How to Obtain Charity Care

An elderly woman receiving in-home care

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Millions of Americans go without health insurance coverage every year. According to U.S. Census data, 28.5 million Americans were without health care coverage in 2017. Though this number is down from the 42 million who were uninsured in 2013, before the bulk of the Affordable Care Act (ACA) was implemented, it's still a significant number. And the uninsured rate increased slightly from 2016 to 2017, which was the first time that had happened since 2010 (the year the ACA was signed into law).

Being Uninsured Means Less Health Care

Unfortunately, those without health insurance will have a much more difficult time finding timely and affordable treatment for health issues and overall medical care. According to the Kaiser Family Foundation, those without insurance tend to not get preventative care which includes important screenings for diseases. In fact, 50 percent of uninsured adults under the age of 65 said they didn't have a source they regularly used for health care—versus just 11% of the people who had private health insurance and 12% of those with Medicaid. However, if you are uninsured, you still have several options when you need medical care.

Options for the Uninsured

If you're uninsured, here are some of your options:

  • Emergency Rooms: Passed in 1986, the Emergency Medical Treatment and Labor Act (EMTALA) requires emergency rooms (that accept Medicare, which is virtually all of them) across the United States to assess and stabilize anyone who walks through the door, regardless of their health care plan or their ability to pay. Thus, the emergency room (ER) can be visited for free health care in emergency situations, which includes pregnant women in labor. But it's important to understand the limitation of EMTALA: The law only requires the emergency room to assess the patient and stabilize them if necessary. They do not have to provide any other treatment beyond what's necessary for stabilization. So while they can't let a patient bleed to death without intervening, they are not required to provide any sort of treatment after the patient is stabilized. So relying on the ER is not an adequate solution in most circumstances.
  • Federally Qualified Health Centers: These clinics provide services on a sliding fee scale in underserved communities, particularly in rural areas. They receive federal grants to fund their operations (in addition to payments from Medicaid and private insurers, when patients have those forms of coverage) and must meet various federal guidelines. You can use this locator tool to find federally qualified health centers near you.
  • Other Free and Sliding Scale Clinics: In additional to federally qualified health centers, there are other free and sliding scale clinics located throughout the United States, often run by churches or non-profit organizations. These clinics provide health care to local low-income residents and needy individuals, and the fees at these clinics typically depend on your income.
  • Charity Care: As the name suggests, charity care is just that; charity. Charity care, also commonly referred to as uncompensated health care, is health care provided for free, or at a reduced cost, to people with limited income who would otherwise be unable to pay for their treatment. Charity care is available at participating hospitals and similar healthcare facilities, and while patients generally need to apply for it, some hospitals are required to screen for it before sending patients' bills to collections. While a community health center or free clinic primarily treats people with limited ability to pay, charity care is provided at hospitals and facilities that typically treat insured patients and those with the ability to pay, but that agree to also provide a certain amount of charity care to patients who are unable to pay.

How to Obtain Charity Care

If you're in need of care that can't be provided at a free or sliding scale clinic, and you have fairly low income and are unable to pay for your treatment—either because you're uninsured or because you can't afford your health plan's out-of-pocket costs—you'll want to familiarize yourself with how charity care works at the nearby hospitals, and what state regulations apply.

The Affordable Care Act implemented some new rules that apply to tax-exempt charitable hospitals [26 U.S. Code 501(r)] in an effort to ensure that patients' bills aren't sent to collections until after the hospital determines whether the patient is eligible for charity care.

There are also a variety of state-based laws and regulations relating to charity care. For example:

  • Colorado requires hospitals to limit charges to the lowest amount that the hospital has negotiated with any insurance company, as long as the patient's income is less than 250% of the poverty level (federal poverty level numbers can be found here).
  • New Jersey's hospital charity care program applies to all acute care hospitals in the state and provides free or reduced-price medically necessary services to people whose income doesn't exceed 300% of the poverty level, and who have limited assets.
  • In California, a patient is eligible for free or reduced care at acute care hospitals if their income doesn't exceed 350% of the poverty level and they're either uninsured or if they are insured, their medical expenses exceed 10% of their income.
  • In Illinois, patients can qualify for charity care discounts with income as high as 600% of the poverty level and are eligible for free care if their income doesn't exceed 200% of the poverty level.

But other states, like Florida and Mississippi, have less generous guidelines and leave more of the details up to the hospitals.

You can find out more information about the specific requirements in your state by contacting your state's hospital association, reaching out to the state insurance department, or asking to speak directly with a social worker or financial assistance counselor at your local hospital.

If you're applying for financial assistance through the hospital's charity care program, be prepared to provide proof of income and assets, and information about any insurance coverage you may have, including the out-of-pocket costs that you have to pay.

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Article Sources
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  1.  Berchick ER, Hood E, Barnett, JC. Health Insurance Coverage in the United States: 2017. U.S. Census Bureau. September 2018.

  2. Garfield R, Orgera K, Damico A. The Uninsured and the ACA: A Primer - Key Facts about Health Insurance and the Uninsured amidst Changes to the Affordable Care Act. Kaiser Family Foundation. Updated January 25, 2019.

  3. American College of Emergency Physicians. EMTALA Fact Sheet.

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