Charity care & financial assistance
Apply for Medicaid retroactively — covers up to 3 months back
Federal Medicaid rules let an eligible patient request retroactive coverage going back up to 3 months before they applied. So a hospital bill from a recent ER visit, while uninsured, can still be covered if the patient applies and qualifies now.
Federal basis
Medicaid Retroactive Eligibility
42 USC §1396a(a)(34) / 42 CFR §435.915
Read the source →What this looks like in practice
Section 1902(a)(34) of the Social Security Act (codified at 42 USC §1396a(a)(34)) requires state Medicaid programs to cover medical bills going back up to 90 days before the application date — provided the patient was eligible during that retroactive period. Some states have requested federal waivers to limit or eliminate retroactive eligibility (Iowa, New Hampshire, others) but the default federal rule still applies in most states.
The practical effect: someone who has a hospital bill from June, was uninsured at the time, and qualifies for Medicaid in August can apply, ask for retroactive coverage to June, and have Medicaid pay the bill. The hospital simply re-bills the claim to Medicaid; the patient owes $0.
How to spot it on a bill
- 01.Bill is from a date within the past 90 days.
- 02.You were uninsured (or had a coverage gap) when the service was rendered.
- 03.Your household income and assets fall in your state's Medicaid eligibility range.
What to write — ready-to-paste language
Replace the bracketed fields with your specific details. Send by certified mail with return receipt, or via the hospital’s patient portal if it offers documented messaging. Keep a copy.
I'm writing about my unpaid balance on the bill dated [date]. I am applying for Medicaid in [state] and intend to request retroactive eligibility under 42 USC §1396a(a)(34) covering the date of service. Per CMS Medicaid policy, hospitals can re-bill claims to Medicaid once retroactive eligibility is approved. Please (1) place a hold on collections activity for this account during my Medicaid application review, and (2) confirm in writing that you will accept retroactive Medicaid payment on this account if my eligibility is approved. The state agency I am applying through is [state Medicaid agency name].
This is a starting point, not legal advice. Your specific situation may warrant additional details. Our scan tool drafts this letter automatically with your bill’s specifics filled in.
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Related scenarios
Charity care — your right to financial assistance at non-profit hospitals
ACA §501(r) requires non-profit hospitals to offer free or discounted care to patients meeting income criteria. Most patients never apply because most never know.
Presumptive eligibility — automatic charity-care qualification
Some non-profit hospitals' Financial Assistance Policies grant automatic charity-care eligibility to certain categories of patients without requiring an income application.
Sliding-scale discount at for-profit hospitals
For-profit hospitals don't have to offer charity care under §501(r), but most have a 'self-pay discount' or 'sliding scale' policy. They just don't advertise it.
Common questions
How do I apply for retroactive Medicaid?
Does my state allow retroactive Medicaid?
P.S. The dispute language above is a starting point. Bills with this pattern often have additional issues alongside it — coding errors stacked with markup, surprise bills stacked with charity- care eligibility. The scan finds all of them in one pass. Start the audit →
P.P.S.Federal law gives you these rights regardless of how the bill arrived. Insured, uninsured, in-network, out-of-network — the underlying patient-protection statutes apply.
P.P.P.S. Bills are time-sensitive. Most insurance appeals must be filed within 180 days. Charity-care discounts at non-profit hospitals are most easily applied within 240 days of the original bill. Acting earlier costs less.