Can't Afford Your Hospital Bill?

Posted April 30, 2025, By Cole Ferrier

Navigating healthcare costs can be stressful, especially when facing unexpected hospital visits. Many Washingtonians worry about how they'll afford necessary medical care, even those with insurance facing high deductibles and copays. The good news is that Washington State has a robust Charity Care law designed to help. If you're struggling with hospital bills, understanding how charity care works could provide significant financial relief.

What is Charity Care?

At its core, charity care is free or discounted medically necessary hospital care provided to eligible individuals who cannot afford to pay. It's not just for the uninsured; even if you have insurance (private, Medicare, or Medicaid), you might qualify for help with your out-of-pocket costs like deductibles and copayments.

Washington State law (RCW 70.170) requires all hospitals to offer charity care. Hospitals must inform patients about the availability of financial assistance and have clear policies outlining eligibility and application procedures. Importantly, eligibility is based primarily on your family size and income, regardless of your citizenship or immigration status.

A Major Update: The 2022 Charity Care Law Expansion

A significant change happened relatively recently that made millions more Washingtonians eligible for financial assistance. Driven by Substitute House Bill (SHB) 1616, the law dramatically expanded income eligibility thresholds.

Here's the breakdown of the minimum requirements under the updated law:

1. Hospital Tiers: Hospitals are now categorized into two tiers, generally based on their size and system affiliation. Larger hospitals and health systems are typically Tier 1, while smaller, independent hospitals are often Tier 2.

2. Expanded Eligibility:

• Tier 1 Hospitals: Must provide free care (100% discount) to patients with household incomes up to 300% of the Federal Poverty Level (FPL). They must offer discounted care for those with incomes between 301% and 400% of the FPL (with minimum discounts of 75% up to 350% FPL and 50% up to 400% FPL).

• Tier 2 Hospitals: Must provide free care (100% discount) to patients with household incomes up to 200% of the FPL. They must offer discounted care for those with incomes between 201% and 300% of the FPL (with minimum discounts of 75% up to 250% FPL and 50% up to 300% FPL).

(Note: The Federal Poverty Level guidelines are updated annually. For 2025, 300% FPL for a family of four is $96,450, and 400% FPL is $128,600. Always check the current FPL guidelines and the specific hospital's policy.)

This expansion means many working individuals and families who previously didn't qualify might now be eligible for significant help with their hospital bills.

How Does the Process Generally Work?

1. Ask for Information: Hospitals are required to notify patients about charity care. Look for signs in admission areas, emergency rooms, and billing offices. Don't hesitate to ask registration staff, financial counselors, or billing representatives about financial assistance.

2. Get an Application: Hospitals must provide a charity care application form and a plain-language summary of their policy, often available on their website or upon request.

3. Apply: Fill out the application completely.

4. Provide Documentation: You'll likely need to provide proof of your household income (like recent pay stubs, tax returns, W-2s, unemployment statements) and family size.

5. Review: The hospital will review your completed application and documentation. 

Charity Care Examples: MultiCare and UW Medicine

Washington's large hospital systems fall under Tier 1 requirements. Here's a glimpse at how charity care works at two major providers (always confirm details directly with the provider, as policies can be updated):

• MultiCare Health System:

  • Eligibility: Offers 100% discount for patients with family income up to 300% FPL. Provides a 75% discount for incomes 301%-350% FPL and a 70% discount for incomes 351%-400% FPL.

  • Policy Link: https://www.multicare.org/patient-resources/billing/financial-assistance/

• UW Medicine: (Includes Harborview, UW Medical Center Montlake & Northwest, Valley Medical Center, UW Physicians, UW Medicine Primary Care, Airlift Northwest)

  • Eligibility: Offers 100% discount for patients with family income up to 300% FPL. Provides a 75% discount for incomes 301%-350% FPL and a 50% discount for incomes 351%-400% FPL.

  • Policy Link: https://www.uwmedicine.org/patient-resources/billing-and-insurance/help-paying-your-bill

Important Notes:

Charity care covers medically necessary services provided by the hospital. You might receive separate bills from doctors or specialists who are not hospital employees, and these may not be covered by the hospital's charity care policy. Always ask!

The Financial Planning Importance of Charity Care

From a financial planning standpoint, understanding and utilizing charity care is crucial for managing financial risk. Unexpected, large medical bills represent one of the biggest threats to a household's financial stability, capable of derailing long-term goals like retirement savings or homeownership and potentially leading to significant debt. Charity care acts as a safety net, mitigating this risk by substantially reducing or eliminating hospital costs for eligible individuals, thereby protecting savings, preventing the accumulation of overwhelming medical debt, and preserving overall financial health, even for those who already have health insurance. Given the significant financial relief provided and the defined income cutoffs based on the Federal Poverty Level, proactive financial planning also includes awareness of these specific eligibility thresholds. Where legitimate financial strategies allow (such as timing controllable income or maximizing pre-tax deductions like retirement or health savings account contributions), careful management might prevent a household from narrowly missing eligibility—and substantial savings—by being just slightly over an income limit.

Don't Delay - Seek Assistance!

Hospital bills can be overwhelming, but Washington's charity care law provides a crucial safety net. If you think you might struggle to pay, don't hesitate to ask for help and apply for financial assistance. Even if you're unsure whether you qualify, it's always worth applying.

Resources:

• Washington State Department of Health - Charity Care: https://doh.wa.gov/data-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-patient-information-and-charity-care

• Washington State Office of the Attorney General - Charity Care: https://www.atg.wa.gov/charitycare

• Full Text of Charity Care Law (RCW 70.170): https://app.leg.wa.gov/rcw/default.aspx?cite=70.170&full=true

• Substitute House Bill (SHB) 1616: https://app.leg.wa.gov/billsummary?BillNumber=1616&Initiative=false&Year=2021