- A number of tax-exempt hospitals expanded their charity care policies during the COVID-19 pandemic, but unclear and unpublicized eligibility criteria remain common and deserve regulatory attention, according to a study published Tuesday in JAMA Network Open.
- Researchers comparing charity care policies at 151 tax-exempt hospitals for 2019 and 2021 found that 47 (31%) of the providers expanded charity care, while 12 (8%) made restrictive changes.
- A total of 127 (84%) hospitals updated their policies, and 77 (51%) made substantial changes, in categories such as income eligibility cutoffs, asset limitations and service exclusions. Even so, vague eligibility criteria were common, the study found.
Hospitals are required to provide charity care to maintain tax-exempt status. The Affordable Care Act also made it a requirement that tax-exempt hospitals publish their policies online with clear eligibility criteria and covered services.
In practice, the content of published charity care policies has tended to vary widely, the JAMA Network Open study found. The analysis comes on the heels of a New York Times investigation of Washington-based health system Providence that found the provider saddled patients with debt who should have been eligible for financial assistance.
California has heightened its focus on the right to charity care. The state's attorney general, Rob Bonta, earlier this summer warned hospitals that failure to alert patients about free or reduced-cost care violates state law. The warning followed complaints to Bonta's office that hospitals were not providing notices in a language that patients understood.
The JAMA research found that the most common changes to charity care policy statements between December 2019 and December 2021 involved expansion of eligibility criteria. Policy changes mostly specified income cutoffs for free and discounted care, residency status, presumptive eligibility, duration of coverage and underinsured eligibility.
Despite the generally positive changes, the researchers found reasons for concern, including the nearly 8% of hospitals that restricted charity care through eligibility requirements and coverage changes and policies that continue to use vague language. Nonspecific language is common in charity care policies, the report said.
“Policy makers should consider requiring greater transparency and simplification for hospital charity care policies to ensure adequate access to care for uninsured and underinsured patients,” the researchers concluded.