Discussion at recent Wayne County Commission meetings revealed that Henry Ford, one of three major hospital systems in Wayne County, is the only major hospital participating in the county’s debt relief program.
As of February, the county said Henry Ford has agreed to settle $17 million in debt.
The other two hospital systems — DMC and Corewell Health — aren’t participating. State reports show the two hospital systems combined account for 60% of emergency room admissions in Wayne County in 2022.
Undue has attempted to purchase accounts from Tenet, which owns DMC and is based in Dallas, Texas, but Wayne County officials said the healthcare system isn’t willing.
There are several reasons a provider wouldn’t want to work with the county to relieve a resident’s medical debt.
“It could be publicity reasons, it could be paperwork. They have to transfer the debt in a certain format so the data can be cleaned. It could be they don’t want bad publicity about how much debt they’re actually holding,” Chief Programs Officer for Wayne County’s Department of Health, Human & Veterans Services, Azia Harris-Martin, told the commission.
Additionally, Harris-Martin said it could be related to the amount of charity care a hospital is required to maintain its non-profit status, or providers expect to recover more money through their third-party collection agencies.
Commissioner Monique Baker McCormick (District 6) said she’s concerned that a neighborhood hospital, like DMC in Detroit, isn’t partnering with Undue.
“I know the type of people that go there really have a need to have their debt eliminated,” Baker McCormick said at a February committee meeting.
Whose benefiting? That’s a secret
Wayne County’s medical debt relief program has settled $43 million for 83,000 residents so far; however, HIPAA and other restrictions prevent the county from knowing which providers Undue is paying off or who it’s actually benefiting.
Aside from a ZIP code, the county has no idea who is benefiting from the debt relief unless they come forward and announce it, and the lack of transparency has been a concern for some commissioners.
Commissioner Allen Wilson (District 11) said the program is “cloaked in secrecy,” and he hasn’t heard from any of his constituents that they received a letter about their debt being settled. He represents Belleville, Flat Rock, Wayne, Sumpter Township, Van Buren Township, Huron Township, and Romulus.
During a February commission meeting, Commissioner Tim Killeen (District 1) referenced a report that contains information about the amount of debt settled for residents in each city. Almost $17 million has been settled on behalf of Detroit residents, Killeen said, and $1.5 million has been settled for Dearborn residents, and over $2 million for Taylor residents.
As of October last year, the maximum amount of debt settled for a single Wayne County resident was $160,000.
About the contract
In 2024, Wayne County approved a $5 million contract to settle up to $700 million in medical debt. The funding came from indigent healthcare funds and the American Rescue Plan Act funding. Around $500,000 has been spent so far.
Undue negotiates debt settlements directly with medical providers, so residents can’t opt in or apply for this program. To qualify, you have to be a Wayne County resident and have an income at or below 400% above the federal poverty level, which is around $103,000 for a family of three.
Hospitals offer assistance with medical bills
Most hospital systems offer financial assistance and other resources to lower-income patients. For example, Henry Ford offers up to 100% financial assistance for patients earning less than 250% above the federal level, which is $39,900 a year for an individual and $89,500 for a family of four.
A household whose income is less than 400% above the poverty level — $62,600 for an individual and $128,600 for a family of four — could qualify for up to 70% in financial assistance for their medical bills.
DMC and Corewell Health also offer similar financial assistance to their patients.
Potential changes in the future
County staff said in February that it expects recent changes to Medicaid and Medicare to increase the debt load residents carry, which would make programs like this even more beneficial and potentially prevent them from delaying their healthcare needs.
The county is also considering changes to the type of debt Undue could settle, such as ambulance services, as well as programmatic changes. For example, Los Angeles County brought together all of its hospital systems to review its charity care policies. A recent report shows hospitals in LA County provided $426.5 million in financial assistance in 2023.