Washington D.C.’s Medical Debt Mitigation Amendment Act of 2026 became effective on August 20 after being enacted without Mayor Muriel Bowser’s signature.
The law introduces sweeping new requirements covering medical debt collection, credit reporting, financial assistance, payment plans, and medical financing products.
Although the legislation is now in effect, its substantive provisions remain tied to an applicability clause linked to funding arrangements in the District.
The District’s FY2027 Budget Support Emergency Act repeals that delay starting October 1, 2026, clearing the path for full enforcement of the law’s provisions.
One of the most significant measures requires covered health care facilities to provide free medically necessary care to patients with household income at or below 200% of the federal poverty level.
Patients with incomes up to 500% of the federal poverty level are entitled to discounted care under the same framework, dramatically expanding charity care obligations across the District.
The law also bans health care providers and debt collectors from reporting medical debt to consumer reporting agencies, a measure that had drawn broad support even from the mayor.
Interest on medical debt is capped at 3% annually, while debt collection is prohibited until 180 days after the consumer receives their first posted medical bill.
Before collection can begin, providers must give patients at least 90 days’ notice, adding a further layer of protection to the process.
The legislation prohibits filing a property lien against a patient’s primary residence and bans wage garnishment for patients with household incomes below 500% of the federal poverty level.
Health care providers and facilities are also barred from promoting or assisting with medical lending products and from requiring credit card authorisation before services are provided or costs are incurred.
Mayor Bowser returned Bill 26-0438 to Council Chairman Phil Mendelson unsigned, but the bill passed into law automatically upon her refusal to sign it.
While Bowser expressed support for provisions including the credit reporting ban and interest rate cap, her core objection centred on the expanded charity care requirements at the heart of the bill.
She warned that combining those charity care mandates with new restrictions on collection tools would render medical debt “effectively uncollectible,” potentially causing some providers to cut services or exit the District entirely.
Health care providers, debt collectors, and medical financing companies operating in D.C. should review their billing, collection, credit-reporting, and financing procedures to ensure compliance as implementing rules develop.