The Washington State Hospital Association filed suit Monday against the state Department of Health over a proposed rule allowing out-of-state patients to receive charity care , saying such a policy would make medical care harder to access and more expensive for Washington residents.
This requires hospitals to provide free or discounted care to anyone, anywhere. The new approach would make Washington state a medical tourism destination, Taya Briley, the association’s attorney, said in a statement.
First established in 1989, Washington’s charitable care law requires hospitals to make financial assistance available to patients within 300 percent of the federal poverty level for their out-of-pocket medical bills. This creates an upper limit of $43,000 per year for an individual and a limit of $90,000 or less for a family of four. People at 400% of the poverty line are eligible for some hospitals.
Four million Washingtonians are eligible for free or reduced-cost hospital care under an expanded charitable program passed by the Legislature last year.
About half of all Washingtonians qualify for free or reduced-cost care in Washington state hospitals, the attorney general’s office noted last year when implementing the expanded program. These protections apply to out-of-pocket hospital costs, including co-pays and deductibles, regardless of insurance status. Washington law now provides the nation’s strongest protections for out-of-pocket hospital costs.
Arguing on behalf of its member hospitals, the hospital association challenged the Department of Health’s interpretation of the updated law, which extends benefits to patients who live out of state but are treated in Washington.
The use of geographic boundaries to determine eligibility for charity care is not supported by current law, the Department of Health determined last month.
Hospitals cannot adopt policies excluding patients from eligibility for charity care if they are otherwise income eligible, the department wrote. He claimed a small number of hospitals have restricted eligibility to people within a geographic boundary, either the state as a whole or smaller boundaries like the hospital’s county or ZIP code.
The Department of Health has required any hospital in violation of its interpretation of the law to revise its charity care policy to comply by January 16.
Rather than comply with the administrative rule, hospitals across the state filed lawsuits.
The Department’s new (and erroneous) interpretation of the law will result in exactly the opposite of what the Legislature intended in enacting the Charity Care Act: requiring Washington hospitals to provide free or reduced-cost care to indigent people from anywhere in the world, the department will decrease access for Washingtonians and increase the costs of care for Washingtonians who will inevitably subsidize the costs of free care for other people from outside the State, reads the lawsuit filed Monday in Thurston County Superior Court.
A Department of Health spokesperson declined to comment on the lawsuit, but provided a statement on the agency’s responsibilities under the charity care program.
The agency is responsible for supporting charity care statutes and ensuring that patients who meet program criteria have access to care, regardless of their financial situation. The ministry’s mission is to support the health and well-being of patients, the Ministry of Health press release said.
According to the hospital association, the increased spending based on the administrative rule will be passed on to patients in the state who pay for their hospital stay.
Free care does not exist. Nurses, doctors, pharmacists, housekeepers and other staff who care for charity care patients must still be paid, Cassie Sauer, CEO of the hospital association, said in a statement . The department’s interpretation is that people living in Washington will subsidize charity care services for people outside the state.
Washington hospitals provided $370 million in free or discounted medical care in 2021 through charity care policies.
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