Sep 28, 2022 - Health

Nonprofit hospitals' vague charity care criteria

Illustration of a question mark with a dot shaped like a medical cross

Illustration: Annelise Capossela/Axios

Tax-exempt hospitals revamped their charity care policies during the pandemic, in some cases using vague language to describe who was eligible and occasionally tightening access based on immigration status, according to an analysis in JAMA Network Open.

Why it matters: Safety net hospitals play a key role in low-income communities and use charity care as a justification for maintaining their tax-exempt status. The Affordable Care Act requires them to establish and publicize financial assistance policies.

By the numbers: The 151 hospitals surveyed mostly expanded eligibility between 2019 and 2021 with more generous income cutoffs or discounted care.

  • But 7.9% made policies more restrictive, through steps like excluding non-U.S. residents or specifying how long a person had to live in the country to qualify for charity care.
  • Some hospitals also excluded coverage of birth control or services to patients in the custody of law enforcement.
  • The vague language in many hospital eligibility guidelines "limits patients' understanding of charity care policies and may conceal policy changes over time," the authors wrote.

The bottom line: The analysis didn't provide sufficient evidence that hospital consolidation and Medicaid expansion could lead to the expansion of charity care and more generous charity care policies, the researchers said.

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