The District of Columbia’s Medical Debt Mitigation Amendment Act of 2026 is now law, even without the mayor’s blessing. According to a post by Accounts Recovery, Mayor Muriel Bowser returned Bill 26-0438 to Council Chairman Phil Mendelson unsigned, but the bill passed into law automatically upon her refusal to sign it.

The Mayor’s Objections

According to the post, Mayor Bowser expressed support for several provisions of the bill, including the prohibition on reporting medical debt to consumer reporting agencies, limits on predatory medical credit products, protections during insurance appeals, and an interest rate cap. Her core objection centered on the bill’s mandate that healthcare facilities provide free care to patients at or below 200% of the federal poverty level and reduced-cost care to patients up to 500% of the federal poverty level. She warned that combining those expanded charity care requirements with new restrictions on collection tools would render medical debt “effectively uncollectible,” potentially causing some providers to cut services or exit the District entirely. She also noted that the law’s requirements exceed those imposed on providers in neighboring Maryland and Virginia.

Key Provisions for Creditors and Collectors

Notwithstanding the mayor’s concerns, the law’s core provisions remain intact, including:

  • Credit Reporting Ban. Providers and debt collectors may not report medical debt to consumer reporting agencies.
  • Collection Delay. Collection activity cannot begin until 180 days after the first posted bill, with at least 90 days’ advance notice to the patient.
  • Interest Cap. Interest on medical debt is capped at 3% annually.
  • Lien and Garnishment Restrictions. Property liens on a primary residence are prohibited, and wage garnishment is barred for households at or below 500% of the federal poverty level.
  • Debt Sale Requirements. Any medical debt sold to a collection entity must retain the patient’s existing payment plan terms.
  • Hospital Lien Cap. Hospital liens on personal injury recoveries are capped at 33%.

Timing and Compliance

While the Act is legally in effect, its operative requirements do not kick in immediately. The substantive compliance obligations apply six months after the fiscal impact of the Act is incorporated into an approved D.C. budget and financial plan, pushing the practical compliance deadline into 2027.

Our Take

The District of Columbia joins a growing number of jurisdictions, including several states that have enacted similar medical debt credit reporting bans in recent years, that are fundamentally reshaping the medical debt collection landscape. All the while, we also are in the midst of such laws being challenged in multiple forums on preemption grounds, including the recent ruling from the U.S. District Court for the Western District of Texas holding that § 1681t(b)(1)(E) of the Fair Credit Reporting Act expressly preempts Texas Business & Commerce Code § 20.05(a)(5), which barred consumer reporting agencies from reporting certain out-of-network emergency medical debts. We will continue to monitor developments in medical debt regulation and provide updates as implementation guidance becomes available.