Hospital association files lawsuit to preserve access to care for Washington patients

October 16, 2023

Today the Washington State Hospital Association (WSHA) filed a legal challenge to the state Department of Health’s new interpretation of the state’s charity care law.

Washington hospitals provide charity care to those with financial need who have an emergency regardless of residence or immigration status. The state has long endorsed hospital policies that limit non-emergency charity care to residents of Washington state or geographies that correspond to the hospital’s service area.

On September 18 the Washington State Department of Health (DOH) issued a statement changing its 30 plus-year interpretation of the state’s charity care law. The department will now require all hospitals to change their policies to provide charity care for any service to anyone in the world who seeks it. Washington hospitals disagree with the department’s interpretation and are gravely concerned the new approach will make it harder and more expensive for Washingtonians to get timely access to the health care they need.

“The new interpretation dramatically departs from more than three decades of established practice based on the state’s current charity care law and now bars hospitals from implementing charity care policies with any geographic limit,” said Taya Briley, executive vice president and general counsel for the hospital association. “Instead, it requires hospitals to provide free or discounted care to anyone from anywhere. The new approach would make Washington State a medical tourism destination.”

Many hospitals in Washington provide patients from other areas with services they cannot get where they live. For example, hospitals provide trauma services, pediatric specialty services, and organ transplants to people from outside Washington state. The new interpretation removes the hospital’s ability to discern what the organization can absorb while still providing care to local patients.

“The opening lines of the law make it clear charity care is intended for the benefit of the people of Washington state: ‘The legislature finds that rising health care costs and access to health care services are of vital concern to the people of this state,’” said association CEO Cassie Sauer. “WSHA’s goal is the same as the law’s goal: to ensure the benefits of charity care are for the people of our state and that hospital resources are available to Washingtonians who need them. If charity care is needed by a patient in the community, they should be able to access the care without competing for space with other patients from other states and around the world.”

In addition to further straining already stretched capacity and impacting timely access to care, the new interpretation will come at the expense of Washington residents. Expenses for the additional delivery of free care will be passed along to other patients who do pay.

“There is no such thing as free care. Nurses, physicians, pharmacists, housekeepers and other staff who care for charity care patients still must be paid,” Sauer said. “Under the department’s interpretation, people living in Washington will subsidize charity care services to people from outside of the state.”

WSHA is seeking an opinion from the Thurston County Superior Court before the DOH imposed January 16, 2024 deadline for hospitals to change their charity care policies.

Background on Washington’s charity care law:

Washington hospitals provide significant benefits to their communities in the form of charity care for both emergency services and non-emergency or scheduled services. In 2021, hospitals statewide provided $370 million dollars in the cost of charity care services to patients.

Charity care is provided to people with no insurance and to many people with insurance who have significant deductibles or cost-sharing. Charity care is provided to Washington residents regardless of insurance status, immigration status, or housing status.

Mid-size and larger hospitals provide free and discounted care for people with income up to 400% of the federal poverty level, which is $58,000 for an individual and $120,000 for a family of four. Smaller hospitals provide free or discounted charity care to people with incomes up to 300% of the federal poverty level or about $43,000 for an individual and $90,000 for a family of four.


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Seattle, WA 98104

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