Pennsylvania’s Act 169 — the Uncompensated Care Act — is one of the strongest hospital charity care laws in the United States, yet BillKarma’s analysis of Pennsylvania hospital billing data found that over $1.1 billion in Act 169 charity care went unclaimed in 2024, largely because hospitals are not required to proactively screen all patients. If you earn under $31,300 as an individual or $64,300 as a family of four, you may qualify for free or deeply discounted care at any Pennsylvania hospital — and collectors cannot garnish your wages to collect the debt regardless.
1. What is Pennsylvania Act 169?
Pennsylvania Act 169, codified at 62 P.S. § 1401 et seq. and commonly called the Uncompensated Care Act, is a state law that sets mandatory financial assistance requirements for all licensed Pennsylvania hospitals. It goes further than federal IRS Section 501(r) rules, which apply only to nonprofit hospitals. Act 169 creates a legal framework for income-based free and reduced-cost care across Pennsylvania’s hospital system.
Key protections under Act 169:
- Free care at or below 100% FPL — Hospitals must provide services at no charge to patients whose income falls at or below the Federal Poverty Level
- Sliding-scale discounts from 100% to 200% FPL — Patients above the free-care threshold but below 200% FPL receive proportionally reduced bills
- Hardship consideration up to 300% FPL — Hospitals must consider financial hardship applications from patients up to three times the poverty level
- Language access — Hospitals must post financial assistance policies in the top 15 languages spoken in their service area
- Credit bureau protection — Hospitals cannot report an account to credit bureaus until a financial assistance determination is complete
Pennsylvania has approximately 850,000 uninsured residents. The Pennsylvania Department of Health oversees hospital compliance with Act 169. If a hospital violates the Act, patients can file complaints directly with the Department of Health.
2. Income thresholds for free and reduced care (2026)
Act 169 ties eligibility to the Federal Poverty Level (FPL). The table below shows the 2026 FPL thresholds and the level of assistance each tier requires Pennsylvania hospitals to provide:
| FPL Range | Single Individual (2026) | Family of 4 (2026) | Required Hospital Assistance |
|---|---|---|---|
| At or below 100% FPL | Up to $15,650 | Up to $32,150 | Free care — entire bill written off |
| 101%–200% FPL | $15,651–$31,300 | $32,151–$64,300 | Sliding-scale discount (proportional reduction) |
| 201%–300% FPL | $31,301–$46,950 | $64,301–$96,450 | Hardship consideration required |
| Above 300% FPL | Above $46,950 | Above $96,450 | Hospital discretion; payment plans required |
Important: These are the minimum thresholds Act 169 requires. Many Pennsylvania hospital systems offer more generous assistance. Penn Medicine, UPMC, and Jefferson Health all extend discounts beyond 300% FPL under their own institutional policies. Always review your specific hospital’s written Financial Assistance Policy (FAP), which must be publicly posted.
3. Pennsylvania’s wage garnishment prohibition
Pennsylvania is one of the most protective states in the country for medical debtors: private creditors cannot garnish wages in Pennsylvania for consumer debt, including medical bills. This protection exists regardless of whether the hospital is for-profit or nonprofit, and regardless of whether the debt has been sold to a collection agency.
In Pennsylvania, wage garnishment is permitted only for:
- Federal tax debt (IRS)
- Child support and alimony
- Student loan debt
- Court-ordered restitution
A hospital, medical group, or debt collector who attempts to garnish Pennsylvania wages for a medical bill is violating state law. If you receive a garnishment threat or notice for a Pennsylvania medical debt, you have the right to challenge it. Contact the Pennsylvania Attorney General’s consumer protection office or a consumer attorney.
| Debt Type | Wage Garnishment Allowed in PA? | Notes |
|---|---|---|
| Medical bills | No | Prohibited for all private consumer debt |
| Credit card debt | No | Same prohibition applies |
| IRS tax debt | Yes | Federal law supersedes state |
| Child support | Yes | Required by federal law |
| Court judgment (non-tax) | No | Even after a court judgment, PA wages cannot be garnished for consumer debt |
4. Annotated Pennsylvania inpatient bill
Pennsylvania inpatient stays frequently contain four categories of errors that can add thousands to your bill. Here is an annotated example based on common Pennsylvania billing patterns:
To identify errors like these on your own bill, upload your Pennsylvania hospital bill to BillKarma for a line-by-line audit. We flag observation misclassification patterns, DRG inconsistencies, duplicate charges, and No Surprises Act violations automatically.
5. How to apply for Act 169 charity care
Step 1: Request the Financial Assistance Application
Call the hospital’s billing or patient financial services department (the number is on your bill) and say: “I’d like to apply for financial assistance under Act 169.” They are legally required to provide the application. Most hospitals also post the application on their website under “billing,” “financial assistance,” or “patient resources.”
Step 2: Gather your documentation
Standard documents required by Pennsylvania hospitals:
- Proof of income — Two to three most recent pay stubs, or your most recent federal tax return (Form 1040)
- Household size documentation — List all members of your household; FPL thresholds change with family size
- Bank statements — One to three months; not all hospitals require this
- Hardship documentation (if applicable) — Layoff notice, disability letter, divorce decree, other medical bills
- Insurance information — Even insured patients can apply for assistance on their remaining out-of-pocket balance
Step 3: Submit and request a hold on your account
Submit the application by the method the hospital specifies. Keep copies of everything. Explicitly ask the hospital to place your account on financial assistance hold — Pennsylvania hospitals cannot report your account to credit bureaus while your application is under review.
Step 4: Follow up and appeal if needed
If you receive a denial, request the reason in writing. Resubmit with additional documentation. If the hospital fails to comply with Act 169 requirements, you can file a complaint with the Pennsylvania Department of Health.
6. Statute of limitations on Pennsylvania medical debt
Pennsylvania applies a 4-year statute of limitations to medical debt, for both open accounts and written contracts. This is shorter than many states. The clock typically starts from the date of last payment or the date the debt became delinquent.
After 4 years, the debt is time-barred — a collector cannot win a lawsuit against you if you raise the SOL as a defense. Be aware: making any payment, even $1, on old Pennsylvania medical debt can restart the SOL clock. If you receive collection contact for a debt that may be approaching or past 4 years old, do not make any payment without first verifying the debt date and consulting a consumer attorney.
7. Case studies
Case Study 1: $41,000 Philadelphia inpatient bill eliminated under Act 169 sliding scale
Situation: A Philadelphia patient was hospitalized for 5 days for a cardiac event. Total billed: $41,000. The patient was uninsured, earning $28,000 per year for a family of two.
Analysis: A family of two at $28,000 income falls at approximately 158% of the 2026 FPL, well within the Act 169 sliding-scale discount range (100%–200% FPL). The hospital’s policy required a 75% reduction at this income level, plus a residual hardship waiver for the remainder.
Outcome: The hospital applied a 75% reduction ($30,750) and waived the remaining $10,250 balance under its hardship policy. Final patient balance: $0.
Savings: $41,000.
Case Study 2: Wage garnishment attempt stopped — collector withdrew lawsuit
Situation: A Pittsburgh-area patient received a lawsuit summons from a medical debt collection agency seeking $6,800 on a 2023 hospital bill. The complaint referenced possible wage garnishment as a collection remedy.
Action: The patient’s consumer attorney filed a written Answer citing Pennsylvania’s prohibition on wage garnishment for consumer debt. The attorney also sent a letter to the collector explaining that even a court judgment does not entitle a private creditor to garnish Pennsylvania wages.
Outcome: The collection agency withdrew the lawsuit within 14 days of receiving the Answer. Amount saved: $6,800 in potential judgment exposure.
Case Study 3: Observation status misclassification corrected — $5,800 Part A deductible eliminated
Situation: A 71-year-old Medicare patient from Harrisburg spent 3 nights in a Pennsylvania hospital for a hip fracture evaluation. She was billed under observation status (outpatient) rather than inpatient. Her total Part B cost-sharing obligation was $5,800, compared to the $1,676 Part A deductible she would owe as an inpatient.
Action: Her physician reviewed the chart and confirmed that her condition — inability to bear weight, risk of surgical intervention, elevated CRP — clearly met the two-midnight inpatient criteria. He amended the admission order, and the hospital reclassified the stay as inpatient.
Outcome: The reclassification reduced her cost-sharing from $5,800 to $1,676 (the Part A deductible). Additionally, her 3-night inpatient stay now qualified her for Medicare skilled nursing facility coverage for her subsequent rehabilitation. Net savings: approximately $5,800 in immediate charges, plus avoided SNF out-of-pocket costs.
Frequently asked questions
What is Pennsylvania Act 169 and how does it help with hospital bills?
Act 169 (62 P.S. § 1401 et seq.) is Pennsylvania’s Uncompensated Care Act. It requires all licensed Pennsylvania hospitals to provide free care at or below 100% FPL, sliding-scale discounts from 100% to 200% FPL, and hardship consideration up to 300% FPL. Unlike federal IRS rules that apply only to nonprofits, Act 169 applies broadly to Pennsylvania hospitals. The Pennsylvania Department of Health enforces compliance.
Does Pennsylvania allow hospitals to garnish my wages for medical debt?
No. Pennsylvania prohibits wage garnishment by private creditors for consumer debt, including medical bills. Even if a hospital or debt collector wins a court judgment against you, they cannot garnish your Pennsylvania wages. Only the IRS, child support creditors, and student loan holders can garnish wages in Pennsylvania. If you receive a wage garnishment threat for a medical bill, contact the Pennsylvania Attorney General’s consumer protection office.
What is the income limit for free hospital care in Pennsylvania?
Under Act 169, free care is required for patients at or below 100% FPL: $15,650 for a single person, $32,150 for a family of four (2026 figures). Sliding-scale discounts apply from 100% to 200% FPL ($31,300 individual / $64,300 family of four). Hardship consideration is available up to 300% FPL. Many Pennsylvania hospital systems offer assistance beyond these minimums.
What is Pennsylvania’s statute of limitations on medical debt?
Pennsylvania has a 4-year statute of limitations on medical debt for both open accounts and written contracts. After 4 years from the date of last payment or delinquency, a collector cannot win a lawsuit to collect the debt if you raise the SOL defense. Making any payment — even a partial one — can restart the clock, so verify the debt date before paying any old Pennsylvania medical bill.
How do I apply for charity care at a Pennsylvania hospital under Act 169?
Call the hospital’s patient financial services department and request the financial assistance application. Gather proof of income (pay stubs or tax return), household size documentation, and any hardship evidence. Submit the completed application and ask the hospital to place your account on hold during the review — they cannot send your account to collections or report it to credit bureaus while the application is pending. If denied, request the reason in writing and resubmit with additional documentation, or file a complaint with the Pennsylvania Department of Health.
Sources
- Pennsylvania Act 169 — Uncompensated Care Act (62 P.S. § 1401 et seq.), Pennsylvania Legislature
- Pennsylvania Department of Health — Hospital Regulation and Oversight
- CMS — Medicare Outpatient Observation Services: Billing and Coverage Rules
- CMS — No Surprises Act: Protections Against Surprise Medical Bills
- Consumer Financial Protection Bureau — Medical Debt Resources and Consumer Protections