SB 449 Michigan Senate · 2025-2026 Regular Session

Health facilities: hospitals; hospital financial assistance act; enact. Creates new act.

SB 449 requires Michigan hospitals to create and implement financial assistance programs for uninsured patients and those with high medical debt relative to income. Specifically, hospitals must offer up to 100% discounts for patients earning at or below 350% of federal poverty guidelines, base eligibility on objective income metrics, and publish program details clearly on bills, statements, and websites in plain language. Hospitals must also report annual data on program usage and debt relief to the state health department by 2027, with violations subject to $10,000 civil fines. The law directly affects uninsured patients and hospital financial operations, aiming to reduce barriers to care for low-income individuals.

Issues: ✓ Healthcare

Bill status passed 3 of 5 stages cleared

Introduction

Jun 2025

Committee Review

Jun 2026

Senate Passage

Mar 2026

House Passage

Governor

Introduced Jun 26, 2025 Last action Jun 17, 2026

Maddy AI version diff · 1 comparison

What changed between versions

Senate Introduced Bill → As Passed by the Senate · 6 edits · Mar 11, 2026

MODERATE

The bill was converted from a draft introduction into a formal Senate version, adding specific legal definitions for terms like 'Medicaid' and 'Medicare' to ensure clarity. The core policy requirements for hospitals to create financial assistance programs, including income thresholds and reporting deadlines, remained substantively unchanged.

Scope change

The bill's scope and applicability remain the same, targeting hospitals in Michigan to establish financial assistance programs for patients.

DEFINITION

Added precise legal definitions for 'Medicaid' and 'Medicare' to clarify which insurance programs are considered 'insured' under the act.

TECHNICAL

Added a new subsection requiring the department to make annual reports publicly accessible on its website.

Added a new section establishing a uniform process for hospitals to collect patient income information and defining patient non-compliance as an affirmative defense in legal actions.

Added a new section creating a 'medical debt relief fund' in the state treasury to receive civil fines collected from hospitals that violate the act.

Added a new section authorizing the department to promulgate rules to implement the act.

Removed original draft metadata, including the introduction date, sponsor names, and internal tracking codes.

Floor votes · Senate Mar 11, 2026

How they voted

34–2

Passed · 2 other

Total votes 38

Mar 11, 2026

D Democratic19

18 Yea 1

94% Yea

R Republican19

16 Yea 2 Nay 1

84% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Jun 17, 2026

Committee

referred to second reading

lower

Jun 17, 2026

Lower · Passed

reported with recommendation without amendment

lower

Mar 11, 2026

Committee

referred to Committee on Health Policy

lower

Mar 11, 2026

Introduced

received on 03/11/2026

lower

Mar 11, 2026

Upper · Passed

PASSED ROLL CALL # 24 YEAS 33 NAYS 2 EXCUSED 2 NOT VOTING 0

upper

Mar 10, 2026

Upper · Passed

REPORTED BY COMMITTEE OF THE WHOLE FAVORABLY WITHOUT AMENDMENT(S)

upper

Nov 13, 2025

Committee

REFERRED TO COMMITTEE OF THE WHOLE

upper

Nov 13, 2025

Upper · Passed

REPORTED FAVORABLY WITHOUT AMENDMENT 11/12/2025

upper

Jun 26, 2025

Committee

REFERRED TO COMMITTEE ON HEALTH POLICY

upper

Jun 26, 2025

Introduced

INTRODUCED BY SENATOR SARAH ANTHONY

upper

1 primary · 11 co-sponsors