Washington Community Action Network

What is “Charity Care?”

Charity Care is a program established under state law which requires hospitals to provide medical care for free or at a reduced cost if the patient is not able to pay fully for the services received. If you need care at a hospital, and are unable to pay your bill because you are uninsured or underinsured, you should ask about the hospital’s charity care program.

What is Washington CAN! doing to promote access to Charity Care?

Community hospitals across Washington State are supported in a number of ways including: large tax breaks, government grants and loans, and preferential regulatory treatment. These are all critical to the survival and health of our community-based hospitals. In return, our expectation is that these facilities will help provide health care to the community members most in need of assistance – namely, low-income people with insufficient health insurance.

That’s why Washington CAN! has been involved in examining the role and commitment of nonprofit health corporations to our local communities, and working to define and expand the community benefits provided by nonprofit health corporations.

• In 1998, WCA intervened in the Certificate of Need process when a local Tacoma hospital was taken over by an out-of-state corporation and solidified new commitments to provide the community with increased charity care and other services
• In 1999, WCA surveyed the charity care procedures of hospitals around the state, and issued a report entitled Not Making the Grade: Washington Nonprofit Hospitals Fail in Their Charity Care Mission.
• In 2000 WCA negotiated with the Sisters of Providence and Swedish Health Systems during their merger and gained new commitments from both organizations to increase community benefits.
• In recent years, Washington CAN! has worked with legal services offices to address the provision of charity care and community benefits to low-income health consumers.

Currently, Washington CAN! members in Thurston County are joining together to improve the delivery of Charity Care at local hospitals. For more information on Charity Care and to become involved in our work to improve access, contact Joshua Welter at 206-389-0050 or Joshua@washingtoncan.org.

How does Charity Care Work?

If you have an income under 100% of the federal poverty level, you are entitled to free care. The hospital may ask you to apply for Medicaid or Medicare, if you are eligible. If your income is between 100% and 200% of the federal poverty level, you are entitled to reduced cost care on a sliding scale. The hospital can take into consideration your other resources (car, house, etc.) when determining its sliding scale subsidy. If you make more than 200% of the poverty level, but you are unable to pay for health services, the hospital can choose to offer you charity care.

Official 2005 Federal Poverty Level (FPL) (All income** amounts rounded up)
Size of Family	Annual 100% FPL	Monthly 100% FPL	Monthly 200% FPL
1	$9,570	$798	$1,595
2	$12,830	$1,069	$2,138
3	$16,090	$1,341	$2,682
4	$19,350	$1,613	$3,225
5	$22,610	$1,884	$3,768
6	$25,870	$2,156	$4,312
7	$29,130	$2,428	$4,855
8	$32,390	$2,699	$5,398
9	$35,650	$2,971	$5,941
10	$38,910	$3,243	$6,484
**"Income" means total cash receipts before taxes received from wages and salaries, welfare payments, Social Security payments, unemployment or disability benefits, strike benefits, child support, maintenance (alimony), and net earnings from business and investments. Changes in the income levels are made each April.

Once you apply for charity care, the hospital must notify you within 14 days about its decision, and the amount you will be required to pay for hospital services. If you are denied charity care services, the hospital must tell you the reason why. They must also inform you about your right to appeal the decision.

If you are denied, you will have 30 days to appeal the decision. If you file your appeal within the first 14 days, the hospital cannot pursue collection actions against you until your appeal has been completed and you have not won the appeal.

The Department of Health is required to review all appeals that result in denials. You can call the Department of Health and ask them to review your denial- (360) 236- 4210. If they find that your denial was inappropriate, the Department can seek civil and criminal fines against the hospital and individual staff members.

You can apply for charity care and any time, even if you have been receiving bills or the hospital is pursuing collection actions against you. Moreover, if you paid for part or all of the charges made for hospital services received which should have been covered by Charity Care, then you are entitled to a refund within thirty days of your being designated eligible for Charity Care.

If the hospital has turned you over to a collection agency, you can inform them that the hospital needs to consider you for charity care, and demand that the hospital immediately process your application for charity care. You can demand that any collections efforts be halted while the hospital processes your application for charity care.

Additional Charity Care Resources

"Charity Care": Medical Coverage for Hospital-Based Medical Services, by the Northwest Justice Project.

How to Present a Charity Care Defense to a Lawsuit for Hospital Debt Collection, by the Northwest Justice Project.

Do You Need Charity Care?

If you have had trouble getting charity care from a non-profit hospital, there is help available. Call the Insurance Commissioner's consumer hotline at 1-800-562-6900.

Legal Help

If you are low-income and feel you need legal assistance with a charity care claim, there is help available. Please call CLEAR - the Northwest Justice Project's Coordinated Legal Education, Advice and Referral Line. The CLEAR toll-free phone number is 1-888-201-1014. For more information about CLEAR, please click here.