US hospital financial aid and nursing home capacity trends

Hospitals in the United States offer charity care to provide free or discounted treatment to low-income patients, but access to this aid is often hindered by complex paperwork and a lack of awareness. In Texas, where medical debt rates are among the highest in the nation, policymakers are considering legislation to require nonprofit hospitals to use presumptive eligibility. This process would involve proactively screening patients for aid before issuing bills, rather than requiring patients to navigate cumbersome applications.

An analysis of 166 nonprofit hospitals in Texas found that 44% bill patients before screening them for discounted care. Some facilities may send multiple bills or utilize collection agencies before determining if a patient qualifies for assistance.

Separately, federal data indicates a decline in nursing home capacity, with nearly 1,000 certified facilities closing between 2015 and 2025. Operators cite staffing shortages and insufficient Medicaid reimbursement as primary drivers. Consequently, many older Americans are increasingly turning to assisted living facilities or home-based nursing services.