Eligibility for these financial aid policies varies from state to state and hospital to hospital, so it’s important to check your hospital’s policies first.
A TikTok Video January told people that most hospitals are required to provide financial assistance, including free care, to people with incomes below a certain level.
The video has gone viral. It has got 1.5 million views to date and a video replay of the same account has gained 3.4 million views. Video has been viewed over 7 million times on Twitter and regains the hair of the beast thanks to a July 6 rerun which has been retweeted over 15,000 times.
THE QUESTION
Are most hospitals required to provide financial assistance, including free care, to people with incomes below a certain level?
THE SOURCES
THE ANSWER
Yes. The Affordable Care Act mandated nonprofit hospitals to provide financial assistance to low-income people, and many for-profit hospitals do the same.
However, the exact policy and eligibility requirements vary by state and hospital, so it’s important to check a hospital’s exact financial aid policies. For example, not all hospitals offer financial assistance to people with incomes under $ 38,000, as some reruns suggest.
WHAT WE FOUND
A provision of the Affordable Care Act requires hospitals to provide a “financial aid policy” which must “apply to all emergency and other medically necessary care provided by the hospital establishment” in order for the hospital to maintain its tax-exempt status as a non-profit organization.
According to the American Hospital Association Fast facts 2021, about 57% of community hospitals are non-profit. This provision therefore applies to most hospitals.
To qualify for this financial assistance, also known as charity care, a patient must receive medically necessary or emergency care in hospital. the the federal government defines “medically necessary” care such as “healthcare services or supplies necessary to diagnose or treat an illness, injury, condition, illness or its symptoms and which meet accepted standards of medicine”.
But there are no eligibility conditions outlined by ACA apart from this. Each state can define its own definitions of what is medically necessary, and there is no income limit set by the federal government.
the Hilltop Institute, which provides advice to policymakers on community benefits policy, identifies state laws on community benefits policies, of which charitable care is a part. The graph shows that some states do not specify the eligibility conditions at all, while others specify conditions that are different from each other.
For example, in Colorado, patients up to 250% of the federal poverty line can receive charitable care, but in Illinois, only patients up to 200% of the poverty line can receive full assistance and patients representing up to 600% of the poverty line. poverty line can benefit from reductions.
Of course, hospitals can offer financial assistance to a larger group of people than they have to. A report from Lown Institute, a think tank that advocates healthcare reform, found that for-profit hospitals – which don’t have the same requirements for providing charitable care – spend as much on it as nonprofit hospitals.
Some nonprofit hospitals have made financial assistance difficult or invisible to patients in the past. A nonprofit hospital system in Washington state lost a lawsuit to the state attorney general in 2019, who forced the hospital to reform its charitable care practices and pay restitution as the state found it was denying charitable care to eligible patients.
“Hospitals are required to notify low-income patients of the availability of charitable care,” Washington Attorney General Bob Ferguson said at the time. “St. Joseph has failed in his duty and placed barriers on vulnerable Washingtonians trying to access affordably. Today’s resolution corrects a wrong committed against thousands of patients across Washington.
Hospitals are required by federal law to post information about financial aid on their websites. The law requires hospitals to include clear eligibility requirements and application resources in online information.
This means that the best way to find out if a hospital has financial aid options and what the conditions are for it is to go online, as the original TikTok video recommended.
Generally, to be eligible for charitable care, a patient must be uninsured, without access to other programs that would cover care, and have an income below a certain level of the federal poverty line.
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