Nearly Half of Texas Nonprofit Hospitals Bill Patients Before Checking for Financial Aid
An analysis of 166 Texas nonprofit hospitals found most will not fully refund patients who later qualify for free care. A Texas lawmaker plans to try again for a fix in 2027.
Nearly half of Texas nonprofit hospitals say they will bill patients before checking whether they qualify for free or discounted care, according to an investigation by Tradeoffs and KFF Health News. The analysis covered the financial assistance policies of all 166 nonprofit general and children's hospitals in Texas.
Nonprofit hospitals typically do not pay income, sales or property taxes. In exchange, they are expected to provide community benefits, such as financial help for patients, the report, published by The Texas Tribune, noted.
What the analysis found
Forty-four percent of the hospitals say they bill before screening for financial aid. Only about 8% require screening for charity care before sending a bill, and 41% say they screen before sending unpaid bills to collectors or taking aggressive steps such as wage garnishment, liens or refusing further care.
Roughly two in three say patients will not get full refunds. Only 10 of the 166 guarantee a full refund to patients later found eligible for aid. When hospitals do wipe out a bill after sending it, about 40% say they will not tell the patient.
Two Texas patients
Aimee Carlock, a self-employed house cleaner, borrowed $5,500 from family and a friend to prepay for surgery at a Texas Health Resources hospital. She later qualified for financial aid, but the system kept the $5,500. Texas Health did not respond to Tradeoffs.
Becca Wahl, an uninsured yoga instructor, got a $38,000 emergency room bill from Memorial Hermann Katy Hospital after a concussion. With help from the nonprofit Dollar For, she applied for aid, and the bill was wiped out a week later.
The hospitals' side
Anna Stelter of the Texas Hospital Association said automatic screening can help, but hospitals must first look for other payment sources such as insurance or Medicaid. "Charity care is the relief of last resort," she said.
A bill to try again
State Rep. Tom Oliverson, a Republican and physician, proposed legislation in 2025 that would have required nonprofit hospitals to screen patients for charity care before billing. The bill analysis for House Bill 3708 shows it would have barred billing statements until that screening was done. The bill failed. Oliverson told Tradeoffs he plans to reintroduce it in 2027.
"If you're advertising that you're willing to accept uninsured patients and that you have a charity program, you got to deliver on that," Oliverson said.
Ask before you pay
If you are uninsured or struggling with a hospital bill, ask for the hospital's financial assistance policy before you pay. A tax break is a public trust, and charity care should reach the people it was meant for. For more on Texas health spending, see our reports on rural health grants and the Albertsons opioid settlement.
Hero photo: Larry D. Moore / Wikimedia Commons, CC BY 4.0 (license).
