About 87% of hospitals offer free or discounted care, but the eligibility requirements vary greatly depending on the facility, a June 2 Lown Institute report found.
In most states, hospitals set their own policies around free and discounted care, as well as how they collect debt. At a given hospital, some middle-income families can receive free care, but at a competing hospital they may not be eligible for free or discounted care at all.
“This isn’t a case of red states versus blue states, or rural areas versus cities,” Vikas Saini, MD, president of the Lown Institute, said in a June 2 news release from the organization. “We’re seeing massive disparities in charity care policies between hospitals that are practically around the corner from each other. Unfortunately, low- and middle-income patients are the ones who deal with the consequences.”
The Lown Institute reviewed financial assistance and collections policies from 2,500 hospitals across the U.S. Read more about the methodology here.
Here are three findings:
1. Free care thresholds vary from below 100% of the federal guidelines ($25,000 for a family of three) up to 600% ($150,000). Most hospitals offer discounted care for families making under 400% of the federal guidelines, or about $100,000 for a family of three. Policies can differ at hospitals in the same city.
2. The most common threshold for free care is 200% of federal guidelines, or $50,000 for a family of three.
3. Almost 60% of hospitals allow at least one extraordinary collection action, such as wage garnishing, selling debt to a third party or denying nonemergency care. Only 10% to 15% of hospitals explicitly state they will not take these actions.
The report said that to improve access to financial assistance and rescue harm from medical debt, state and federal policymakers should set minimum eligibility standards, require patient screening for financial assistance, create a uniform application and restrict allowed collection actions.
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