Medical Debt Elimination Policy Tracker

With two in every five adults behind on medical bills that total more than $220 billion, soaring medical debt is a national crisis—one that disproportionately burdens low-income people and communities of color. Recognizing the profound impact of medical debt on both health and financial security, Cook County, Illinois allocated $12 million of its American Rescue Plan Act (ARPA) recovery funds in July  2022 to erase up to $1 billion in medical debt.* Toledo, Ohio quickly followed suit, launching a policy trend that now stretches from California to Florida.

As part of our research into how ARPA and other public funds are advancing racial and economic equity, we’ve been tracking the steps local and state governments are taking to confront medical debt through debt cancellation and additional strategies. To capture these efforts, we created a comprehensive database that compiles key information on each effort including its status, the amount of public funding, anticipated impacts, approval dates, and outcomes to date.

Our review shows that: 

• As of October 25, 2025 29 state and local governments across 19 states have dedicated public funds to medical debt relief programs. 
• Collectively, these initiatives promise to deliver $15.8 billion in debt relief to more than 6.3 million low- and moderate-income residents.
• Already, 22 of these programs have abolished nearly $11 billion worth of medical debt, directly benefiting over 6 million residents.

Since our last update in September, North Carolina’s groundbreaking program announced initial outcomes. As former North Carolina Secretary of Health and Human Services Kody Kinsley described in our December 2025 webinar, the state passed bipartisan legislation in 2023 requiring hospitals to adopt a set of debt mitigation practices as a condition for receiving enhanced Medicaid payments. All 99 acute care hospitals signed on to the three-pronged initiative to forgive old debts, expand access to financial assistance to prevent new debt, and curb aggressive collection practices. On October 13, Governor Stein announced that the program had relieved $6.5 billion in debt for 2.5 million residents—exceeding their initial goal of abolishing $4 billion in debt for 2 million people. 

In addition, New York City announced additional relief. On October 22, New York City Mayor Adams announced that its program—the largest municipal effort in the country—has cancelled nearly $135 million in medical debt for over 75,000 people.

Explore the map below to learn about each effort, and find our 2024 analysis here. You can also read our policy brief and case studies of medical debt cancellation efforts in Toledo and Columbus and watch our medical debt webinars.

* Cook County subsequently reduced this allocation to $9 million, as reflected in the map below.