Thursday, January 22, 2026-North Carolina implemented a statewide medical debt relief effort that has eliminated more than $6.5 billion in outstanding medical bills for approximately 2.5 million residents.
The program was launched through a collaboration between the state government, all 99 of North Carolina’s acute care hospitals, and federal partners. Rather than relying on state tax dollars, hospitals receive enhanced payments through the state’s Medicaid directed payment program in exchange for forgiving qualifying medical debt and adopting stronger financial assistance practices.
Under the agreement, hospitals agreed to wipe out certain unpaid medical bills dating back to 2014 and to automatically provide financial assistance discounts without requiring patients to apply for people who meet income eligibility requirements.
They also agreed not to sell qualifying debts to collection agencies or report them to credit bureaus, removing a major barrier to financial stability for many families. North Carolinians who qualify have been notified by mail that their debt has been erased, often without needing to take any action themselves.
The program also includes reforms to help prevent new medical debt from building up. Participating hospitals adopted more generous charity care policies and streamlined processes for identifying and enrolling patients in financial assistance, reducing the risk that future costs will become unmanageable. State officials say this dual approach erasing old debt and strengthening protections against new debt aims to improve both financial security and access to care across the state.
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