A proposed shared screening system aims to help hospitals identify patients who qualify for financial assistance before unaffordable bills accumulate.
In Los Angeles County, medical debt affected approximately 778,000 adults in 2024, totaling more than $2.8 billion, according to the Los Angeles County Department of Public Health. The burden falls disproportionately on families with children, lower-income households, and Latino, Black and multiracial adults.
County health officials and hospital partners are working on a system designed to help prevent some of that debt before patients receive bills they cannot afford. The idea is to help hospitals identify patients who may qualify for financial assistance, rather than rely on patients to find and complete an application themselves.
The proposed system could make assistance easier to access. But its impact will depend on how many hospitals use it, how accurately it identifies eligible patients and whether it can be sustained over time.
How the proposed system would work
Hospitals often have financial assistance programs for patients who cannot afford their medical bills. Yet patients may not know those programs exist, and the application process can be difficult to navigate.
A process called presumptive eligibility offers another approach. Instead of waiting for patients to apply, hospitals use available information to identify people who may qualify for free or discounted care.
Some hospitals already use electronic screening tools, but the systems can be expensive for individual institutions to implement. According to KFF Health’s October 8 report on the county initiative, only about one in five hospitals in Los Angeles County currently uses such systems.
The Hospital Association of Southern California, working with L.A. Care Health Plan and the county Department of Public Health, has been pursuing a shared portal that could make screening more accessible to participating hospitals. The association announced its request for proposals for the portal in November 2025.
L.A. Care committed $2 million toward setting up the system, KFF Health reported. The partners have discussed a target of getting it running by January 2027.
The proposal is intended to reduce costs and administrative work for hospitals while helping more eligible patients receive financial assistance. It is not, however, evidence that the system is already operating countywide or that every eligible patient will receive assistance automatically.
Several questions will determine whether the initiative makes a meaningful difference for families.
One is participation. Los Angeles County has 88 acute-care hospitals, but it remains unclear how many will ultimately use the shared system.
Long-term funding is another issue. The initial investment may help establish the portal, but maintaining it and expanding participation will require a sustainable funding arrangement.
Accuracy is also important. The system depends on information used to estimate or verify patients’ financial circumstances. The partners have been exploring ways to improve that information, including potential links to state income records.
California’s AB 1312, enacted in 2025, is scheduled to take effect July 1, 2027. It will require hospitals to proactively screen eligible patients for financial assistance and apply that assistance before billing, according to the county’s medical-debt policy information. The shared portal could help hospitals prepare, but its effectiveness will depend on how it works in practice.
The county also has a separate medical-debt relief initiative. In partnership with the nonprofit Undue Medical Debt, the program had erased more than $451 million in medical debt for over 220,000 Angelenos as of October 2026, according to the county’s program update. That effort addresses qualifying existing debt, while presumptive eligibility is intended to help prevent unaffordable bills from accumulating in the first place.
What patients can do now
Patients do not need to wait for the proposed portal to ask about financial assistance.
- Ask the hospital about its financial assistance policy. Request the policy and application, even if you have already received a bill.
- Ask whether you may qualify for free or discounted care. Eligibility rules vary, and you should not assume you earn too much or have the wrong type of insurance without checking.
- Keep your paperwork. Save bills, notices, applications and any communication with the hospital.
- Contact the county for guidance. The Los Angeles County medical-debt resource page provides information about financial assistance, debt relief and consumer protections.
Receiving a bill does not necessarily mean financial assistance is no longer an option. Patients should contact the hospital and ask what help remains available. For more information about affordable care options, read Parriva’s guide to what Californians can do if they cannot afford health insurance.
The key test for the proposed system is whether it reaches patients who would otherwise miss out on assistance. That means tracking how many hospitals participate, how many patients are screened, how much financial assistance is awarded and whether fewer families end up with unaffordable medical bills.
For families already struggling with healthcare costs, the promise is straightforward: identifying people who qualify for help before a bill arrives could spare them an avoidable financial burden. The wider issue of rising healthcare expenses is explored in Parriva’s report on why California healthcare costs are rising even as people use less care. Whether the county’s approach delivers on that promise will become clearer as the system develops and hospitals begin using it.
