North Carolina has initiated a statewide agreement with hospitals to eliminate medical debt for approximately 2.5 million residents and implement measures to prevent future debt accumulation. All 99 hospitals in North Carolina committed to discontinuing collection on specific debts dating back to 2014. They also agreed to automatically provide care discounts for patients eligible for financial assistance, removing the application burden. For a family of four, an annual income below $96,000 qualifies for this assistance. The Undue Medical Debt charity collaborated with hospitals to identify eligible individuals, with one resident, Dawn Daly-Mack, reporting her $459 debt from a 2014 emergency room visit was cleared. The initiative was developed by Kody Kinsley, former North Carolina Secretary of Health. The plan involved linking additional Medicaid funding for hospitals to their participation in the debt relief effort, dating back to 2014, which was the earliest opportunity for the state to expand Medicaid. Medical debt is a national issue, impacting an estimated 1 in 12 Americans with a total of $220 billion. Other states have adopted various approaches: Arizona and New Jersey have utilized state funds for debt forgiveness. Oregon and Illinois conduct screenings for financial assistance eligibility. Colorado and New York have enacted bans on reporting medical debt to credit agencies; federal protections were recently reversed. Heather Howard, director of Princeton University's State Health and Value Strategies program, commented on the variability of protections across states and suggested that federal rules may be necessary for comprehensive impact. Potential Medicaid cuts and an increase in uninsured individuals could pose challenges for hospitals in maintaining these debt relief initiatives.