Revenue Cycle & Medical Debt
The hospital revenue cycle — from patient visit to payment collection — reveals where Americans struggle most to pay for care. Medical debt is the clearest signal: it represents accounts receivable that may never be collected. This map shows the share of adults carrying medical debt by state, exposing the geographic concentration of unpaid medical bills and the regions where the revenue cycle breaks down.
The National Picture
Medical Debt by State
Share of adults with more than $250 in medical debt, per KFF's analysis of Census SIPP data (2019–2021). States in the darkest red have the highest prevalence — meaning the largest pool of uncollected accounts receivable and the longest effective time-to-pay. Hover any state for its percentage. States marked "verified" come directly from KFF; others are estimated from regional patterns (see methodology below).
Highest Medical Debt Burden
South Dakota leads the nation at 17.7% — nearly 1 in 5 adults. The top 5 states are all in the South or Great Plains, clustering in states that historically did not expand Medicaid.
Lowest Medical Debt Burden
Hawaii (2.3%) and D.C. (2.7%) have the lowest rates. High-income states with near-universal insurance coverage and strong Medicaid programs keep medical debt rare — their revenue cycles collect faster and more reliably.
How Long Does It Take to Pay?
Days in Accounts Receivable (A/R days) measures the average time from billing to collection. The industry benchmark is 40–45 days, but the real story is what happens after that window: accounts past 90 days become "aged receivable," and many are ultimately written off or sent to collections — becoming medical debt.
By Census Region
Highest — non-expansion states cluster here
Above national average
Lowest — strong coverage, high income
Lowest — expanded Medicaid, high income
Rural vs. Metro
Collections average $5,764 recent / $15,445 total
Collections average $2,469 recent / $7,871 total
Rural households face collection amounts 3× higher than metro households — $15,445 vs. $7,871 in total estimated collections. The revenue cycle in rural areas is fundamentally broken: patients can't pay, hospitals can't collect, and both sides absorb the loss.
Methodology: State-level percentages come from KFF's analysis of Census Bureau SIPP data (2019–2021 pooled), published February 2024. KFF explicitly reported values for 7 states (South Dakota 17.7%, Mississippi 15.2%, North Carolina 13.4%, West Virginia 13.3%, Georgia 12.7%, Hawaii 2.3%, D.C. 2.7%). The remaining states are assigned to KFF's 5 categories based on regional averages (South 10%, Midwest 9%, Northeast 6%, West 6%) adjusted for Medicaid expansion status, rurality, and poverty rate. These estimates are approximate and should not be treated as precise figures — they reflect the geographic pattern KFF documented, not exact state-level measurements.
The Urban Institute's Credit Bureau Panel provides complementary data on medical debt in collections at the county and state level (2011–2023), available as a downloadable dataset. CFPB data tracks medical debt on credit reports, which declined from $88B (2021) to $49B (2022) after credit reporting changes removed debts under $500.
Data Sources & Further Reading
KFF analysis of Census SIPP data (2019–2021); state-level medical debt prevalence by % of adults.
County, state, and national medical debt in collections from the Urban Institute Credit Bureau Panel (2011–2023).
CFPB research on medical collections on consumer credit records; $88B → $49B after reporting changes.
2024 survey: 36% of US households have medical debt; rural collections 3× higher than metro.
Industry benchmarks for days in accounts receivable and aged A/R in hospital revenue cycles.
CMS HCRIS cost report data including hospital accounts receivable and days in A/R.
Disclaimer: For educational and informational purposes only. This dashboard aggregates publicly available data from IRS Form 990 filings and third-party sources; figures may be incomplete, estimated, or out of date. Nothing here constitutes legal, financial, tax, or medical advice, or an endorsement or judgment of any organization or individual. Always verify with official filings and qualified professionals before relying on any figure.