Yes, the Hill-Burton Act is still partially in effect. While the federal government stopped issuing new funding under the program decades ago, hundreds of hospitals and health facilities that received Hill-Burton money are still legally required to provide free or reduced-cost care to eligible patients. As of December 2024, 126 facilities across the country still carry active Hill-Burton obligations, and HRSA (the Health Resources and Services Administration) continues to oversee compliance.
What the Hill-Burton Act Actually Does
The Hill-Burton Act, passed in 1946, gave federal construction grants and loans to hospitals and other health facilities. In exchange for that money, facilities agreed to two key conditions: they had to serve their surrounding community regardless of a patient’s ability to pay, and they had to provide a certain amount of free or below-cost care to people who couldn’t afford it.
No new Hill-Burton funding has been awarded in years, but the obligations attached to that original funding don’t simply expire when the checks stop. The legal commitments run with the facility, not the funding cycle.
Why Some Obligations Are Permanent
How long a facility must provide free or reduced-cost care depends on which part of the law funded it. Facilities that received grants under Title VI of the Act carry an uncompensated care obligation lasting approximately 20 years from the date they received funds. Most of those 20-year windows have closed by now.
Facilities funded under Title XVI, however, are required to provide uncompensated care in perpetuity. That means forever. These are the facilities that still show up on HRSA’s active list, and they cannot shed this obligation simply because the program is old. As long as the facility operates, it owes free or reduced-cost care to qualifying patients.
Where Obligated Facilities Still Exist
The 126 facilities with active obligations are spread unevenly across the country. Sixteen states plus the District of Columbia have no obligated facilities at all: Alaska, Delaware, Indiana, Maryland, Minnesota, Nebraska, Nevada, North Dakota, Ohio, Rhode Island, South Dakota, Utah, Vermont, Wyoming, and all U.S. territories except Puerto Rico. If you live in one of those states, no nearby hospital carries a Hill-Burton obligation.
HRSA maintains a searchable list of all 126 obligated facilities on its website, organized by state. That’s the fastest way to check whether a hospital near you participates.
Who Qualifies for Free or Reduced-Cost Care
Eligibility is based on income. Each obligated facility sets its own thresholds within federal guidelines, and you’ll need to provide documentation like a recent pay stub to verify what you earn. If you’re applying for or have been denied Medicaid, Medicare, or another assistance program, a letter showing that approval or denial may also be required.
You can apply before receiving care, after receiving care, or even after a bill has already been sent to a collection agency. That last detail surprises most people: a bill in collections does not disqualify you. If the facility is obligated and you meet the income criteria, the program still applies.
How to Apply
The process starts at the facility itself, not through a government office or website. Contact the hospital’s admissions office or business office and ask for a Hill-Burton application along with the facility’s “Individual Notice,” which spells out exactly what services are covered and at what income levels.
Fill out the application, attach your income documentation, and return everything within a reasonable timeframe. The facility is then required to give you a written Determination of Eligibility that explains what free or reduced-cost services you’ll receive, or, if you’re denied, the specific reason why. If you fail to submit the required documents, the facility can deny your application on that basis alone, so gathering paperwork upfront saves time.
What Hill-Burton Does Not Cover
Hill-Burton obligations apply only to the specific facility that received federal funds. A hospital system with ten locations might have just one facility on the obligated list. The obligation also covers a defined amount of uncompensated care each year, not unlimited care. Once a facility meets its annual threshold, it has technically satisfied its requirement for that period, though in practice most obligated facilities continue accepting applications year-round.
The program also doesn’t override other billing. If you have insurance or qualify for Medicaid, those sources are expected to cover what they can. Hill-Burton fills the gap for people whose income is low enough that they still can’t afford care after other options are exhausted, or for people who have no coverage at all.