If a letter shows up telling you your medical debt has been erased, your first instinct will probably be that it's a scam. In Rhode Island, it usually isn't. Since 2024, the Office of the General Treasurer has been quietly buying up and canceling medical debt for residents across the state, and the people it helps never applied for anything.
That surprises people, and it's the most misunderstood part of the program. There is no form. There is no phone number that gets you on a list. This guide explains how the program actually works, why most people who qualify still won't be helped, and — more importantly — what you can do about bills you're carrying right now.
How the Program Works
The General Assembly appropriated $1 million for medical debt forgiveness as part of the Fiscal Year 2025 budget. Treasury partnered with Undue Medical Debt, a national nonprofit built around one specific mechanism: buying medical debt in bulk for pennies on the dollar, then canceling it instead of collecting on it.
The leverage is real. Undue generally purchases roughly $100 of medical debt for every $1 it spends. A small appropriation buys a very large amount of relief — the program has erased more than $16.3 million in debt for thousands of Rhode Islanders as of announcements in July 2026.
The program is expected to run until the $1 million appropriation is fully spent.
Why You Cannot Apply
There is no application. Undue buys portfolios of qualifying debt from providers and secondary debt collectors. Nobody reviews individual requests, and no one at Treasury can add you to a list. If your debt is in a purchased portfolio and you meet the criteria, it gets canceled and you're told afterward.
Who Qualifies
Relief targets Rhode Islanders who meet either condition:
- Medical debt equal to 5% or more of estimated annual income, or
- Estimated annual income at or below 400% of the federal poverty line
Your credit isn't checked. You aren't asked to prove anything.
The Part Most Coverage Leaves Out
Meeting the income test is not enough. Three additional filters decide whether anything actually happens:
1. The debt has to be old enough. Qualifying debt must be in collections or have gone through a provider's standard collection efforts — which generally means it's at least one year old. New medical debt is unlikely to be covered. There is no upper age limit, so a bill from 2015 is as eligible as one from 2024.
2. The care has to have been medically necessary. Undue only abolishes debt from treatment files the provider deems medically necessary. That's a clinical determination made by health care professionals, not a policy category.
3. The provider has to be willing to sell. This is the big one. Relief is source-based, and participation is entirely optional for providers. Some hospitals negotiate. Some take a long time. Some won't sell debt at all. If your provider is in that last group, you can meet every eligibility rule and still never receive relief.
Treasury is candid that the process could take several years. That's not a reason to wait around — it's the reason the rest of this guide exists.
One thing that isn't a limit: there's no cap on how much relief a single person can receive. And debt held by out-of-state providers can sometimes qualify, particularly for care received in a neighboring state.
If You Get a Letter — and How to Spot a Fake
Beneficiaries are notified by mail with a letter from the Treasurer's office and Undue Medical Debt, stating the amount forgiven and who previously held the debt. It does not ask for payment, a Social Security number, a bank account, or a fee.
Treasury publishes a sample of the real letter on its Medical Debt Relief Program page. If something arrives and you're unsure, compare it against that sample — that's a far better test than anything else in this article.
Anything that asks you to pay to unlock debt relief is a scam. Treat all of these as red flags:
- A fee to "process," "unlock," or "expedite" your relief
- Requests for bank or Social Security numbers to "verify eligibility"
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- Pressure to act within 24 hours
- Anyone claiming they can add you to the state's list — nobody can
Verify through the official program contact, DebtReliefRI@treasury.ri.gov, or the Treasurer's office at 82 Smith Street in Providence. Never use a phone number or link printed in the suspicious message itself. If you've been targeted, here's how to report a scam in Rhode Island.
Forgiven debt handled this way is generally structured so it isn't treated as taxable income to you. That's not tax advice — if you get an unexpected tax form, ask a preparer.
What to Do About Bills You Have Right Now
The state program is a backstop, not a plan. These are the moves that actually work.
1. Ask for Charity Care Before You Pay Anything
Rhode Island has some of the strongest hospital free-care rules in the country, and most patients never hear about them. Hospitals generally provide free care to qualifying uninsured patients up to 200% of the federal poverty level, with discounted care on a sliding scale up to roughly 300% of FPL.
What to know:
- You request an application from the hospital's business office — they aren't required to offer it
- Expect to show Rhode Island residency, household size, and household income
- Most hospitals allow up to 240 days from your first billing statement to apply
- If denied, appeal — ask for a patient financial advocate
Charity care is per-hospital. Treated at two systems? Apply twice. Each hospital publishes its own financial assistance policy, so confirm current thresholds directly.
This matters doubly given the program's one-year rule: charity care is how you deal with a bill now, while the state program only ever reaches debt that's already aged into collections.
2. Check Whether You Should Have Been Covered
A surprising share of "medical debt" is an insurance problem in disguise. Before negotiating, confirm the claim went to the right place. If you were uninsured at the time of service, retroactive coverage is sometimes possible — Medicaid in particular has a limited look-back window. Start with our Rhode Island health insurance guide and the Rhode Island ACA marketplace explainer.
3. Itemize, Then Negotiate
Always request an itemized bill, not the summary. Duplicate charges, services never received, and miscoded procedures are common.
Then:
- Ask for the self-pay or cash price, often dramatically lower than billed
- Ask for a zero-interest payment plan — most RI systems offer one
- Get any agreement in writing before sending money
Never move medical debt onto a credit card or medical credit line. You'd be converting a debt with weak collection leverage and flexible terms into ordinary consumer debt with interest.
4. Know Your Credit Report Position
Medical debt is treated differently from other debt on credit reports, and the rules have shifted repeatedly — the three national bureaus removed paid and small-balance medical collections starting in 2023, and federal rulemaking since has been contested. Because this is genuinely in flux, pull your reports at AnnualCreditReport.com and see what's actually there. Dispute inaccuracies in writing.
5. Get Free Help
Rhode Island has real infrastructure for this, at no cost:
- RIPIN runs health insurance and consumer assistance programs that help with bills and coverage denials
- Rhode Island Legal Services and other providers handle debt collection defense — see Rhode Island legal aid resources
- RIDOH can point you toward charity care and appeals
- If ongoing care is the issue, Rhode Island free clinics stop new bills stacking on old ones
- When debt is genuinely unpayable, understand your options in our Rhode Island bankruptcy guide
6. If You're Sued, Respond
This is the most damaging mistake people make. If a collector files in Rhode Island District Court and you don't appear, you lose by default — and a default judgment opens the door to wage garnishment. Showing up changes outcomes far more often than people expect, even without a lawyer. Get free legal help first if you can.
Frequently Asked Questions
How do I apply for Rhode Island medical debt relief?
You can't, and that's by design. Undue Medical Debt buys qualifying debt in bulk and cancels it. There is no application, no waiting list, and nobody at Treasury can add you. Anyone who says otherwise is running a scam.
Who qualifies?
Rhode Islanders whose medical debt equals 5% or more of estimated annual income, or whose estimated annual income is at or below 400% of the federal poverty line. But qualifying on income alone isn't enough — the debt also has to be old enough, medically necessary, and held by a provider willing to sell it.
How old does the debt have to be?
Generally at least one year. Qualifying debt must be in collections or have gone through a provider's standard collection efforts, so new medical debt is unlikely to be covered. There's no upper age limit — decade-old debt is as eligible as recent debt.
Is there a limit on how much debt can be forgiven for one person?
No. There's no cap on individual relief under the program.
What if my medical debt is from a provider outside Rhode Island?
It may still qualify. The program prioritizes Rhode Island-based providers, but residents with debt from out-of-state providers can receive relief, particularly for care received in a neighboring state.
Will forgiven medical debt hurt my credit or count as income?
Relief is structured so it generally isn't treated as taxable income to you. If you receive an unexpected tax form, talk to a tax preparer. On credit, pull your reports at AnnualCreditReport.com and confirm what's actually listed rather than assuming.
How do I know the letter I received is real?
Real letters come by mail from the Treasurer's office and Undue Medical Debt, state the amount forgiven and who held the debt, and never ask for money or personal information. Treasury publishes a sample letter on its program page — compare yours against it, and verify through DebtReliefRI@treasury.ri.gov if you're unsure.
The Bottom Line
Rhode Island's medical debt relief program is real and has erased more than $16.3 million in debt. But it only reaches debt that's aged into collections, was medically necessary, and is held by a provider willing to sell it. You can't apply, nobody can add you, and plenty of people who qualify on paper will never get a letter.
So treat it as a bonus, not a plan. What you control is everything else: charity care before you pay, an itemized bill, the self-pay rate, keeping medical debt off your credit cards, and responding if you're sued. Every one of those is available today and costs nothing but phone calls. The hospital business office is the first call — it's usually worth more than the rest combined.
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