Unrepresented patients lack decision-making capacity to make their own healthcare decisions. And they also lack any available surrogate to make decisions on their behalf. This poses a big problem for these thousands of patients, for other patients whose access is blocked, and to hospitals.
Among other jurisdictions, Maryland recently tried to follow Colorado and other innovative states. But while Maryland did not succeed, other states have. Consider Iowa and Wisconsin.
Iowa. On July 1, 2026, amendments from H.F. 2305 go into effect. This expands the list of default surrogates (in 144A.7) to include "close adult friend." The risk of being unrepresented in Iowa is now lower because more individuals are authorized to serve as substitute decision makers.
Wisconsin. On June 1, 2026, amendments from A.B. 598 go into effect. This authorizes patient representatives to discharge patients to post-acute facilities without having to seek guardianship. Under the previous rule, patients were unrepresented for 50 to 100 days or more while guardianship petitions were pending.
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