(r) and frequently goes further.
Top Massachusetts Hospital Systems
These are the largest healthcare systems in Massachusetts. Each publishes a Financial Assistance Policy on its website. Search the system name plus "Financial Assistance Policy" to find the current eligibility cutoffs and AGB rates.
- Mass General Brigham (Mass General + Brigham and Women's)
- Beth Israel Lahey Health
- Boston Medical Center
- Tufts Medicine
- UMass Memorial Health
HSN is administered through the same eligibility system as MassHealth. Apply via the Massachusetts Health Connector. If you're denied HSN, you can request reconsideration through the appeal process within 30 days.
How to Apply for Massachusetts Charity Care, Step-by-Step
1. Find the FAP
Search "[hospital name] Financial Assistance Policy." Every nonprofit hospital must publish one. The FAP includes eligibility cutoffs, the application form, required documents, and the AGB rate.
2. Gather documents
Most Massachusetts hospitals require: most recent tax return, last 2-4 pay stubs, current bank statements, government ID, household composition documentation. Some require an asset declaration.
3. Submit the application
Most accept online submission, fax, or mail. Always send via a method that produces a receipt. If submitting by mail, certified mail with return receipt protects you against "we never received it" denials.
4. Track the deadline
Federal 501(r) gives you 240 days from the first post-discharge bill. Massachusetts state programs sometimes go longer (New Jersey: 2 years; Massachusetts: 10 days backdating from receipt). Mark your calendar at the 200-day mark for federal claims.
5. Request reconsideration if denied
Denials are appealable. Common denial reasons that can be overcome: incomplete documentation (just resubmit), borderline income (request the catastrophic-care exception if your bill exceeds 10-25% of annual income), or asset test failure (challenge based on the specific hospital's policy text).
6. Escalate if the hospital won't engage
File a complaint with the Massachusetts Health Connector, HSN Eligibility. If the hospital is nonprofit and you believe they're violating 501(r), file IRS Form 13909. Massachusetts has its own enforcement mechanisms layered on top.
Pause collections during your application
Under 26 CFR § 1.501(r)-6, a pending charity care application pauses extraordinary collection actions: the hospital cannot send your account to collections, sue you, or report the bill to credit bureaus during the determination period. If they do, that's a 501(r) violation reportable to the IRS.
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