A hospital can refuse service in some situations but not in others, and the dividing line is whether you have a medical emergency. Under federal law, any hospital with an emergency department that takes Medicare must screen and stabilize anyone who arrives with an emergency, no matter their insurance or ability to pay. For routine, elective, or scheduled care, hospitals have far more freedom to say no.
When a Hospital Cannot Refuse You
The Emergency Medical Treatment and Active Labor Act, known as EMTALA, is the 1986 federal law that stops hospitals from turning away emergency patients. Congress passed it to end “patient dumping,” the practice of shipping uninsured patients to public hospitals without checking whether they were in danger. It applies to virtually every hospital in the country with an emergency department, because nearly all of them participate in Medicare.
EMTALA imposes three duties the moment you show up at an emergency department asking for care:
- The hospital must give you a medical screening exam thorough enough to determine whether you have an emergency medical condition. It cannot delay that screening to ask about insurance, run a credit check, or verify your ability to pay.1Office of the Law Revision Counsel. 42 US Code 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor
- If the screening finds an emergency, the hospital must provide whatever treatment is needed to stabilize you, using the staff and resources it has on hand.
- If the hospital cannot stabilize you, it must arrange a proper transfer. A physician has to certify in writing that the benefits of transfer outweigh the risks, the receiving hospital must accept you, and your medical records travel with you.2Centers for Medicare & Medicaid Services. Certification and Compliance For The Emergency Medical Treatment and Labor Act (EMTALA)
Hospitals also have to keep a list of on-call physicians who can respond after the initial screening to help stabilize patients. If an on-call doctor refuses to come in, the hospital still owes you stabilization or a proper transfer, and the doctor who refused can be penalized personally.
EMTALA reaches beyond the main emergency room. Federal regulations treat any hospital department as a “dedicated emergency department” if the state licenses it as an emergency room, if it holds itself out to the public as a place for emergency care, or if at least one-third of its visits in the prior year were for urgent conditions.3Centers for Medicare & Medicaid Services. Appendix V – Interpretive Guidelines – Emergency Medical Treatment and Labor Act A hospital-owned urgent care center that regularly handles emergencies can qualify. Off-campus hospital facilities that meet none of those three tests are not covered.
Every hospital with an emergency department must post signs in the entrance, admitting area, waiting room, and treatment areas explaining your right to a screening and stabilizing treatment regardless of ability to pay. The signs must be in language the community can understand and must state whether the hospital participates in Medicaid.4Centers for Medicare & Medicaid Services. Emergency Medical Treatment and Labor Act
What Counts as an Emergency
EMTALA only protects you when an emergency medical condition exists. The statute defines that as symptoms severe enough that, without immediate care, your health could be in serious jeopardy, a bodily organ could be seriously impaired, or bodily functions could be seriously disrupted.5Legal Information Institute. 42 USC 1395dd(e)(1) – Emergency Medical Condition In everyday terms, that covers chest pain, severe bleeding, trouble breathing, major injuries, and similar crises.
Psychiatric emergencies count too. If you arrive expressing suicidal or homicidal thoughts and are determined to be a danger to yourself or others, the hospital owes you the same screening and stabilization as any other emergency patient.
Pregnancy gets its own rule. An emergency exists when a pregnant patient is having contractions and there is not enough time to transfer safely before delivery, or when transfer could threaten the health of the mother or child.
The hospital’s emergency duty lasts until you are “stabilized,” meaning your condition is unlikely to get materially worse from a transfer. For a patient in active labor, stabilization means delivery of the baby and placenta. Once you’re stabilized, EMTALA no longer requires continued care, though the hospital’s own policies and other laws may.
When a Hospital Can Legally Refuse Care
Outside of emergencies, hospitals can decline to treat you for ordinary business reasons. Common grounds include:
- You cannot pay, lack insurance, or have outstanding unpaid bills at the hospital.
- The hospital does not have the specialists, equipment, or capacity to handle your condition. A facility that does not perform a particular surgery is not required to start.
- The care you’re seeking is elective or scheduled, not urgent.
Federal conscience laws also let hospitals and clinicians refuse to participate in specific procedures on religious or moral grounds. The Weldon and Coats-Snowe Amendments protect healthcare entities that decline to provide, pay for, or refer for abortions, and federal regulations under 45 CFR Part 88 extend similar protections for sterilization, assisted suicide, and other procedures a hospital objects to on institutional beliefs.6U.S. Department of Health and Human Services. HHS Takes Comprehensive Action to Enforce Conscience Rights7eCFR. 45 CFR Part 88 – Ensuring That Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law A religiously affiliated hospital can refuse to perform an elective abortion or tubal ligation. Conscience protections do not override EMTALA, though. If you arrive at any hospital’s emergency department with a life-threatening condition, it still has to screen and stabilize you.
Reasons a Hospital Still Cannot Refuse You
Even for non-emergency care, a hospital cannot pick and choose patients on discriminatory grounds. Section 1557 of the Affordable Care Act bans discrimination in any healthcare program that receives federal funding, which reaches almost every hospital because almost every hospital accepts Medicare or Medicaid. It incorporates existing civil rights laws prohibiting discrimination based on race, color, national origin, sex, age, or disability.8Office of the Law Revision Counsel. 42 USC 18116 – Nondiscrimination
A hospital cannot turn you away because of your ethnicity, your age, or because you have a disability. It also has to take reasonable steps to give patients with limited English proficiency meaningful access to care, including qualified interpreters at no cost.9U.S. Department of Health and Human Services. Section 1557 – Protecting Individuals Against Sex Discrimination
Whether Section 1557’s ban on sex discrimination also covers sexual orientation and gender identity has been in flux. HHS issued a 2024 rule interpreting sex discrimination to include those categories, a federal court blocked the gender identity portions with a nationwide injunction, and in May 2025 HHS rescinded the guidance documents that had interpreted the law to cover sexual orientation and gender identity. Federal enforcement on those grounds is not currently happening, though the underlying legal questions are not settled.
What to Do If You’re Refused Care
If you believe a hospital wrongly denied you care, start with the hospital’s patient advocate. Many disputes get resolved at this level without escalating.
If that fails, two formal channels are open. For EMTALA violations, you can file a complaint with the Centers for Medicare and Medicaid Services through its online complaint form, or contact the State Survey Agency in the state where the hospital sits. CMS investigates, and the state agency usually handles the on-the-ground work.10Centers for Medicare & Medicaid Services. How to File an EMTALA Complaint For discrimination complaints under Section 1557, file with the HHS Office for Civil Rights. Each state also has its own hospital licensing agency that takes complaints about hospital conduct generally. Investigations can take weeks to several months.
You can also sue. EMTALA gives you a private right of action if you suffered personal harm as a direct result of a hospital violating the law. You can recover whatever personal injury damages are available under the law of the state where the hospital is located, and you have two years from the violation to file. EMTALA is not a malpractice claim, so you don’t have to prove the medical judgment was wrong, only that the hospital failed to screen, stabilize, or transfer you properly. The lawsuit is only against the hospital itself; individual doctors cannot be sued under the private right of action, though they can still face government penalties.
Hospitals that violate EMTALA face fines up to $50,000 per violation ($25,000 for hospitals with fewer than 100 beds) and, in serious cases, termination from Medicare. That last threat is what gives EMTALA its practical force, since losing Medicare would shut most hospitals down.1Office of the Law Revision Counsel. 42 US Code 1395dd – Examination and Treatment for Emergency Medical Conditions and Women in Labor Filing a complaint does not stop you from pursuing a private lawsuit at the same time.