Updated October 5, 2026: corrected where the state medical debt laws stand in court, added the August 2026 federal ruling on Texas's law and the District of Columbia's new law, and tightened how each scoring model treats medical collections.

Somewhere in 2025, a lot of people absorbed the headline "medical debt is coming off credit reports" and stopped paying attention. Here's how that goes wrong: a hospital bill goes to collections, the borrower assumes it can't show up anymore, and it's still sitting on the report a year later, dragging the score down.

Here's what actually happened, what still reports in 2026, and why the details matter more than the headline ever did.

The Federal Rule Is Dead

In January 2025, the CFPB issued a rule that would have barred the credit bureaus from including medical debt on credit reports and barred lenders from considering it. That rule is gone. Its effective date was put on hold while the industry challenged it in court, and on July 11, 2025, a federal court in Texas vacated it.

So if you've been assuming a federal law has your back on medical collections, it doesn't. What's protecting you instead is voluntary: rules Equifax, Experian and TransUnion set for themselves in 2022 and 2023. Voluntary is the key word. These are business decisions by Equifax, Experian, and TransUnion, not statutes, and the bureaus could change them.

What the Bureau Policies Actually Cover

Under the current voluntary policies:

  • Paid medical collections come off entirely. Not updated to "paid." Removed. That's the opposite of how most collections work, where paying usually leaves a paid collection on the file.
  • Medical collections under $500 don't report. That's measured by the balance when the collection was first reported, and it holds even if the debt is unpaid.
  • New medical collections wait a year. An unpaid medical debt isn't supposed to appear until it's been delinquent for a year, which gives you time to fight insurance billing errors before your credit gets involved.

Flip that around and you get the only medical debt that should show on a credit report today: an unpaid medical collection of $500 or more that has been delinquent for at least a year.

That's a much narrower category than most people fear, and a much bigger one than the "medical debt is gone" headlines suggested.

What Lenders See Depends on Which Score They Pull

Here's where your file gets complicated, because a medical collection doesn't hit every scoring model the same way.

VantageScore said in 2022 that VantageScore 3.0 and 4.0 no longer use medical collection data at all, regardless of the amount or the age of the collection. myFICO says unpaid medical collections over $500 still count in FICO Scores, but with less weight in FICO Score 9 and the FICO Score 10 suite than in older versions. FICO Score 8, which myFICO calls the version most widely used by lenders, is one of those older versions.

So the same $800 hospital collection can be invisible to VantageScore 4.0 and still counted by FICO 8. It matters for mortgages too: as of October 2026, lenders selling loans to Fannie Mae and Freddie Mac choose between Classic FICO, which is older still, and VantageScore 4.0. Here's which score a mortgage lender actually uses. Before you assume a medical collection doesn't matter, find out which score the lender pulls.

State Laws: A Patchwork, and an Honest Caveat

Fifteen states and the District of Columbia restrict medical debt on credit reports, according to the National Consumer Law Center (NCLC): California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Minnesota, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, and Washington. Nine of the state laws took effect in 2025 or on January 1, 2026, and D.C.'s took effect August 20, 2026. They don't all work the same way: some bar the bureaus from reporting medical debt, and some bar hospitals and collectors from sending it to the bureaus in the first place. If you live in one of these places, your protections may go further than the bureau policies.

Now the caveat, because I'd rather you hear it from me than get surprised later. The CFPB took a side in October 2025. Its interpretive rule, applicable October 28, 2025, says the Fair Credit Reporting Act generally preempts state laws covering broad areas of credit reporting, and these medical debt laws fall inside that. NCLC points out that, by the CFPB's own admission, that interpretive rule isn't legally binding and the question is one for the courts.

The courts have started answering it, one law at a time. On August 10, 2026, a federal court in Texas held in CDIA v. Paxton that the FCRA overrides a Texas rule that kept certain surprise out-of-network medical balances off credit reports. NCLC also describes a lawsuit the debt collection industry filed against Colorado's law, and a renewed preemption fight over Maine's law in federal court after Maine tightened it in 2025. That's two of the listed laws in court as of NCLC's September 2026 update. If your strategy depends on a state medical debt law, build in the possibility that the ground shifts.

Everywhere else, NCLC lists no state medical debt reporting law. Texas's narrow surprise-bill rule was the exception, and a court has now held it preempted. Outside those fifteen states and D.C., you're working with the bureau policies and nothing else.

What This Means for Your File

If you have medical debt showing on your report, the playbook is more favorable than for almost any other derogatory:

  1. Check the balance. A medical collection that was first reported under $500 and is still showing? That breaks the bureaus' own policy and is worth a challenge.
  2. Check the age. A medical collection that appeared less than a year after the bill went delinquent is reporting early. Same story.
  3. Check whether it's actually valid. Insurance was supposed to pay, the balance is wrong, or the account isn't yours? Dispute it. The bureau has to investigate.
  4. If it's valid, $500 or more, and over a year delinquent, paying it removes it. This is the opposite of a normal collection, where paying leaves a "paid collection" on the file for the rest of its seven years. With medical, payment is deletion.

That last point deserves repeating because it reverses the advice I give on nearly every other collection type. You'll hear "paying a collection won't help your score." For medical debt specifically, that advice is wrong. The account comes off.

Don't Guess Which Rules Apply to You

Between a vacated federal rule, voluntary bureau policies, state laws the CFPB now says are preempted, and scoring models that each treat medical debt differently, this is one of the most confusing corners of credit reporting in 2026. Here's how it goes wrong in practice: insurance pays its share months after the bill went to collections, and nobody updates the balance. Or the collection gets paid and keeps reporting, even though paid medical collections aren't supposed to appear at all.

If you're already working with me, text me at 1-877-892-6691 before you pay a medical collection or apply for anything new. If a medical collection is sitting on your report and we haven't met, grab a spot on my calendar for a free consultation. I'll tell you whether it should even be there, and if it is, the order I'd handle it in.