U.S. hospitals reported $50.62 billion in bad debt from patients in their 2023 Medicare cost reports, and $30.18 billion in charity care. The two numbers are measured differently. Bad debt is counted at the hospital’s full billed charges. Charity care is converted to the hospital’s estimated cost of the care. Bad debt at cost would be much smaller than the billed-charge figure.
Bad debt is money hospitals billed patients, tried to collect and wrote off. Charity care is care the hospital decided up front, under its financial assistance policy, that the patient would not have to pay for. Both are part of what hospitals call uncompensated care, which they reported at $41.85 billion at cost.
Texas hospitals reported the most bad debt, $7.64 billion, followed by Florida ($4.90 billion), Georgia ($3.25 billion) and California ($3.21 billion).
What the figures measure
The data come from Worksheet S-10 of the cost reports that hospitals file with the Centers for Medicare & Medicaid Services (CMS) each year. Bad debt is reported at the hospital’s billed charges. Charity care is reported at the hospital’s charges multiplied by its cost-to-charge ratio, which estimates what the care cost to provide. Uncompensated care is charity care plus bad debt, both at estimated cost. The gap between uncompensated care and charity care, about $11.67 billion, gives a rough idea of bad debt at cost, against $50.62 billion at charges.
Hospitals report these numbers themselves. Policies differ: one hospital may classify an unpaid bill as charity care while another sends a similar bill to collections and writes it off as bad debt. That makes comparisons between individual hospitals rough.
The file covers 6,109 cost reports from 6,046 hospitals, with fiscal years that began between October 1, 2022 and September 30, 2023. Some hospitals filed more than one report for the year, for example after a change of ownership. We added those together, so each hospital appears once. 4,402 hospitals reported bad debt above zero and 4,217 reported charity care above zero.
By ownership
| Ownership | Hospitals | Bad debt (charges) | Charity care (cost) |
|---|---|---|---|
| Nonprofit | 3,034 | $30.56 billion | $17.23 billion |
| Government | 1,204 | $11.06 billion | $8.74 billion |
| For-profit | 1,808 | $9.00 billion | $4.21 billion |
Ownership groups combine the Type of Control codes in the cost report: nonprofit (church and other), for-profit (individual, corporation, partnership and other) and government (federal, state, county, city, hospital district and other).
By state
| State | Hospitals | Bad debt (charges) | Charity care (cost) | Uncompensated care (cost) |
|---|---|---|---|---|
| Texas | 575 | $7,639.4M | $6,894.0M | $8,240.1M |
| Florida | 263 | $4,903.1M | $3,090.1M | $3,898.4M |
| Georgia | 164 | $3,249.8M | $1,965.6M | $2,623.5M |
| California | 408 | $3,208.3M | $1,830.2M | $2,557.5M |
| North Carolina | 129 | $2,713.4M | $1,251.1M | $1,892.3M |
| Ohio | 229 | $1,699.1M | $756.6M | $1,152.5M |
| New York | 189 | $1,666.8M | $2,081.9M | $2,845.8M |
| South Carolina | 86 | $1,626.3M | $696.8M | $1,026.1M |
| Pennsylvania | 210 | $1,442.9M | $527.9M | $809.9M |
| New Jersey | 95 | $1,428.8M | $981.1M | $1,247.0M |
| Alabama | 112 | $1,425.0M | $427.8M | $720.8M |
| Illinois | 207 | $1,335.4M | $824.6M | $1,181.4M |
| Tennessee | 142 | $1,234.8M | $946.5M | $1,186.4M |
| Missouri | 134 | $1,074.5M | $608.8M | $881.0M |
| Michigan | 160 | $1,061.5M | $324.3M | $617.1M |
| Indiana | 169 | $1,059.7M | $421.8M | $665.5M |
| Mississippi | 112 | $1,022.2M | $306.7M | $528.9M |
| Virginia | 105 | $897.6M | $614.2M | $819.4M |
| Arizona | 125 | $860.1M | $408.3M | $559.2M |
| Nevada | 56 | $822.9M | $206.9M | $317.8M |
| Oklahoma | 150 | $756.6M | $314.1M | $482.0M |
| Kentucky | 118 | $729.4M | $188.0M | $361.0M |
| Louisiana | 205 | $722.5M | $285.1M | $459.4M |
| Wisconsin | 151 | $643.4M | $261.2M | $449.0M |
| Massachusetts | 98 | $616.7M | $356.1M | $573.6M |
| Colorado | 107 | $602.7M | $481.8M | $609.7M |
| Washington | 104 | $523.2M | $443.2M | $592.8M |
| Kansas | 150 | $513.5M | $280.3M | $417.7M |
| Arkansas | 109 | $449.5M | $212.3M | $321.4M |
| Connecticut | 40 | $428.4M | $168.8M | $283.8M |
| Utah | 58 | $421.0M | $250.1M | $369.3M |
| Minnesota | 138 | $415.4M | $246.5M | $395.2M |
| West Virginia | 60 | $309.4M | $78.4M | $173.4M |
| Iowa | 122 | $309.1M | $132.0M | $237.2M |
| Maine | 38 | $289.2M | $71.4M | $185.3M |
| Nebraska | 96 | $257.2M | $143.6M | $230.7M |
| Idaho | 51 | $251.0M | $101.0M | $192.0M |
| South Dakota | 61 | $209.4M | $90.9M | $151.3M |
| New Mexico | 54 | $208.1M | $127.0M | $184.4M |
| New Hampshire | 30 | $203.2M | $102.4M | $164.9M |
| Oregon | 62 | $186.8M | $236.7M | $302.7M |
| Wyoming | 29 | $145.4M | $32.7M | $91.5M |
| North Dakota | 49 | $135.3M | $50.8M | $103.0M |
| Delaware | 15 | $122.5M | $54.5M | $92.6M |
| Alaska | 24 | $121.6M | $39.6M | $98.3M |
| Rhode Island | 14 | $108.6M | $40.9M | $73.0M |
| District of Columbia | 12 | $96.2M | $39.5M | $61.3M |
| Montana | 64 | $92.2M | $51.9M | $97.0M |
| Vermont | 16 | $75.1M | $20.2M | $51.2M |
| Hawaii | 26 | $61.7M | $17.3M | $35.8M |
| Maryland | 58 | $50.6M | $94.6M | $126.0M |
50 states and D.C., by the state code in the cost report. Hospitals with other codes (GU, MP, PR, VI) are in the hospital CSV but not in this table. Bad debt is at billed charges; charity care and uncompensated care are at estimated cost.
Hospitals with the most bad debt
| Hospital (as named in the cost report) | State | Ownership | Bad debt (charges) | Charity care (cost) |
|---|---|---|---|---|
| DALLAS CO. HOSP. DIST. | TX | Government | $379.8M | $714.3M |
| SOUTH TEXAS HEALTH SYSTEM | TX | For-profit | $373.6M | $33.4M |
| JACKSON MEMORIAL | FL | Government | $329.5M | $156.8M |
| GRADY MEMORIAL HOSPITAL | GA | Government | $308.6M | $270.7M |
| UNIVERSITY OF ALABAMA HOSPITAL | AL | Government | $270.2M | $111.9M |
| BAPTIST HEALTH SYSTEM | TX | For-profit | $245.6M | $67.1M |
| MEMORIAL HERMANN HOSPITAL SYS | TX | Nonprofit | $223.7M | $187.2M |
| HUNTSVILLE HOSPITAL | AL | Government | $206.6M | $23.6M |
| CAROLINAS MEDICAL CENTER | NC | Government | $190.3M | $86.5M |
| NORTHSIDE HOSPITAL – GWINNETT | GA | Nonprofit | $172.8M | $65.4M |
| ADVENTHEALTH ORLANDO | FL | Nonprofit | $171.4M | $214.5M |
| TALLAHASSEE MEMORIAL HOSPITAL | FL | Nonprofit | $164.5M | $16.3M |
| HENDRICK MEDICAL CENTER | TX | Nonprofit | $152.7M | $23.7M |
| SARASOTA MEMORIAL HOSPITAL | FL | Government | $150.1M | $13.3M |
| SPARTANBURG REGIONAL MEDICAL CENTER | SC | Government | $145.8M | $42.9M |
| UNIVERSITY HEALTH SYSTEM | TX | Government | $142.6M | $312.4M |
| NORTH CAROLINA BAPTIST HOSPITAL | NC | Nonprofit | $142.4M | $40.6M |
| TX HLTH HARRIS METHODIST HOSPITAL | TX | Nonprofit | $137.4M | $77.8M |
| METHODIST HOSPITAL | TX | For-profit | $136.3M | $152.4M |
| NORTHWEST TEXAS HOSPITAL | TX | For-profit | $129.1M | $24.2M |
| BAYLOR UNIVERSITY MEDICAL CTR | TX | Nonprofit | $128.4M | $88.7M |
| TCHD D/B/A JPS HEALTH NETWORK | TX | Government | $126.2M | $356.7M |
| BAPTIST MEDICAL CENTER | FL | Nonprofit | $126.2M | $52.6M |
| UH – UNIVERSITY HOSPITAL | NJ | Government | $125.8M | $69.1M |
| MEMORIAL HERMANN TEXAS MEDICAL CNTR | TX | Nonprofit | $124.4M | $123.6M |
The 25 largest by reported bad debt. Large public and safety-net hospitals rank high partly because they treat many uninsured and underinsured patients, and partly because bad debt is counted at charges, which vary widely between hospitals. The CSV lists all 6,046 hospitals, with net patient revenue for context.
Source
Centers for Medicare & Medicaid Services, Hospital Provider Cost Report, 2023 final data file (data.cms.gov), downloaded October 25, 2026, and the CMS data dictionary for Worksheet S-10. U.S. government data in the public domain. Totals by state and ownership, and the combining of multiple reports per hospital, are our calculations. Our tables are available under CC BY 4.0. Credit "My Credit Guide (mycreditguide.org)".
Steven Reynolds, "Hospital Bad Debt and Charity Care by State," My Credit Guide, October 25, 2026, https://mycreditguide.org/data/hospital-bad-debt-charity-care/.