Texas Hospital Charity Care (2026): TX Eligibility, Statutes, and How to Apply
Texas hospitals have weaker statutory protection but stronger leverage through the Texas Hospital Charity Care reporting requirement.
Quick answer
Texas eligibility floor: 200% FPL for nonprofit hospital community benefit; varies by hospital FAP (federal 501(r) floor). Statute: Texas Health & Safety Code Chapter 311 (hospital indigent care reporting); 25 TAC § 13.13. The federal 501(r) framework also applies to every nonprofit hospital, with the 240-day retroactive window for refunds. Texas does not have a single mandatory state-level charity care statute beyond federal 501(r). However, Texas requires nonprofit hospitals to report annual charity care provided as a percentage of revenue (Chapter 311). This creates leverage: hospitals failing to meet the threshold face nonprofit status review.
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What Texas Hospitals Are Required to Do
Texas does not have a single mandatory state-level charity care statute beyond federal 501(r). However, Texas requires nonprofit hospitals to report annual charity care provided as a percentage of revenue (Chapter 311). This creates leverage: hospitals failing to meet the threshold face nonprofit status review. 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. Texas state law layers on top of 501(r) and frequently goes further.
Top Texas Hospital Systems
These are the largest healthcare systems in Texas. 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.
- HCA Healthcare (for-profit; not 501(r))
- Houston Methodist
- Baylor Scott & White Health
- Memorial Hermann Health System
- Texas Health Resources
HCA, Tenet, and other Texas for-profit chains are NOT covered by 501(r). Their FAPs are voluntary and weaker. For HCA in particular, escalate via state AG and CMS complaint when in doubt.
How to Apply for Texas 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 Texas 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. Texas 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 Texas Attorney General, Consumer Protection. If the hospital is nonprofit and you believe they're violating 501(r), file IRS Form 13909. Texas 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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