Washington’s hospitals are committed to ensuring patients get the hospital care they need regardless of their ability to pay for that care. Charity care eligibility is based on family size and income. Providing health care to those that cannot afford to pay is part of the mission of Washington’s hospitals. State law requires hospitals to provide free and discounted inpatient and outpatient care. Each hospital is responsible for maintaining its own charity care program.
Hospitals care for everyone who comes through their doors. Often, that care is intense and expensive, but is provided regardless of a patient’s ability to pay. Hospitals are required to help low-income patients cover their medical bills through charity care. This helps ensure that everyone is able to get the care they need.
If you don’t have health insurance at all, contact www.wahealthplanfinder.org. There are a broad variety of plans available, and if you qualify for the state’s Apple Health program, you may be able to get coverage for bills already incurred—even though you didn’t have insurance at the time you were in the hospital.
Learn more about how to understand your hospital bill by downloading this brochure or this Word template. You can also contact the Washington State Department of Health, which regulates hospitals. See their webpage here or call 360-236-4210.
Contact information for the Department of Health
Washington’s charity care law is administered by the Washington State Department of Health. If you have questions about the law, you can contact the charity care program at CharityCare@doh.wa.gov or (360)236-4210.
About Washington State’s Charity Care Laws:
Washington’s charity care law was established in 1989. The law can be found in the Revised Code of Washington, Chapter 70 Section 170. The rules implementing the law can be found in the Washington Administrative Code at Chapter 246, Section 453
About Hospital Charity Care Policies
Every hospital’s charity care policy is available on the Washington State Department of Health’s website.
At WSHA, we continue to work with our member hospitals and health systems to make it easier to apply for and get charity care. We created a standardized charity care application form that is available in multiple languages. We are pleased to say that these forms have been adopted by more than 90 percent of our member hospitals. Our goal is to make it easy for patients to know when help is available, and make it easy for hospitals to follow the law and provide compassion to patients in financial distress.
Hospital finances remain one of the trickiest elements of health care. Hospitals absorb the costs of charity care, which amount to more than $180 million annually. Medicare and Medicaid don’t cover the full cost of what it takes to treat a patient, which leads to further financial loss. Running a hospital is expensive. Privately insured patients make up the difference so hospitals can hire nurses, buy pharmaceuticals and keep equipment running.
WSHA members are committed to ensuring that all patients who need assistance are able to get it, but we also understand that offering these programs drives up the cost of care for others. It’s a balancing act to make sure that we’re taking care of all of our residents.
We are here to help you as you ensure your charity care program is working.
WSHA Standard Documents
WSHA has developed a standard financial assistance application form and standard plan for communicating about financial assistance. The WSHA Board of Trustees unanimously voted to urge every hospital in Washington State that is subject to the state’s charity care law to adopt the standard application form and communication plan. Adopting the application and communication plan are the right thing to do for our patients, our communities, and our hospitals. Read more about this work here.
- Download guidance on adoption of standard application form and Instruction sheet—SHB 1616 Compliant (PDF)
- Download Tier 1 standard financial assistance/charity care application and Instruction sheet (Word Document)
- Download Tier 2 standard financial assistance/charity care application and Instruction sheet (Word Document)
The English language version of the WSHA standard application has been updated for SHB 1616. The translated versions have not yet been updated. WSHA is working on updating the translations and will have translated versions uploaded to our website shortly
- Download standard communication plan for financial assistance/charity care (PDF)
- Download model plain language summary (Word Document)
- Sample policy language
- Sample Policy Language for Policy Updates Based on SHB 1616—updated 5/26/2022 (PDF)
- Guidance on staff training requirements
- List of Charity Care Hospital Tiers
Hospitals should review financial assistance policies and procedures and, if necessary, update them to ensure the new form and communication plan fit within the hospital’s financial assistance/charity care structure. These policies should include the voluntary pledge made by hospital CEOs in 2007 to provide care at a sliding scale up to 300% of the Federal Poverty Guidelines. Hospitals must submit any change to financial assistance policies to the Department of Health for approval.
Signage and Notice Resources
Materials for Complying with Billing Notification Law (RCW 70.41.400)
State law requires hospitals to give each inpatient on or before discharge a written statement providing a list of professional partners that commonly provide care for patients at the hospital and from whom the patient may receive a bill. WSHA has produced the following materials for hospitals to use to help in informing patients.
- Understanding Your Hospital Bill Sample Insert (PDF/Word template)
- A template of a 3.375” by 8.5” single-panel card insert (MS Word template)
- A full page sheet insert (MS Word)
- “Understanding Your Hospital Bill” brochure (available on the WSHA online bookstore)
Materials for Complying with Notice Requirements (WAC 246-453)
State law requires hospitals to post or prominently display information on charity care within public areas of the hospital. WSHA has produced a model sign about financial assistance, including information in English and eight other commonly spoken languages. Order free financial assistance signs from the WSHA online bookstore.
- Hospital charity care policies (from the Department of Health)
- Department of Health Annual Charity Care Report
- Department of Health Charity Care Rulemaking Website
- Current Federal Poverty Guidelines (from U.S. Health and Human Services)
- April 2022: Changes to state charity care law effective July 1, 2022
- September 2018: WSHA bulletin on legislative changes to state charity care law
- January 2017: Reminder of changes in charity care assessment process
- September 2017: Caring for our entire community
- July 2017: Change to charity care assessment process
- February 2017: Hospitals adopt standardized charity care forms
- April 2016: WSHA Board approves standard charity care forms
- April 2014: WSHA bulletin on state and federal activity impacting charity care
- 2007 WSHA voluntary pledge for hospitals on billing to the uninsured.
- Webinars (members-only; please contact Zosia Stanley for information)