Fair Access to Hospital Care

Advocates pushed forward the Hospital Charity Care Notice bills before the state's House (HB 1359) and Senate (SB 5231). These bills would have required that patients receive verbal and written notice about the availability of charity care in English and Spanish, as well as clearly stating that patients can contact the hospital for more information. It would have also required that all medical financial statements have written a notice about the availability of charity care in English and Spanish. (En Español)

Clients in our charity care case submitted letters before the House and Senate on why they supported HB 1359 and SB 5231, they shared the challenges they faced when receiving medical bills:

Unfortunately these bills did not go forward. Advocates are continuing to push this work through other avenues.

When families and workers across Washington State receive the necessary health care services they need, we all benefit from healthier communities today and dollars saved on essential medical care in the future. Yet, too many low-income families in Washington State face barriers when health problems arise, a primary obstacle being cost. The cost of medical services, especially during emergencies, shouldn’t prohibit people from seeking hospital care. Columbia Legal Services, working closely with patients and allies, aims to help break down these barriers to affordable health care so all families can thrive.

Charity Care Class Action Lawsuit

In June 2016, patient advocates announced a class action lawsuit against Northwest Hospital in Seattle, Washington for failing to meet its responsibility to screen patients for charity care. The Washington State Charity Care Act (CCA) requires that all hospitals in the state provide charity care in order to ensure access to health care for low-income residents. However, low-income uninsured and underinsured emergency room patients have been consistently denied access to charity care at the hospital, as well as other hospitals across Washington State. Most patients who are eligible do not receive charity care: 522,000 (7.3%) of Washingtonians lack healthcare insurance and most of them would qualify for charity care, yet charity care accounts for only 1.8% of hospital charges as a percentage of revenues. See this factsheet on charity care in Washington State 

Instead, the hospital sends the medical bills to collections and many patients have their wages garnished, often turning patients into debtors. This is a systemic unlawful practice that is depriving many thousands of patients every year of the charity care to which they are entitled under the law.

The plaintiffs in Amireh v. Northwest Hospital, both former emergency care patients, claim that the Seattle hospital failed to screen them to determine their eligibility for charity care before demanding payment and before sending them to collections. Read case introduction which provides a useful summary

At a press conference announcing the complaint (see video), Kamal Amireh (pictured above), one of the plaintiffs, described how he would have been deemed eligible under both the CCA and Northwest Hospital’s own charity care policy had he been affirmatively screened. Amireh was taken in for emergency treatment at Northwest after vomiting all night. He was feeling dizziness and vertigo. He was not asked for information about his income, and signed a financial responsibility form which did not state the costs he would pay.

Less than two months later, Amireh received notice of a collections lawsuit, without any screening for charity care eligibility. Immediately, he went to the hospital requesting charity care, only to be told – inaccurately – that he could not make such a request once a collections suit was filed. Although the Charity Care Act clearly states that hospitals must provide charity care at all times for eligible patients, Northwest has a written policy that states patients cannot request charity care when their collection is brought to court.

While Amireh represents himself and other uninsured individuals who visited the hospital, Hugo Cabrera Villalobos, another plaintiff, represents underinsured individuals. A trailer he was working on fell on his arm, pinning him to the ground. He was taken to Northwest’s emergency room for x-rays and a general examination. While there, he signed a financial responsibility form and showed proof of medical insurance. He was not asked about his income while in the hospital or anytime afterwards, and no screening for charity care eligibility took place. He later learned that his insurance did not fully cover the expenses and he was billed $1,146.50.

Columbia Legal Services and Schroeter Goldmark & Bender, who are representing Amireh and Villalobos, believe that these plaintiffs represent thousands of other patients who visited Northwest Hospital and were not screened to determine their eligibility for charity care. More broadly, the issues presented in this case affect the rights of the several million uninsured and underinsured Washingtonians who may be eligible for charity care based on their low income and should be screened to determine their eligibility when they receive hospital care.

Fair Access to Hospital Care Campaign

In June 2016, Columbia Legal Services launched a public education campaign to inform low-income patients and the broader public about charity care and to stand with eligible patients across the state who are not screened for charity care as required by law and do not receive financial assistance they deserve. Our campaign includes litigation to enforce existing statutes and requirements for hospitals to affirmatively identify patients’ eligibility, policy reform to increase access to charity care, and research, education, and analysis that informs Washingtonians about their rights. Find out more 

Ally organizations are joining us to highlight the impact of medical debt on families and how one unplanned health emergency can lead to a devastating cycle of debt. This broad group of organizations works with impacted communities and includes Northwest Justice Project, Northwest Health Law Advocates, Casa Latina, NAACP, El Centro de la Raza, Washington CAN!, OneAmerica, and Solid Ground.

Watch this space or contact Columbia Legal Services for more information about how you can get involved and help share information about our state’s charity care laws.

Do you qualify for free or discounted hospital care?

Download this helpful brochure to help determine if you qualify for charity care, how to apply, and find out about more charity care resources available in Washington State.

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