In the United States, health concerns that land someone in the hospital or require multiple visits to the doctor can be a taxing experience on emotional, logistical and financial fronts.

But for about 17% of Marylanders facing medical debt, these struggles get compounded, leading to additional stressors that can further impact health outcomes, particularly for Black families and patients, according to economic policy organizations.

“[Medical debt] really does impact everyone on some level. It doesn’t impact folks equally,” according to Berneta Haynes, senior attorney for National Consumer Law Center. “It does have a disparate impact based on race and income.

Haynes participated in a webinar hosted by Economic Action Maryland this month, aiming to shine a light on how medical debt disproportionately impacts communities of color.

Economic Action Maryland conducted a poll in October 2020 surveying Marylanders, and found that 12% of survey participants had a medical debt they could not pay. In addition, 26% of participants stated that they would be unable to pay for an unexpected $500 medical bill out of pocket.

Marceline White, executive director of the organization, said that the average costs of a four-day hospital stay is about $14,200.

“It’s expensive to go to the hospital,” she said during the webinar.

White explained that when people have medical debt hanging over them, problems can compound and result in credit issues and even lead into other health concerns as patients delay medical care.

“We saw this particularly during the COVID pandemic. People did not go to hospitals to get treatment because they were afraid. They already had a medical bill they already medical debt,” she said.

Haynes, with the National Consumer Law Center, echoed White’s concern about people delaying hospital visits during an interview with Maryland Matters.

“People start making risky decisions related to their health,” Haynes said. “They start foregoing necessary health care visits that can then worsen whatever condition they may currently have — and snowball into more medical debt down the road.”

Which is a particular concern when it comes to the higher rate of Black families facing medical debt.

According to data from the Urban Institute, which tracks various forms of debt and how they impact Black communities, about 13% of communities of color in Maryland have medical debt, compared to 9% of white communities.

According to the most recent U.S. Census data from 2020, 48.7% percent of Marylanders are white and 29.5% are Black. About 21.9% of Marylanders are some other race or a mix of two races.

Another factor leading to medical debt can be whether a patient has insurance or not. Haynes explained that Black communities tend to have higher rates of various chronic illnesses but also may not have insurance, which can lead to medical debt

“Even in the states that have expanded Medicaid, like Maryland, we still see that Black folks are more likely to be uninsured, more likely to lack access to hospitals and health care providers nearby, so they have to go to providers that are out of network,” she said. “More likely to see higher maternal fatality rates. All kinds of cancers are highly concentrated in Black families. All of that makes Black people more likely to accrue medical debt than other groups.”

Both Haynes and White said Maryland’s efforts to reduce medical debt should be be a role model for other states.

The Medical Debt Protection Act, which took effect without being signed by former Gov. Larry Hogan (R) in 2021, issued a handful of protections for patients facing medical debt.

Under this law, hospitals are not permitted to request arrest warrants on patients if they are trying to collect medical debt.

“I don’t think it ever crosses people’s minds that a medical debt can lead to your arrest,” Haynes noted.

The 2021 law requires hospitals to check a patient’s eligibility for financial assistance before filing a lawsuit. In addition, hospitals are required to refund patients if they are deemed eligible for financial assistance within 240 days of billing.

“Maryland would be seen as one of the states that is doing the most,” White said. “But we still see, despite that effort, thousands and thousands of people falling through the cracks for a variety of reasons. And again, disproportionately affecting Black and Brown communities.”

Part of the issue to how patients get medical debt in the first place is the lack of knowledge that non-profit hospitals are required to provide financial assistance, also referred to as charity care, for low income people under the federal Affordable Care Act.

With charity care, hospitals may provide free or discounted services to eligible low-income patients who cannot afford services,

But hospitals may have different qualifications for who is considered “eligible” for financial assistance.

“That means from hospital to hospital, the threshold for when you qualify for financial assistance will differ. You may qualify for one hospital in the Baltimore area and not in another hospital in the Baltimore area,” according to Haynes.

For example, Lifebridge Health’s financial assistance policy says that it “provides hospice care at a discount to eligible patients of limited means whose household income is between 300% and 375% of the Federal Poverty Guidelines for the patient’s family size,” according to its website.

But Medstar’s financial assistance policy says that “partial financial assistance for medically necessary care provided to uninsured and underinsured patients with household income between 201% and 400% of the FPL.”

Haynes says that one of the most impactful way to address medical debt would be to set an income floor for all hospitals under the ACA. But she also urges lawmakers in Maryland and across the United States to consider policies that can specifically help with the inequity in medical debt that Black families and patients face.

“I think a little bit of both would be the right approach,” she said.

“But I think it’s also important for lawmakers to figure out how to prioritize relief for Black families…or at least be aware that the legislation that they are introducing may have a specific impact on Black families and Black folks,” she added.

By Danielle J. Brown

A year ago, a new three-digit phone line launched nationwide, making it easier for people facing a mental health crisis and other issues to find resources and support.

Since then, national data show that more people are reaching out to what’s called the 988 Suicide and Crisis Lifeline. Yet call counselors and call center managers in Maryland want more people to be aware of the line and how it can help.

The 988 Lifeline — previously called the National Suicide Prevention Lifeline — had been ten-digits long. But in 2020, a new federal law required the phone number to be changed to 988 and that it be designated as the national suicide and mental health crisis hotline.

Chris Niles, senior hotline counselor with the Baltimore Crisis Response, said that the three-digit number is easier to remember, especially when people are in crisis and may not be in the clearest mindset.

“When your house is on fire, you’re in a car accident, someone steals your purse, it’s real easy to remember ‘I call 911,’” Niles said. “But when you’re experiencing extreme depression or suicidal thoughts, grieving the loss of a loved one, memorizing an 800-number when you’re in that type of emotional distress is probably not the easiest thing.”

“So, when they established 988, they made it so much easier for people reach out and get the help that they need,” he said.

The 988 line has been active nationwide for a year as of July 16, and 26 states have passed laws and appropriated funds to support the line, according the National Academy for State Health Policy.

That includes Maryland. In the 2022 session, Gov. Larry Hogan (R) approved Senate Bill 241/House Bill 293, which established a fund for the program. In 2023, Gov. Wes Moore (D) approved Senate Bill 3/ House Bill 271, which carved out $12 million for the 988 fund in the 2025 budget.

In addition, the 988 line has a new LGBTQ+ pilot program that focuses on connecting that population to resources and counseling specific to their struggles.

The original number, 1-800-273-8255, “will always remain available to people in emotional distress or suicidal crisis,” according to the 988 Lifeline website.

In the year since the 988 line’s launch, Niles with the Baltimore Crisis Response has noticed an increase in callers who are looking for support while facing housing instability, as COVID-era federal support comes to an end even when many are still struggling to make ends meet.

Just last week, he spoke with an elderly woman who was recently evicted.

“Her story is pretty commonplace here. When the eviction restriction moratorium from the White House was lifted … she was one of many in Baltimore City that wasn’t able to pay. And the landlord ended up evicting once they were allowed to,” he said.

“And now she’s living, alternating between the street and a hotel. And so she was calling and asking for information on different shelter programs, different programs to help her get into an apartment and also local resources for food and whatnot,” he added.

Niles noted that people will call the 988 lines when they are in less dire situations as well.

Amid the COVID-19 pandemic, he noticed an increase in people calling to talk about their interpersonal relationships, with family members or with partners, as the pandemic led people to spend more time at home.

He also noted that some people will call if they have stress at work.

“They’ll ask ‘Is it okay that I’m calling? I’m not suicidal – I just had a really crap day at work and want someone to talk to.’ And we tell them ‘of course.’” Niles said.

Niles explained that the types of calls will determine what resources will be most helpful for the person in crisis. Many calls are just looking for information on resources that are available.

Others may need community intervention, he said, which is typically addressed by a mental health team sent out from a crisis center. Law enforcement is not usually involved unless it’s absolutely necessary.

According to national data from the federal Substance Abuse and Mental Health Services Administration, answered calls to the 988 line increased by 45% in May 2023 compared to May 2022, before the 988 Lifeline launched. Online chats for the crisis line saw an increase of 52% from May 2022 to May 2023.

But the largest percentage increase in people reaching out to the crisis line came in the form of text messages. From May 2022 through May 2023, the percentage of texts answered increased by 938%, according to SAMHSA data.

Dan Rabbit, policy director at Behavioral Health System Baltimore, which oversees the 988 and crisis services for the Central Maryland region, has seen similar increases locally.

“That explosion in text messages — not many people texted it before, so [it’s] starting from a lower number, but still — that little increase is astounding,” he said. “And that way of contacting 988 is more popular with younger people. So, it’s a sign that young people are hearing about this and are using our services to get the support they need.”

Rabbitt said that the 988 line has made a lot of progress in the year since it launched and he is excited to see how it will continue to “transform how Marylanders receive care for their mental health challenges.”

“988 counselors are here to help anyone, regardless of the intensity or the acuity of whatever is concerning them,” he said. “So there’s no wrong reason to call.”

By Danielle J. Brown

When Sara Rich came on board to lead the Choptank Community Health System in the summer of 2016, she and her board immediately started to work on a plan that would fundamentally change and improve the health care of the entire Mid-Shore. Despite the impact of COVID, Choptank has nonetheless moved forward on the nonprofit organization’s commitment to improve and expand affordable and accessible healthcare in the region.

Over the next few months, the Spy will be talking with Sara about Choptank’s increased support for local health needs and the advances they have made in Caroline, Dorchester, Kent, Queen Anne’s, and Talbot counties.

We begin with Chestertown the Kent County.

This video is approximately four minutes in length. For more information about Choptank Community Health System please go here.