RIP Medical Debt, a New York-based nonprofit that uses donated funds to pay off the nongovernmental-payer medical debts of financially burdened individuals, has announced an agreement with Ballad Health to eliminate medical debt totaling more than $277.9 million for about eighty-two thousand patients.

RIP Medical Debt will purchase the debt accounts directly from the not-for-profit health system serving twenty-nine counties of the Appalachian Highlands in Kentucky, North Carolina, Tennessee, and Virginia. The average per-capita income in the region is significantly lower than state and national averages, while the burden of disease is much higher.

While RIP previously acquired accounts from the secondary debt market, such as debt buyers and collection agencies, in July 2020 the Department of Health and Human Services Office of the Inspector General issued an advisory opinion allowing hospitals and physician groups to sell or donate debts directly to RIP for the purpose of abolishing a patient's liability under certain conditions. According to the organization, since its creation in 2014 RIP has acquired and abolished more than $4.5 billion in medical debt.

"Nearly everyone who will receive their debt abolishment through this collaboration with RIP Medical Debt qualifies for our updated charity care policy, but for various reasons they either did not qualify at the time or did not take advantage of it in prior years," said Anthony Keck, chief population health officer for Ballad Health. "By removing this burden of old debt, we hope to better engage with our patients, so they access care and other services when they need them without the fear of unmanageable expenses."