Emergency Care Rights
Written in plain language for general understanding. This is educational content, not legal advice. Based on federal statutes and official sources.
What is this right?
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that requires every hospital with an emergency department that participates in Medicare to provide emergency care to anyone who comes through the door — regardless of their ability to pay, insurance status, citizenship, or any other factor.
Under EMTALA, the hospital must provide a medical screening examination to determine if you have an emergency medical condition. If you do, the hospital must stabilize your condition before discharging or transferring you. Hospitals that violate EMTALA face civil monetary penalties of up to $133,420 per violation (inflation-adjusted), and individual physicians can also be fined and excluded from Medicare.
When does it apply?
This right applies when:
- You go to a hospital emergency department — regardless of whether you have insurance, money, or identification
- You believe you are having a medical emergency (severe pain, difficulty breathing, chest pain, active labor, psychiatric crisis, etc.)
- A hospital tries to turn you away, asks about your ability to pay before screening you, or transfers you before stabilizing your condition
- You are in active labor — hospitals must deliver the baby and stabilize both mother and child
Common misconceptions:
- “The ER can refuse to see me if I don't have insurance” — Absolutely not. EMTALA requires screening and stabilization regardless of insurance or payment ability. The hospital can bill you afterward, but they cannot refuse to see you.
- “EMTALA means free healthcare” — EMTALA requires emergency screening and stabilization, not free care. You may still receive a bill after treatment. However, you cannot be turned away for inability to pay.
- “EMTALA covers all hospitals” — It applies only to hospitals that have emergency departments and participate in Medicare. This covers the vast majority of hospitals, but some small facilities and urgent care centers may not be covered.
- “They can transfer me to another hospital because I can't pay” — A hospital cannot transfer you until your condition is stabilized, unless you request the transfer or a physician certifies that the benefits of transfer outweigh the risks. This is called the anti-dumping provision.
What should you do?
Step 1: Go to the emergency room if you believe you have a medical emergency. You do not need insurance, ID, or money. Tell the triage staff your symptoms clearly.
Step 2: If staff asks about your insurance or ability to pay before examining you, say: “I need a medical screening examination. I understand I have a right to be screened under EMTALA.” The hospital must screen you before discussing payment.
Step 3: If the hospital tries to transfer you before stabilizing your condition, ask why and whether the transfer is medically necessary. You have the right to refuse a transfer. If you consent, the hospital must ensure the receiving facility has agreed to accept you and has the capacity to treat you.
Step 4: If you believe a hospital violated EMTALA, file a complaint with CMS at cms.gov or call 1-800-633-4227 (1-800-MEDICARE). You can also file a complaint with your state health department.
Step 5: You may have the right to sue the hospital under EMTALA's private right of action (42 U.S.C. § 1395dd(d)(2)). Contact a medical malpractice or patients' rights attorney. The statute of limitations is typically 2 years from the date of the violation.
What should you NOT do?
Don't leave the ER before being screened. If you walked in with an emergency complaint, do not leave against medical advice without being screened. If the wait is long, tell staff your symptoms are getting worse.
Don't let billing questions delay your care. The hospital can ask about insurance for record-keeping, but they cannot delay your screening or treatment because of billing. If you feel pressured, remind staff of your EMTALA rights.
Don't agree to a transfer you're uncomfortable with. If the hospital wants to transfer you before your condition is stable, you can refuse. If you do agree, make sure the receiving hospital has accepted you and can treat your condition.
Don't assume EMTALA covers follow-up care. EMTALA requires screening and stabilization of emergency conditions. Once you are stabilized and discharged, the hospital is not required to provide ongoing treatment under EMTALA. However, ask about financial assistance, charity care, and follow-up resources before you leave.
How Texas differs from federal law
Texas relies primarily on federal EMTALA for emergency care protections, with some additional state rules:
- Texas Health & Safety Code § 773 (Emergency Health Care Act): Governs emergency medical services (EMS) and requires that emergency care be provided without regard to the patient's ability to pay. Provides liability protections for healthcare providers who render emergency care in good faith.
- Texas "prudent layperson" standard: Texas Insurance Code § 1301.155 requires health plans to cover emergency care based on the presenting symptoms, not the final diagnosis, using the prudent layperson standard.
- Texas Medicaid emergency coverage: Because Texas has not expanded Medicaid under the ACA, many low-income adults do not have regular Medicaid coverage. However, Emergency Medicaid covers emergency conditions for people who meet income requirements but are excluded from regular Medicaid.
- Trauma center requirements: Texas Health & Safety Code Chapter 773 establishes a statewide trauma system. Designated trauma centers must meet specific staffing and equipment requirements to ensure emergency patients receive appropriate care.
- Limited state enforcement: Texas relies heavily on federal CMS enforcement of EMTALA. State-level enforcement of emergency care requirements is handled by the Texas Health and Human Services Commission and the Texas Medical Board.
Additional Steps in Texas
File a complaint with CMS at 1-800-633-4227 (1-800-MEDICARE). For state-level complaints, contact the Texas Health and Human Services Commission at hhs.texas.gov or call (888) 973-0022. For insurance disputes about emergency coverage, contact the Texas Department of Insurance at tdi.texas.gov or call (800) 252-3439.
Relevant Law: Texas Health & Safety Code Chapter 773 (Emergency Health Care Act), Texas Insurance Code § 1301.155 (prudent layperson standard), Texas Insurance Code § 1467 (balance billing in emergencies), Federal EMTALA, 42 U.S.C. § 1395dd
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