Oregon Mandate Linking Nonprofit Hospitals to Enhanced Financial Assistance Results in Significant Reduction of Medical Debt Collections

A Tulane-led study finds that Oregon's financial assistance mandate for hospitals reduced medical debt collections by nearly 1,200 people per county.

By: AXL Media

Published: Mar 31, 2026, 3:29 AM EDT

Source: Information for this report was sourced from Tulane University

The Impact of Strengthened Financial Protections

The state of Oregon has successfully demonstrated that targeted legislative requirements on nonprofit hospitals can drastically alter the landscape of local medical debt. Unlike federal laws, which require nonprofit hospitals to have a financial assistance policy but do not specify the level of aid, Oregon’s 2019 mandate established clear, aggressive benchmarks. Researchers found that in the first three years of implementation, the share of residents with medical debt in collections fell significantly more in Oregon than in comparable states that expanded Medicaid but did not adopt similar hospital requirements.

Expanding Eligibility and Charity Care Spending

The core of Oregon’s policy success lies in its expanded eligibility criteria and strict procedural protections. The mandate:

Extended Aid: Financial assistance was made available to households with incomes up to 400% of the federal poverty level.

Prohibited Collections: Hospitals were barred from sending unpaid bills to debt collection agencies if the patient had not first been screened for financial assistance eligibility.