Washington, D.C., Mayor Muriel Bowser has raised concerns about the City Council’s recently passed medical debt legislation, which would significantly change how medical debt is managed, reported and collected throughout the district.
The D.C. City Council unanimously passed the Medical Debt Mitigation Amendment Act of 2025 (Bill 26-438) in June and sent the legislation to the mayor for approval. While Bowser expressed support for provisions intended to strengthen protections for patients, she returned the bill to the council unsigned, citing concerns about the potential impact on the district’s health care system and access to care.
Bowser did not veto the legislation, allowing it to move forward through the next stage of review.
The legislation would introduce several significant changes to medical debt policies in Washington, D.C., including:
- Requiring health care facilities to offer payment plans to low-income patients with unpaid medical bills and prohibiting the reporting of medical debt to consumer credit reporting agencies.
- Prohibiting wage garnishments, home liens related to medical debt, and certain lawsuits and collection actions.
- Establishing uniform income eligibility requirements and requiring documentation to verify income.
- Requiring health care facilities to provide good-faith estimates of health care costs before treatment, except in emergency situations.
- Granting enforcement authority to DC Health and the Office of the Attorney General.
The legislation was refined earlier in the year to address concerns related to fiscal feasibility and the scope of health care entities covered under the requirements. Updates included adjustments to which entities would be required to comply, changes to income eligibility standards and thresholds for free or discounted care, and a broader prohibition on reporting medical debt to consumer credit agencies.
Bowser expressed support for several provisions of the legislation, including restrictions on medical debt reporting, limitations on certain collection actions while insurance appeals are pending, and interest rate limits on medical debt.
However, she raised concerns about the bill’s requirements for health care providers. In her letter to the council, Bowser stated that the mandate requiring health care facilities to provide free medically necessary care for patients up to 200% of the federal poverty level and reduced-cost care for patients up to 500% of the federal poverty level could create challenges for the district’s health care system.
Bowser also noted that the requirements outlined in the legislation exceed those currently in place in neighboring states, including Maryland and Virginia.
She encouraged the City Council to consider a more targeted approach that builds on existing medical debt relief programs, improves transparency around medical pricing and financial assistance options, and incorporates additional data analysis before expanding uncompensated care requirements.
Because the mayor did not veto the bill, the legislation is now subject to a 30-day congressional review period.
For most provisions, the effective date will occur one year after the completion of that review process.
The full text of Bill 26-438, Medical Debt Mitigation Amendment Act of 2025, can be reviewed here:
https://lims.dccouncil.gov/downloads/LIMS/60562/Signed_Act/B26-0438-Signed_Act.pdf?Id=242238
Author: Jennifer Evancic
Jennifer.Evancic@ResourceManagement.com
Jennifer Evancic is a third-party auditor valued by creditors and large organizations for her knowledge in call monitoring within the collections industry. With meticulous attention to detail and a firm grasp of regulatory requirements, she ensures compliance with clients’ criteria and state and federal regulations.
Jennifer audits collections calls, ensuring they meet client-specific criteria and comply with regulations, providing valuable insights and maintaining industry standards.
Beyond her auditing responsibilities, Jennifer takes the lead in organizing and facilitating monthly call calibrations. These sessions serve as a collaborative forum where clients and their vendors come together to discuss call monitoring results and address any findings or areas for improvement. Jennifer’s guidance fosters open communication and ensures alignment between clients and vendors, driving continuous improvement in collections practices.
Jennifer stays up-to-date with compliance and industry best practices by participating regularly in peer meetings, regulatory updates and industry webinars. This keeps her informed about emerging issues and ensures she remains a knowledgeable leader in collections compliance.
