Abstract
Rural Washington State hospitals are failing to provide required charity care and burdening low-income patients with medical debt lawsuits
APHA 2022 Annual Meeting and Expo
Background
Washington State law requires all hospitals to provide charity care to patients with incomes below 100% FPL; hospitals are expected to “make every reasonable effort to determine eligibility. However, low-income patients are often not made aware of charity care benefits, and hospitals frequently sue these patients for unpaid medical bills.
Methods
We used publicly available court records to identify 354 patients in two rural Washington state counties, Clallam (N=127) and Chelan (N=227), who were sued for medical debt (2020 to present.) In each county, there is only one small hospital provider. The first author sent letters to each patient, in both English and Spanish, asking them to contact her to share their story. She conducted semi-structured interviews with respondents (n=5); two in Spanish and three in English.
Results
Four participants had never heard of charity care. Two were eligible for charity care at the time of service. All five participants had chronic health conditions; three reported they stopped seeking medical care after being sued for medical debt. Spanish-speaking participants reported additional burdens around health insurance and interpretation services. The average participant medical debt was $5,309; the average annual income was $35,800.
Conclusions
Washington State’s Attorney General sued two large state hospitals, Providence and Swedish, for failing to make charity care available to eligible patients (02/24/22), but state legislators have not imposed penalties on hospitals for failing to offer charity care. No laws restrict hospitals and collections agencies from suing low-income patients.