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Bottom line: The federal rule that would have scrubbed medical debt from credit reports and barred lenders from using it in credit decisions was vacated by a federal court on July 11, 2025. That means the pre-existing national framework (FDCPA + FCRA + IRS 501(r) for nonprofit hospitals) is back to being the operative baseline—layered with a fast-moving patchwork of new state laws that (in some places) ban reporting, cap interest, and even prohibit selling medical debt to third-party buyers. If you collect or sell healthcare receivables, you’ll want to recalibrate policies now to the states you operate in, tighten 501(r) compliance, and build controls for “surprise billing” and dispute resolution.