Many Texas nonprofit hospitals send bills before they check whether a patient qualifies for financial aid, and most will not fully refund money paid before that aid is granted, according to a review published Thursday by The Texas Tribune with Tradeoffs and KFF Health News.
Tradeoffs reviewed the charity care rules at each of the state's 166 nonprofit general and children's hospitals. Nearly every one can screen patients automatically for charity care, a practice known as presumptive eligibility. How and when they do it varies widely.
What the policies say
About 8% of the hospitals require screening before a bill goes out. Some 41% promise to screen before sending unpaid bills to collectors or taking steps such as garnishing wages, placing liens or refusing further care until a patient pays. Nearly half say they will bill first.
Roughly two of every three policies say patients will not get full refunds, the analysis found. When a bill is erased after it has been sent, about 40% of hospitals say they will not tell the patient, and only 8% require that patients be notified.
Only one system, Lubbock-based Covenant Health with five hospitals, said it does not grant aid automatically even though its policy permits it. A spokesperson cited regulatory requirements and administrative complexity.
One patient described in the report paid $5,500 up front to Texas Health Resources for surgery in August 2025, then learned she qualified for financial aid. The system forgave the rest of her bill but kept the prepayment. Texas Health did not respond to the reporters.
