Free Hospital Care You May Not Know About: The Hill-Burton Program

There are hundreds of hospitals and healthcare facilities in the United States that are legally required to provide you with free or reduced-cost medical care if you cannot afford to pay—and most people have no idea this obligation exists. Under the Hill-Burton program, healthcare facilities that received federal construction or renovation funding are obligated to provide a “reasonable volume” of free or below-cost services to people who meet income eligibility requirements. This is not charity in the discretionary sense. It is a legal obligation that facilities must fulfill, and you have the right to ask for it.

The Hill-Burton Act was passed in 1946 to help rebuild America’s hospital infrastructure after World War II. In exchange for receiving billions of dollars in federal construction grants and loans, participating hospitals agreed to two key conditions: they would not discriminate based on race, and they would provide free care to people in their community who could not pay. While the construction funding ended decades ago, the free care obligation for many facilities continues in perpetuity. Today, approximately 140 healthcare facilities across the country still have active Hill-Burton obligations.

If you are facing a medical bill you cannot afford, or if you need care but are avoiding it because of cost, checking whether your local hospital has a Hill-Burton obligation could save you thousands of dollars. The program covers inpatient hospital care, outpatient services, and in some cases dental and nursing home services at obligated facilities.

Opportunity Snapshot

Detail	Information
Program Type	Ongoing obligation for free or reduced-cost healthcare
Who It Serves	Patients who cannot afford to pay for medical care
Income Limit	Varies by facility; generally at or below 100%–200% of Federal Poverty Guidelines
Number of Obligated Facilities	Approximately 140 with active obligations
Services Covered	Inpatient hospital care, outpatient services, and some dental and nursing home services
Application	Apply at the facility’s admissions or business office
Administered By	HRSA Division of Facilities Compliance and Recovery
Cost to Patient	Free or reduced, depending on income

How Hill-Burton Works

When Congress passed the Hill-Burton Act in 1946, it created a bargain: the federal government would help pay for hospital construction, and in return, those hospitals would serve their communities—including people who could not pay. Facilities that received Hill-Burton funds agreed to either a 20-year obligation to provide uncompensated care or, for facilities funded after 1975, a perpetual obligation. Many facilities have satisfied their 20-year commitments, but those with perpetual obligations must continue providing free care indefinitely.

Each obligated facility must provide a specific dollar amount of free or reduced-cost care each year. This amount is set by HRSA based on the facility’s size, revenue, and the federal funding it received. The facility reports its compliance annually, and HRSA monitors whether the obligations are being met.

As a patient, you can request Hill-Burton assistance at any obligated facility. The facility is required by law to inform you about the availability of Hill-Burton free care, to post notices in admissions areas, and to evaluate your eligibility. If you qualify, the facility must provide the covered services at no charge (or at reduced cost, depending on your income level and the facility’s specific obligation terms).

Who Qualifies

Eligibility is based primarily on income. Each Hill-Burton obligated facility sets its own income eligibility criteria, but they generally follow one of these patterns:

Free care: Patients with household income at or below 100% of the Federal Poverty Guidelines (approximately $15,650 for a single person in 2025) typically qualify for completely free care.

Reduced-cost care: Patients with income between 100% and 200% of FPG may qualify for reduced-cost care. The specific discount depends on the facility’s policies and the extent of its Hill-Burton obligation.

Facility-specific thresholds: Some facilities have voluntarily set their income thresholds higher than the federal minimum—sometimes up to 200% or even 300% of FPG—especially if they have large uncompensated care obligations to fulfill. Always ask the facility about their specific criteria.

No insurance requirement: You do not need to be uninsured to qualify. If you have insurance but face significant out-of-pocket costs (deductibles, copays, coinsurance), you may still qualify for Hill-Burton assistance on the patient responsibility portion of your bill.

No citizenship requirement: Hill-Burton eligibility is based on income, not citizenship or immigration status. Undocumented individuals can receive Hill-Burton free care at obligated facilities.

Retroactive application: In many cases, you can apply for Hill-Burton assistance after you have already received care. If you received treatment at an obligated facility and are now facing a bill you cannot pay, contact the facility’s business office and ask about Hill-Burton. Some facilities will apply the benefit retroactively to recently incurred charges.

How to Find Hill-Burton Facilities

Step 1: Check the HRSA database. HRSA maintains a list of all facilities with current Hill-Burton obligations, searchable by state. Visit the HRSA website or call the HRSA Hill-Burton hotline at 1-800-638-0742 (or 1-800-492-0359 in Maryland) to find obligated facilities in your area.

Step 2: Call the facility directly. Contact the hospital’s admissions office, patient financial services department, or billing department and ask: “Does this facility have an active Hill-Burton free care obligation?” Staff should be able to tell you immediately.

Step 3: Look for posted notices. Hill-Burton facilities are required to post notices in admissions areas, emergency rooms, and business offices informing patients of the availability of free or reduced-cost care. If you are in a hospital and see such a notice, you are in a Hill-Burton facility.

How to Apply for Hill-Burton Free Care

Step 1: Request an application. Ask the facility’s admissions office, financial counselor, or business office for a Hill-Burton free care application. Some facilities incorporate this into their general financial assistance application process.

Step 2: Provide income documentation. You will typically need to show proof of household income and size. Acceptable documents include recent pay stubs, tax returns, Social Security or disability award letters, unemployment documentation, or a signed statement if you have no income. Bring whatever you have—facilities cannot deny your application solely because you lack a specific document type.

Step 3: Submit the application. Complete and return the application with supporting documents. Some facilities process applications while you are in the hospital (especially for emergency admissions), while others handle them through the billing department after discharge.

Step 4: Receive a determination. The facility must evaluate your application and notify you of the result. If you are found eligible, covered services will be provided at no charge or at reduced cost. If you are denied, you have the right to appeal.

Step 5: Know your rights if denied. If a Hill-Burton facility denies your application and you believe you qualify, you can file a complaint with HRSA’s Division of Facilities Compliance and Recovery. HRSA investigates complaints and can require facilities to comply with their obligations.

What Hill-Burton Does and Does Not Cover

Covered services typically include:

Emergency room care
Inpatient hospital stays (medical and surgical)
Outpatient services (lab work, imaging, clinic visits)
Some dental services at facilities with dental departments
Some nursing home care at Hill-Burton obligated nursing facilities

Limitations to understand:

Hill-Burton only applies at obligated facilities. A hospital across town with no Hill-Burton obligation is not required to participate.
The obligation has an annual dollar cap. If a facility has already met its annual Hill-Burton compliance amount, it is not required to provide additional free care that year (though many do under separate charity care policies).
Hill-Burton covers the facility’s charges but may not cover separately billed physician fees (such as surgeon, anesthesiologist, or radiologist fees). Ask about this when you apply.
The program does not cover elective cosmetic procedures or services not medically necessary.

Hill-Burton vs. Other Financial Assistance

Hill-Burton vs. hospital charity care: Most hospitals have their own financial assistance or charity care policies separate from Hill-Burton. These are often more generous and cover physician fees in addition to facility charges. If you qualify for Hill-Burton, you likely also qualify for the hospital’s own charity care program. Apply for both—they can complement each other.

Hill-Burton vs. Medicaid: Medicaid is a much broader program that covers ongoing care across many providers. Hill-Burton is facility-specific and covers only the obligated facility’s services. However, Hill-Burton can cover costs that Medicaid does not, or serve patients who do not qualify for Medicaid. The two programs are not mutually exclusive.

Hill-Burton vs. emergency room obligations (EMTALA): The Emergency Medical Treatment and Labor Act requires all hospitals with emergency departments to stabilize patients regardless of ability to pay. However, EMTALA does not require free follow-up care, inpatient treatment beyond stabilization, or outpatient services. Hill-Burton obligations are broader and can cover the full spectrum of care at an obligated facility.

Tips for Maximizing Hill-Burton Benefits

Ask before you receive care. If you know in advance that you will need hospitalization or a procedure, call the facility’s financial counselor before your admission date. Getting approved for Hill-Burton before you receive care is simpler than applying retroactively.

Apply even if you think you might not qualify. Income limits vary by facility, and some facilities set their thresholds higher than the federal minimum. You may be surprised to find that you qualify.

Do not ignore hospital bills. If you received care at a Hill-Burton facility and cannot pay, contact the billing department immediately rather than letting the bill go to collections. Mention Hill-Burton by name and ask for an application. Many billing representatives are trained to offer financial assistance but may not proactively mention Hill-Burton unless asked.

Combine with other assistance. Apply for Medicaid, the hospital’s own charity care program, and Hill-Burton simultaneously. Different programs may cover different components of your bill. For example, Medicaid might cover physician fees while Hill-Burton covers the facility charges, potentially reducing your total out-of-pocket cost to zero.

Keep copies of everything. Photocopy your application, income documents, and any correspondence with the facility. If a dispute arises, having a paper trail is essential.

The Ongoing Legacy of Hill-Burton

The Hill-Burton Act helped build nearly 40% of the hospital beds in America’s community hospitals during the 1950s and 1960s. Even small, remote communities gained access to hospital care because of this program. While the construction funding ended long ago, the free care obligations attached to that funding continue to benefit patients today.

The program demonstrates an important principle: when public money builds healthcare infrastructure, the public has a right to access that infrastructure regardless of ability to pay. This is not a handout—it is a contractual obligation that facilities accepted in exchange for receiving taxpayer-funded construction support.

As healthcare costs continue to rise and millions of Americans remain uninsured or underinsured, Hill-Burton represents a valuable but underutilized resource. The biggest barrier to accessing Hill-Burton benefits is simply not knowing they exist. Facilities are required to post notices, but in practice, many patients walk past those notices without reading them and never learn that they could receive care for free.

Frequently Asked Questions

How do I know if my hospital has a Hill-Burton obligation? Call HRSA at 1-800-638-0742 or check the HRSA Hill-Burton compliance database online. You can also ask the hospital’s financial counselor directly.

Can I apply for Hill-Burton after I have already received care? Yes, in many cases. Contact the facility’s billing department and ask to apply retroactively for charges you have already incurred.

Does Hill-Burton cover emergency room visits? Yes, if the emergency room is at a Hill-Burton obligated facility and you meet the income criteria.

Will I be turned away if the facility has met its annual obligation? Possibly, for Hill-Burton specifically. However, the facility likely has its own separate charity care program that may still cover you. Always ask about all available financial assistance options.

Does Hill-Burton affect my credit? If you are approved for Hill-Burton free care, the covered charges should not be sent to collections or reported to credit agencies. If you receive a bill that should have been covered, contact the facility and HRSA immediately.

How to Get Started

Call the HRSA Hill-Burton Hotline at 1-800-638-0742 to find obligated facilities near you
Visit hrsa.gov/get-health-care/affordable/hill-burton for facility listings and program information
Contact the financial counselor at your local hospital and ask about Hill-Burton eligibility
Apply for Hill-Burton assistance at the same time as the hospital’s own financial assistance or charity care program

You have a right to affordable healthcare, and hundreds of hospitals across the country have a legal obligation to provide it. If you need medical care and cannot afford it, the Hill-Burton program may be the most powerful financial tool you have never heard of.