The District of Columbia’s sweeping medical debt overhaul took effect last week, despite Mayor Muriel Bowser’s refusal to sign it.
Bowser returned Bill 26-0438, the Medical Debt Mitigation Amendment Act of 2026, to Council Chairman Phil Mendelson without her approval, laying out detailed objections.
Why the mayor balked: Bowser said she supports parts of the bill, including the ban on reporting medical debt to credit agencies, limits on predatory medical credit products, protections during insurance appeals, and the cap on interest. Her central concern was the mandate that facilities provide free care to patients at or below 200% of the federal poverty level and reduced-cost care up to 500%. She warned that removing existing guardrails on uncompensated care, combined with restrictions on collection tools such as wage garnishment and home liens, would render medical debt “effectively uncollectible” and could push some providers to cut services or leave the District. She also noted the requirements exceed those in neighboring Maryland and Virginia.
What it means for collectors: The core provisions flagged in earlier coverage remain intact. Providers and debt collectors cannot report medical debt to consumer reporting agencies. Collection cannot begin until 180 days after the first posted bill, with at least 90 days’ notice. Interest is capped at 3% annually. Property liens on a primary residence are barred, and wages cannot be garnished for households under 500% of poverty. Any debt sold to a collection entity must retain the patient’s payment plan terms, and hospital liens on injury recoveries are now capped at 33%.
One caveat on timing: While the act is legally in effect, its operative requirements apply six months after the fiscal impact is included in an approved budget and financial plan, pushing actual compliance obligations into 2027.
The bottom line:
