Why Should Delaware Care?
Healthcare in Delaware is costly not only for patients, but also state taxpayers. This year, lawmakers took aim at those costs with multiple bills targeting how patients are billed, and how high a hospital can charge for both inpatient and outpatient procedures.
Delaware healthcare faced a reckoning in 2026, as legislators approved a number of bills that could dramatically reshape access and the price of care for patients.
Proposals on how much hospitals can charge patients for both inpatient and outpatient services, broadening federally mandated free and reduced care requirements, as well as easing regulatory approvals for hospitals all passed the General Assembly and are headed to Gov. Matt Meyer’s desk to be considered, if they haven’t been signed already.
Lawmakers debated these changes as healthcare spending in Delaware has grown unchecked in recent years, and outside taxpayer injections helped to pay the medical debts of thousands of Delawareans, despite hospital policies that could have made those treatments free or discounted in the first place.
Additionally, Delaware is making legislative changes to create an onramp for hundreds of millions of federal dollars meant to bolster rural healthcare. Those funds were awarded to all 50 states to ease congressional lawmakers into voting to gut billions of dollars in Medicaid funding in 2025.
Here’s what to know about the most important healthcare bills that passed this year, and what they could mean for costs in the coming years.
Primary care reforms
One of this year’s most contested healthcare bills, introducing hospital price caps and deeper investments in primary care, led to fierce debate in the State Senate.
Senate Bill 1 aims to rein in healthcare costs to consumers, which have exploded in Delaware in recent years.
By capping how much a healthcare system can charge for services, while incentivizing investments in primary care, legislators hope to force a reset in how healthcare is approached in the state: If patients can be seen in low-cost primary care settings, they may avoid more costly emergency care later.
The challenge is that virtually all of Delaware’s healthcare services are tied up in just a few major hospital systems, whose budgets are largely dependent on sending patients through a variety of primary, specialty and surgical care.
Disapproval from the state’s hospital systems led to extended closed-door negotiations between lobbyists and legislators over amendments to the bill.
The bill’s prime sponsor, Senate Majority Leader Bryan Townsend (D-Newark), filed two substitute versions of his original bill — changing some of its most controversial provisions.
Those changes would delay the implementation of price caps on hospital procedures, limit some state oversight in setting those caps, and completely exempt some hospitals from the regulations altogether.
Lawmakers unanimously passed the amended bill and sent it to Gov. Matt Meyer’s desk early Wednesday morning.
Free and discounted care
Another bill filed in early May expands the pool of patients eligible to receive free and discounted care from the state’s nonprofit hospital systems.
Senate Bill 13, sponsored by Sen. Marie Pinkney (D-Bear), examines a program already required by the federal government for nonprofit hospitals to receive tax breaks.
Nonprofit hospitals are mandated by the Internal Revenue Service to provide a “community benefit” to earn their tax-exempt status. Historically, that benefit has been offering free or discounted care, sometimes called “charity care.”
The legislation comes months after a Spotlight Delaware investigation called into question the charity care practices at the state’s largest healthcare system, ChristianaCare.
The new legislative push also follows a separate effort last summer in which the state paid off medical debts for thousands of Delawareans, despite hospital charity care policies that could have mitigated those costs.
In October, Spotlight Delaware reported hospitals had to provide free or discounted care to patients living at or below 350% of the federal poverty line, or about $55,860 annually.
Under the new proposal, the state’s nonprofit hospitals would be required to provide free care to patients living below 300% of the federal poverty line, with large discounts for patients in higher percentage brackets.
- Below 300% of the FPL ($46,950 a year) – Full discount
- 300-350% of the FPL ($46,950 to $54,775 a year) – 75% discount
- 350-400% of the FPL ($54,775 to $62,600 a year) – 50% discount
Separately, the legislation allows people living at 500% of the federal poverty line — $78,250 a year — to seek out a 50% discount if billed expenses are greater than 10% of their income.
The bill also requires the Diamond State Hospital Cost Review Board, an embattled regulatory board, to establish rules surrounding what information hospitals are allowed to request when determining eligibility for free or discounted care.
It also says the board will establish those regulations “with input from the Delaware Healthcare Association,” the state’s hospital lobbying group.
Senate Bill 13 faced little resistance in the Delaware Senate, but almost all of the Republicans in the House of Representatives voted against the bill. Lawmakers sent the bill to Meyer’s desk on June 23.
Mental health insurance protections
Separately, lawmakers passed legislation that would ensure people in need of mental health and substance use treatment receive fair treatment from insurers, and that they are not denied care required for their recoveries.
Senate Bill 22, also introduced by Townsend, would bolster mental health and addiction treatment by requiring insurers to improve the number of providers in their networks. The bill also includes language hamstringing insurers’ ability to deny covering care.
Delaware’s proposal aims to strengthen what is called “mental health parity,” a federal rule created to ensure patients had equal access to mental health and medical services.
And while SB 22 looks to improve access to mental health treatment in the state, there are still questions about its impact on the quality of care. Delaware relies on inpatient facilities to fulfill many of the state’s most acute mental health needs.
But Spotlight Delaware has recently reported on two of the state’s largest inpatient mental health facilities, and how some patients felt they left treatment worse than when they entered.
SB 22 now sits on Meyer’s desk.
Hospital oversight board changes
Nearly two years after the state formed a hospital oversight board with the ability to modify and veto budgeted spending by private hospitals, lawmakers had to pass a bill repealing much of that board’s power.
Senate Bill 213 was introduced in late December as part of a proposed legal settlement between ChristianaCare and state officials. Lawmakers passed the bill in January and Meyer quickly signed it into law.
The settlement stems from a lawsuit filed by ChristianaCare in 2024 that challenged the state’s formation of the oversight board, also known as the Diamond State Hospital Cost Review Board.
As part of the settlement, ChristianaCare agreed to dismiss the case as long as the state removed the Diamond State Hospital Cost Review Board’s budget veto powers.
Before SB 213, the Diamond State Hospital Cost Review Board’s oversight would have followed a four-step process.
Hospitals would submit detailed financial documents, which board members would review. If they deemed hospital spending to be too large, they would put the facility on a “performance improvement plan.”
If a hospital failed to correct its overspending, the board could then modify or veto its budget.
Now that SB 213 has been signed into law, the board no longer has the power to modify or veto the budgets of hospitals they deem to be too extravagant.
Instead, the oversight board can require hospitals to follow compliance plans outlining how they intend to lower costs that are deemed to be too high.
The law also introduces “meaningful cost containment arrangement” plans, which are described as “contracts between hospitals and payers” meant to hold the hospitals responsible for controlling health care spending in a specific area.
Hospitals can enter these agreements and be exempt from compliance plans for one year, the law said. But it does not exempt them from the financial reporting requirements outlined in the law, like sharing budget information and labor costs.
Hospital approvals
House Bill 17 eases regulatory approvals for healthcare providers looking to expand their campuses or buy new medical equipment. It comes as other states have repealed this regulatory requirement, and the state agreed to reform its own process to receive hundreds of millions of dollars from the federal government.
The legislation updates the state’s certificate of public review program, in which an oversight board governs additions to Delaware’s health care ecosystem by requiring approval for equipment purchases and campus expansions.
Prior to HB 17, the Delaware Health Resources Board would field applications from the state’s health care providers and determine whether they can introduce new services or facilities into the state.
Under the new law, providers would still need to receive approvals from the Delaware Health Resources Board for equipment purchases and large capital projects that cost more than $5.8 million.
The new law also maintains regulations that require state approval when a hospital requests an increase in bed capacity greater than 10%.
The board is meant to act as a watchdog to ensure the state does not become oversaturated with one type of service, and to vet both programs and providers wishing to offer care in Delaware.
It has long been targeted by Republicans as an example of over-regulation that spurns free market investments in the health care sector. A dozen states, including Pennsylvania, have removed their certificate of need laws in recent decades.
In a letter signed by the entirety of Delaware’s legislature, lawmakers said they would “reform” the certificate of need process “in areas where current rules may limit access or innovation, particularly in rural and underserved regions.”
The letter came as the state began to pursue federal funds through the “Rural Health Transformation Program,” a new $50 billion nationwide program meant to bolster rural health care.
