Charity Care vs Bad Debt at NYC Hospitals: What 34 Hospitals Reported to Medicare

Every hospital that takes Medicare files an annual cost report, and since 2010 the report has included a worksheet on uncompensated care, Worksheet S-10. It asks each hospital how much charity care it gave and how much bad debt it wrote off, and converts both from list-price charges to the hospital’s own cost. CMS publishes the reports as raw data. We pulled the latest complete file, matched each report to a hospital in the five boroughs, and compared the two numbers side by side.

Our comparison of hospital financial assistance policies shows what each hospital promises. This is what they reported giving.

Two kinds of unpaid bills

Charity care is care a hospital decides, under its financial assistance policy, not to charge for or to charge less for, because the patient cannot pay. In New York every hospital must offer it on the same floor: free care at or below 200% of the federal poverty level, capped charges up to 400%.

Bad debt is a bill the hospital expected to collect and later wrote off. It includes uninsured patients who never applied for assistance, and insured patients’ unpaid deductibles and coinsurance. A bill that ends as bad debt has usually been through statements and, often, a collection agency first.

The difference matters to patients. A hospital with high charity care and low bad debt is finding the people who qualify for help before their bills go to collection. A hospital whose bad debt runs higher than its charity care is writing off more as uncollectible than it is giving away up front.

Both figures here are at cost: the worksheet multiplies charges by the hospital’s cost-to-charge ratio, so a dollar of charity care and a dollar of bad debt are comparable across hospitals.

Public hospitals carry the load

The top ten are all NYC Health + Hospitals facilities. Queens Hospital Center spent 21.1% of its operating expenses on charity care, Elmhurst 20.2% and Metropolitan 19.8%. Even the lowest of the public hospitals, Jacobi, at 8.3%, gave more than twice the share of the highest private one.

In dollars, the largest charity care totals in the city were at NYU Langone Hospitals, $283.3 million, and at Bellevue, $238.7 million, followed by Elmhurst at $226.6 million. NYU Langone’s total is large because the hospital is large: it is 2.9% of its $9.84 billion in operating expenses.

The first private hospital on the list is SBH Health System in the Bronx, at 3.7%. The typical private nonprofit spent 1.3%, and the 23 together $739.5 million, about half of what the ten public hospitals gave.

Most of the city’s charity care, 83.7% of it, went to uninsured patients. The rest covered insured patients’ balances that hospitals forgave under their policies.

Where bad debt outweighs charity care

BronxCare Hospital Center reported $71.2 million in bad debt at cost against $12.8 million in charity care, a ratio of 5.6 times. Its bad debt equaled 7.2% of its operating expenses, the highest share in the city.

Four more hospitals wrote off more as bad debt than they gave as charity care. SBH Health System reported $22.5 million in bad debt and $21.2 million in charity care; St. John’s Episcopal Hospital South Shore in Far Rockaway, $3.0 million and $2.4 million. At SUNY Downstate, the state-run hospital in East Flatbush, bad debt was $7.6 million and charity care $0.4 million. New York Community Hospital of Brooklyn reported $3.8 million in bad debt and $25,207 in charity care. Jamaica Hospital was close to even: $19.9 million in bad debt and $20.8 million in charity care.

None of the ten NYC Health + Hospitals facilities reported more bad debt than charity care. Because they are large and serve many uninsured patients, they still carry most of the city’s bad debt, $308.2 million or 62.8% of it.

A high bad debt figure is not proof of anything on its own. Hospitals classify accounts differently, and a hospital whose patients are mostly insured will have more bad debt from unpaid deductibles. But it is the clearest public signal of how many bills end up in collection instead of in a financial assistance file.

All 34 hospitals

Latest Medicare cost report, sorted by charity care as a share of operating expenses. Dollar figures are at cost. ◆ marks the five hospitals where bad debt is larger than charity care.

Fiscal years differ: most private hospitals report the calendar year 2024; NYC Health + Hospitals reports July 2024 to June 2025, and NYU Langone September 2024 to August 2025. Several systems file one report for several campuses under one provider number, so the figures cover the whole provider number. Long Island Jewish Medical Center sits on the Queens–Nassau line; its cost report lists Queens County.

What this means for you

Apply for financial assistance before a bill goes to collection. Once an account is written off as bad debt, it has usually been through months of statements. Under New York law you can apply at any stage, and the hospital must accept the state’s uniform application:

• At or below 200% of the federal poverty level: nothing out of pocket.
• Up to 400%: charges capped at a share of what Medicaid would pay.
• No lawsuits against patients with income under 400% of the poverty level, and payment plans capped at 5% of monthly income.

What to say to the billing office:

“I’d like the financial assistance application, and I’m asking you to hold my account, and not send it to collection, while it’s decided. State law lets me apply at any stage.”

If your account is already with a collector, the same application still applies to the hospital’s bill. What collectors can and cannot do in New York.

Hospital-by-hospital help: BronxCare, NYC Health + Hospitals, SUNY Downstate, Montefiore, NYU Langone, NewYork-Presbyterian, Mount Sinai, Northwell, Maimonides, and any other hospital. If a hospital refuses an application or ignores its own policy, complain to the Attorney General’s Health Care Bureau at 1-800-428-9071.

Methodology

Data. Centers for Medicare & Medicaid Services, Hospital Cost Report Information System (HCRIS), form 2552-10, fiscal year 2024 file, with data files dated October 2, 2026, downloaded on October 16, 2026. The fiscal year 2024 file holds reports for fiscal years that began in the federal fiscal year 2024, which is why it includes years ending in 2024 and in 2025.

Hospitals. Acute care hospitals in the five boroughs listed in CMS’s Hospital General Information file, matched to the cost reports by CMS Certification Number, with the borough from each report’s county. 34 hospitals had a report. Memorial Sloan Kettering’s report has no Worksheet S-10 figures and is left out; VA hospitals, which do not file, and state psychiatric centers are also not included. Hospitals that report under another hospital’s number, such as the Montefiore and NewYork-Presbyterian campuses, are counted inside that number.

Measures. From Worksheet S-10 Part I, which covers the whole hospital complex: charity care is line 23, column 3, the cost of charity care for uninsured and insured patients net of partial payments; bad debt is line 29, the cost of non-Medicare and non-reimbursable Medicare bad debt; uncompensated care is line 30, their sum. Operating expenses are Worksheet G-3, line 4. Shares are each cost divided by operating expenses. “Typical” is the median across hospitals; group totals are sums. The reports are as filed or amended by the hospitals, and most are not yet final-settled by Medicare’s contractors; the figures can change.

Download: nyc-hospital-charity-care-bad-debt-hcris.csv, one row per hospital, with charity care for uninsured and insured patients separately, bad debt expense before the cost conversion, the Medicaid shortfall the hospitals reported and the cost-to-charge ratio, plus the headline figures. Free to reuse under CC BY 4.0. Credit: NYC Med News, “Charity Care vs Bad Debt at NYC Hospitals,” October 16, 2026, from CMS cost report data.