Orange County eliminates more than $472.5 million in medical debt for residents

The Orange County government has managed to wipe out more than $472.5 million in medical debt for over 310,000 local residents, in partnership with the nonprofit Undue Medical Debt.

The county initiative, approved by the Orange County Commission last August, was funded by federal relief funds allocated to the county during the COVID-19 pandemic under the Biden administration’s American Rescue Plan Act. All in all, this has cost the county just $3 million in the program’s budget, which was then leveraged by Undue Medical Debt to erase the debt for pennies on the dollar.

“This program is the latest countywide effort to improve the quality of life for our residents,” said Orange County Mayor Jerry Demings in a statement. “This collaboration with Undue Medical Debt has allowed our Board to efficiently maximize the impact of public funds, helping as many individuals as possible to become financially stable.”

The County Commission approved the use of up to $4.5 million in ARPA funds for this initiative last year, allowing Undue Medical Debt to work with the county to erase medical debt associated with the Orlando Health system, Advent Health, and third-party debt collection agencies.

The program did not accept applications. Instead, the nonprofit identified debt eligible for relief in partnership with healthcare providers and debt collectors. Debt was considered eligible for relief if the debt exceeded 5 percent of the individual’s total household income or if the debt came from a household with income at or below 400 percent of the federal poverty line. As of 2024, that was equal to about $60,000 for a one-person household, or $124,800 for a family of four.

“For over a decade, we have been at the forefront of relieving the burden of medical debt for everyday families, many of whom are uninsured or underinsured,” said Allison Sesso, president and CEO of Undue Medical Debt, in a statement. “We look forward to continuing our mission in partnership with Orange County.”

Beneficiaries of the medical debt relief initiative began receiving letters in the mail informing them of their debt cancellation last week, according to the county. Unpaid medical bills are the largest source of debt reported to collection agencies nationwide, affecting more than 14 million U.S. adults.

Central Florida Jobs With Justice, a coalition of labor and social advocacy groups, organized the initial call to action for the county to pursue the debt relief initiative last year, rallying members of the community who had personal experience with debt.

“When I think of a life without medical debt, I don’t think of buying a fancy car or going out to a nice restaurant. I think about the people who have swiped their card for me at the grocery store when my transaction was declined, and I think about paying it forward,” wrote Eimar Roy, a volunteer with Central Florida Jobs with Justice, in an op-ed for the Weekly. “I think about how much more present I could be for all the beauty and goodness this life has to offer if my mind weren’t constantly ravaged with worry about my house being foreclosed.”

The group initially asked the county to dedicate $8.7 million in remaining ARPA funds to the project, but nonetheless celebrated county leaders’ decision to move forward with the $4.5 million allocation in August. Orange County is the first and so far only municipality in Florida to partner with Undue Medical Debt, a nonprofit (formerly known as RIP Medical Debt) founded in 2014 by former debt collectors.

To date, Undue Medical Debt has eliminated over $15 billion in medical debt for nearly 10 million people. Since 2022, the nonprofit has partnered with nearly two dozen local and state governments nationwide. They also accept private donations from individuals and groups to fund debt cancellation efforts.

Over 90 percent of the U.S. population has some form of health insurance, but health insurance alone isn’t always enough to cover the cost of a major surgery, mental health care, or treatment for a debilitating illness like cancer. The United States, to date, is the only industrialized country in the world that doesn’t guarantee health care for its citizens through universal healthcare coverage.

Florida, specifically, is one of just 10 states that hasn’t accepted federal funds to expand Medicaid — a publicly-funded health program for low-income populations. Florida also has one of the highest rates of uninsured adults in the country.

Polling has found that adults often delay or avoid seeking care for health concerns due to worries about the potential cost. Medical debt can also negatively affect a person’s credit score, impacting the ability to secure loans, a safe and stable place to live, and credit cards.

“Throughout my 11 years as a social worker in this county, I’ve seen that medical debt has created incredible barriers for people to gain stability,” said Adam Hartnett, a licensed social worker with Poverty Solutions Group, speaking in front of county commissioners last year. “I’ve worked with families who have hundreds of thousands of dollars in medical debt, who simply can’t move economically because of this burden.”

Orange County’s allocation of $4.5 million for the medical debt relief program represents just a fraction of the roughly $270 million the county received from the American Rescue Plan Act. The county opted to dedicate the rest of those federal relief funds to initiatives addressing homelessness, food insecurity, social and community services like childcare, and financial support for small businesses.

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This article appears in May 14-20, 2025.