Washington Hospitals Fall Short of Serving Patients Most in Need

Wednesday, August 30, 2017

Hospitals across Washington State are falling far short of meeting their legal requirement to provide free or reduced cost of care to thousands of eligible patients, a new report reveals. The report, "Access Denied: Washington's Charity Care System, its Shortfalls, and the Effect on Low-Income Patients," includes original research and analysis by Columbia Legal Services (CLS) and provides recommendations for changes in law, policy, and practice aimed to ensure that charity care fulfills its original purpose - guaranteeing that those in greatest need are able to obtain critical health care services. (En Español)

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“Charity care eligibility should be a straight-forward process, but we’ve identified current hospital charity care practices and policies across Washington that are failing many of those with the greatest need,” said Ty Duhamel, an attorney with the Basic Human Needs project at Columbia Legal Services. “As a result, our courts are full of people who are being sued for hospital bills they never should have received in the first place.”

Hospitals in Washington have an affirmative duty to determine if patients are eligible for charity care, but when eligible patients are not made aware of the benefit they may forego essential care or face crushing debt collection lawsuits after receiving care. As detailed in the report, CLS’s findings indicate that there are significant problems with how Washington’s charity care program is working, including:

  • Hospitals are not doing enough to address language barriers, and some even make it more difficult for limited English speakers,
  • Hospitals are not screening patients for charity care eligibility at or near the time of admission by requesting income information as legally required,
  • Notice practices fail to adequately inform patients of their charity care rights, and
  • Hospitals and debt collectors improperly collect on hospital bills that charity-care-eligible patients do not actually owe.

As a result of these shortfalls, patients and their families suffer. State law also requires that hospitals make charity care accessible to their patients who may speak a language other than English, yet many hospitals fall short in this area. Obstacles would only be compounded by repeal of the Affordable Care Act. CLS retained a nationally renowned research group, the Equal Rights Center (ERC), to conduct a comprehensive survey regarding what barriers exist to accessing charity care and how they can be addressed.

The testing focused on language access and whether charity care was offered to Spanish-language speakers in hospitals throughout Washington State and the results demonstrate widespread language barriers for non-English speaking individuals:

  • Only 28% of the Spanish-language calls were offered any information from the hospital about financial assistance where the main hospital number was called, although that information was relayed 90% of the time to English speakers. In other words, 72% of Spanish-language calls were not given any information about financial assistance.
  • Just 13% of the time, a Spanish-speaking caller received information regarding the application process for financial assistance or was offered an application for financial assistance, while that information was provided to English speakers more frequently in 40% of total tests. 
  • 80% of the sites surveyed disconnected the calls at least once because the tester was trying to communicate in Spanish.  
  • Just 10% of the tests resulted in the Spanish-speaking caller being connected to an interpreter where the main hospital number was dialed.

A thorough examination of hospital charity care policies also revealed numerous legal shortfalls when it comes to provision of charity care.

As part of an ongoing campaign to increase access to charity care, CLS authored 12 letters to hospitals across the state that performed poorly in providing adequate language access, have charity care policies which violate state or federal law, or have unreasonably low provisions of charity care compared to other hospitals. Together, these policies, practices, and procedures prevent patients in great need from obtaining critical information regarding their health care, which can lead to unmanageable medical debt, bankruptcies, and long-term poverty.

“The law in Washington is clear – low income residents of this state have a right to charity care,” said Tony Gonzalez, an attorney with CLS. “We urge these hospitals, which represent just a cross-section of all hospitals across our state, to correct their illegal or insufficient practices immediately.” The hospitals CLS has reached out to and those included in the survey are geographically diverse and represent both urban and rural areas. The problem of accessing charity care disproportionately impacts farm worker communities in agricultural areas and CLS is focusing outreach and training efforts on these communities.