What happens to guarantee letters under zero-balance billing policy?

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January 9, 2026 | 7:15am

MANILA, Philippines — For years, a single piece of paper — a guarantee letter from a politician — has been treated as a pass to medical care in public hospitals. Now, the Department of Health says patients no longer need one, even as hospitals continue to accept them under old rules.

The 2026 General Appropriations Act (GAA) includes an “anti-epal” provision aimed at banning political involvement in aid distribution, including the Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP), a program long criticized for its use in patronage politics.

Health Secretary Ted Herbosa said the DOH is still drafting new implementing rules and regulations (IRR) for MAIFIP following the enactment of the new provision, with guidelines expected by mid-February.

Old rules remain in effect

Until the new IRR is issued, Herbosa said the 2025 rules remain in effect.

Asked whether referral or guarantee letters from politicians would still be accepted under the current rules, Herbosa said they would.

However, he stressed that the DOH does not require patients to secure guarantee letters from politicians, especially with zero-balance billing in place at public hospitals.

“You know, constituents are free to ask assistance from their elected officials. But do they need a guarantee letter from them to get assistance? No. They can go straight to the Department of Health and we will help them if they need help and if we have the funds, we will provide the funds if they are qualified to get the funds,” Herbosa said.

Letters still entertained

Herbosa was less clear on whether a guarantee letter helps patients secure treatment, saying that while the law technically prohibits guarantee letters, “request” letters are still entertained.

“I talked to the Senate President regarding this. Of course, if you’d write me a letter and you want someone, the DOH, to help your constituents, we will help them,” he said.

Herbosa did not specify whether he was referring to current Senate President Tito Sotto or former Senate President Francis Escudero.

He also clarified that if a patient seeks assistance directly from a politician, any financial help provided would come from the official’s personal funds, not the national budget.