Delaware hospitals must begin giving free care to residents with household income up to a set share of the federal poverty level on January 1, 2027. For a one-person household, the 2026 federal guideline puts that cutoff at $47,880 a year.
The law was signed July 20, 2026, so the January start is the news. Not every part of it starts that day: the rules on collections and several patient protections have a later trigger, and the state board writing the details has not finished.
Who gets free care under Delaware Senate Bill 13
Senate Substitute 1 for Senate Bill 13, sponsored by Sen. Pinkney, is listed on the General Assembly’s bill detail page as signed 7/20/26 and recorded as Chapter 349 of Volume 85 of the Laws of Delaware. The page’s action history is blank, so it does not show when each chamber voted.
The enacted text sets three tiers for a “financially qualified patient,” meaning a Delaware resident whose household income is at or below the listed level:
- Up to 300% of the federal poverty level: full financial assistance, meaning free care for medically necessary hospital services.
- Over 300% to 350%: a discount cutting the patient’s share by at least 75%.
- Over 350% to 400%: a discount cutting the patient’s share by at least 50%.
The tiers cover inpatient stays, emergency visits, observation stays and outpatient procedures, and they apply whether or not a patient has insurance. The act applies to hospitals generally, with an exception for hospitals that provide only psychiatric, rehabilitative or long-term acute care services. Hospitals may go further than the minimums but not below them.
Paperwork help: A medical bill that reaches a collector can generate letters, calls and disputed balances. The debt-validation steps and the protected-funds and dispute log in The Bank Account & Debt Protection Kit give a patient a way to record each collection letter and the balance it claims.
What $47,880 means for one-person and two-person households
The act uses percentages, not dollar amounts. The U.S. Department of Health and Human Services’ 2026 poverty guidelines list $15,960 for one person and $21,640 for two people in the 48 contiguous states and the District of Columbia.
The following figures are arithmetic, not state-published numbers. Three times $15,960 is $47,880 for one person. Three times $21,640 is $64,920 for two. For the discount tiers, one person at 350% is $55,860 (3.5 times $15,960) and at 400% is $63,840 (4 times $15,960).
The guideline is updated each year, so the dollar cutoffs in effect on a patient’s date of service may differ from these 2026 figures. The medical hardship route reaches higher: hospitals must offer at least a 50% discount to patients whose out-of-pocket hospital costs equal or exceed 10% of annual household income, with an income ceiling that cannot be set below 500% of the poverty level. For one person, 5 times $15,960 is $79,800.
Collection pause while an assistance application is pending
The enacted text bars hospitals and facility-based providers from sending an account to a collection agency, selling the debt, reporting it to credit bureaus, or suing while a financial assistance determination is pending. Hospitals must also tell the patient in writing that no bills are owed during that period.
The law separately says medical creditors and debt collectors may not take “extraordinary collection actions” against a patient who qualifies for assistance. The act text read for this article does not define that term, so the regulations may fill it in. A patient may apply at any time during the collections process, and a hospital must decide a completed application in writing within 21 days, with appeal rights in any denial.
Courts get a role too. Noncompliance by the hospital, or the patient’s eligibility, is a complete defense in a medical debt lawsuit, and no default judgment may be entered without an affidavit from a hospital officer saying screening was offered.
Why only part of the law starts on January 1
Section 6 of the bill text makes the income-based minimums take effect January 1, 2027. Every other provision starts on the earlier of two dates: a notice from the Diamond State Hospital Cost Review Board that final regulations are adopted, or July 1, 2027.
That means the collection pause and the application rules are not guaranteed for January 1. The Board’s October 5 working-session slides list a February 2027 target for approving the regulation and describe a collections freeze as a new requirement for all six hospital systems. Those slides are draft planning material, not adopted rules.
Hospital Cost Review Board rules still being written
Spotlight Delaware reported on October 7 that hospital leaders asked regulators to widen the documents hospitals may request to verify eligibility, and that regulators hoped to finish by February. A later October 21 report said the Board will take complaints first and pass credible ones to the Division of Health Care Quality, and that its next meeting is 10 a.m. Tuesday, November 17, in New Castle.
The Board’s slides propose that hospitals ask only for income and household size, and that some patients be presumed eligible, for example those already enrolled in income-based programs such as Medicaid or SNAP. The slides do not set an application window and name no state patient hotline. They list the six hospital websites with current policies: bayhealth.org, beebehealthcare.org, christianacare.org, nemours.org, trinityhealthma.org and tidalhealth.org.
The costliest mistake: assuming a bill is settled
The likeliest way to lose money or time is to wait for the rules to be final while a bill ages. Until regulations are adopted, the hospital’s existing policy governs most screening, and some hospitals ask for records within days. A patient with a pending application should keep dated copies of the application, the hospital’s written decision and every bill and collection letter that arrives, since the act treats a pending application and a wrongly collected account differently. Rules vary by hospital, and nobody is guaranteed free or discounted care until a hospital approves the application.
Medical bills and collection letters in Delaware
Delaware’s new financial assistance rules do not stop every hospital bill from reaching a debt collector, and the collection pause tied to a pending application has a later start than the income tiers. A disputed balance can leave a trail of letters from a hospital, a collector and sometimes a buyer of the debt that is hard to untangle afterward.
The Bank Account & Debt Protection Kit includes the debt-validation steps and a protected-funds and dispute log for recording what each collector claims and when it wrote.
Read the debt-validation steps in The Bank Account & Debt Protection Kit.
This article was created with AI assistance and reviewed for accuracy against the Delaware General Assembly, HHS poverty guidelines and Diamond State Hospital Cost Review Board materials.
Elias Broderick specializes in residential and commercial real estate, with a focus on market cycles, property fundamentals, and investment strategy. His writing translates complex housing and development trends into clear insights for both new and experienced investors. At The Daily Overview, Elias explores how real estate fits into long-term wealth planning.
