Medical Debt Relief Initiative

Medical Debt Relief Initiative

Under the leadership of Cook County Board President Toni Preckwinkle, we’ve created the Cook County Medical Debt Relief Initiative (MDRI) with funding from the American Rescue Plan.

Across the country, people are swimming, and some are drowning, in medical debt. They have bills they can’t pay for many reasons. It may be they welcomed a new baby, received diagnostic tests after worrying news from their doctor, were rushed to an emergency room after an accident, or a myriad of other reasons. Today, medical debt is the number one reason for bankruptcy in the United States.

So, we decided to cancel as much of that debt as we can.

As the first local government to initiate an endeavor at this scale, Cook County is partnering with RIP Medical Debt - a national nonprofit that has erased debt for more than 3.6 million individuals and families so far. With just $12 million of our federal funds, they have the potential to negotiate the purchase of up to $1 billion in medical debt for Cook County residents and cancel it.

Those who are recipients of this program will no longer owe the specific medical debt(s) erased through MDRI and will not have to pay taxes on this one-time donation toward the purchase of their medical debt.


    Many patients with medical debt are uninsured or underinsured and are experiencing financial hardship. And Black and brown communities have been disproportionately impacted both financially and medically by COVID-19. Many people impacted by medical debt also lost their jobs during the pandemic and cannot afford to pay their medical bills. Medical debts impose psychological and  financial burdens and often deter people from seeking the health care services they need. In some circumstances, financially vulnerable people with medical debt feel lasting impacts due to reduced credit scores, wage garnishment, and property liens. With the additional burden of medical debt due to COVID-19, this debt relief program will potentially help hundreds of thousands of Cook County residents obtain financial stability, improve their health equity, and reduce stress.

    There is no way to apply for this program. RIP Medical Debt (RIPMD) performs an analysis of hospital debt portfolios and identifies qualifying accounts. All accounts that qualify (typically a significant percentage of accounts) will have their debt canceled and will be notified without taking any action. The MDRI can only cancel medical debts if hospitals and health systems located in Cook County sell or donate portfolios of medical debt to RIPMD.

    RIP Medical Debt will notify program recipients by mail if specific medical debts have been acquired and canceled under this program.  Program recipient letters will be signed by Cook County and RIP Medical Debt. Emails may also be used to send notifications.

    To fund this initiative, Cook County has committed $12 million in American Rescue Plan Act (ARPA) funds. Cook County is the first government agency to commit ARPA funds to medical debt relief. RIP Medical Debt will be a sub-recipient of these funds. RIP Medical Debt will also raise and/or use funds raised from its donor base for transactions with Cook County Health and other costs.

    Cook County is partnering with RIP Medical Debt (RIPMD, see, a national, independent 501(c)(3) charitable organization. RIPMD will be contacting hospitals and health systems located in Cook County and will ask them to sell or donate portfolios of medical debt, allowing MDRI to cancel debts for Cook County residents who qualify based on financial hardship and other criteria. The benefits of the MDRI program for patients, communities, and the hospitals themselves will be communicated during these interactions (see:

    RIPMD will also notify each qualifying patient that their specific medical debt (that RIPMD has been able to acquire) has been canceled, and that the debt cancelation does not lead to income tax liabilities for program recipients.

    RIPMD will share regular reports with Cook County regarding program progress and success throughout the three-year program duration.

    To be eligible for medical debt relief, MDRI program recipients must be:

    • residents of Cook County, and
    • have incomes up to 400% of current Federal Poverty Guidelines (FPG), or
    • have a medical debt that is 5% or more of their estimated household annual income.

    Hospitals in Cook County that provided services to these individuals also must sell or donate medical debts to RIP Medical Debt for purposes of cancelation. 

    Any hospital located in Cook County can partner with RIP Medical Debt and participate in the Medical Debt Relief Initiative. Cook County Health (CCH) plans to participate, but ARPA funds will not be used to acquire qualified medical debt from CCH. Instead, RIP Medical Debt will raise and/or use funds from its donor base to acquire CCH medical debt.

    Participating hospitals will enter into a Business Associate Agreement and a Non-Disclosure Agreement with RIP Medical Debt to protect the confidentiality of patient health information and other aspects of the transactions. The hospitals will send account data files to RIP Medical Debt for analysis. Once accounts for qualifying individuals have been identified, hospitals will make decisions on selling and/or donating accounts to RIPMD. Some hospitals may decide to make their participation public. Others may keep their participation confidential. Either way, patients will be notified of their debt relief.

    Professionals from RIP Medical Debt will share presentations and have discussions with hospitals and health systems about the benefits of the program to patients, communities, and to the hospitals themselves. Numerous hospital organizations across the United States have already recognized these benefits, have completed transactions with RIP Medical Debt and will provide references upon request.

    The MDRI program will focus on patient accounts that are anywhere from 18 months to 7+ years old (measured from the date services were provided) and after the billing and collections process have been completed. Importantly - even though collections activities may have stopped - the medical debts remain outstanding and continue to have negative economic and health impacts on Cook County residents. Overall, the impact on hospitals’ finances will be positive if they sell medical debt to RIPMD for cancelation.

    Agreements will include:

    • Business Associates Agreement
    • Non-Disclosure Agreement
    • Purchase or Donation Agreement (which specifies transaction terms and responsibilities for removing any adverse credit information that applies to the accounts)

    Hospitals will need to share patient account data files, following specifications as provided by RIPMD. The data includes patient demographic information, insurance status and payer, dates of service, balances still owed, and other information that identifies which individuals qualify for debt cancelation and which do not. All of the data sharing is HIPPA compliant.

    RIP Medical Debt offers a standard pricing model that proxies the fair market value of medical debt. Prices vary based on the age of the accounts. Older accounts are priced lower. Overall, qualified medical debt will be purchased for pennies on the dollar of the debt’s face value.