The Orange County government has eliminated $559 million in medical debt held by an estimated 345,000 county residents through an initiative the county first launched in 2024.
The medical debt cancellation program, funded by about $4 million of federal American Rescue Plan Act funds, was approved by the board of county commissioners in August 2024 and made possible through a partnership with Undue Medical Debt.
Undue Medical Debt, formerly known as RIP Medical Debt, is a nonprofit founded by former debt collection executives that works with governments, student groups, churches and other advocacy groups to cancel medical debt by acquiring it in bulk at a fraction of its face value. On average, one dollar invested by the nonprofit can erase $100 in medical debt, according to the organization.
“This historic initiative has transformed the lives of hundreds of thousands of Central Floridians,” Orange County Mayor Jerry Demings shared in a statement Monday. “Relieving medical debt gives families the freedom to focus on their health and build a brighter future.”
Orange County was the first — and is still the only — local government in Florida to cancel medical debt through a partnership with Undue Medical Debt, although the nonprofit has worked with more than two dozen other state and local governments elsewhere. Orange County leaders agreed to invest in the initiative in response to the advocacy of Central Florida Jobs With Justice, a coalition of social and labor rights groups.
Advocates pointed out that, amidst widespread cost-of-living concerns in the Orlando metro, medical debt is the leading cause of bankruptcy in the U.S., affecting roughly four in 10 adults.
“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,” Adam Hartnett, a licensed social worker, told Orange County commissioners at the time. “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.”
The medical debt cancellation program was funded by just a small sliver — 1.6 percent — of the roughly $270 million the county received under the American Rescue Plan Act of 2021, a federal Covid-19 pandemic relief package distributed to state and local governments under the Biden administration.
Orange County was required to allocate this funding by the end of 2024 and must spend it by the end of 2026. The rest of the funds received by the county were dedicated to “business assistance,” health and public safety, infrastructure projects, social and community services, and revenue recovery, according to county documents.
Orange County announced its first wave of $472.5 million in medical debt relief, stemming directly from this initiative, last May. Another $42.9 million in relief was announced in October, and Monday’s announcement added an additional $43 million in debt relief on top of that, impacting an additional 42,000 residents alone.
“At a time when families across Florida, and the country, face growing uncertainty about access to care, Mayor Demings and the Orange County Board of County Commissioners are demonstrating bold, community-minded leadership,” Allison Sesso, president and CEO of Undue Medical Debt, said in a statement. “We’re proud to continue this partnership and hope this relief encourages recipients to re-engage with the healthcare system without fear of the cost.”
The program, notably, was not administered through any sort of application process. That is, residents who have seen their debt relieved did not have to apply for it.
Under the program, Undue Medical Debt identifies debt eligible for relief in partnership with local healthcare providers such as Orlando Health and debt collectors.
Debt was considered eligible for relief if it 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 2025, that was equal to about $62,600 for a one-person household, or $128,600 for a family of four.
Sheila Santiago, an Orange County resident with multiple sclerosis who saw her debt relieved by the program, said in a statement that “this gift from Orange County brings a sense of peace to me and my family.”
“Knowing that our elected officials care about us and our wellbeing means the world to me and my family as we plan for our future,” she added.
According to the county news release, all medical debt acquired by Undue Medical Debt under the program “is fully paid with no tax consequences for the recipient.” Impacted individuals and families should have received a letter in the mail notifying them of the cancellation of their medical debt.
Orange County’s news release described this as “the largest medical debt-relief initiative in Florida’s history.” And a county spokesperson confirmed that their contract with Undue Medical Debt “remains ongoing.”
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