Federal law requires that all nonprofit hospitals have financial assistance policies — also known as 'charity care' — to reduce or expunge people's medical bills.
Federal law requires that all nonprofit hospitals have financial assistance policies — also known as "charity care" — to reduce or expunge people's medical bills. New research from Dollar For, an organization dedicated to helping people get access to charity care, suggests that fewer than one-third of people who qualify for charity care actually receive it.
Nothing super-dramatic: Remy broke his ankle in August of last year. Hello, emergency room. Hello, ER bill. Dan: So they went. And the folks at the ER gave Isaac more tylenol, he didn’t spit it out, his fever went down. They went home, relieved about Isaac and a little anxious about the bills. To reduce people’s bills, or even forgive them entirely, if their income falls below a level the hospital sets.
And in the past year, they’ve been up to a LOT and they've been learning alot. Before we pick up Clara’s story — which ends with her offering a new resource we can share — let’s get a big download from Jared. Dan: Finally, they undertook a major research project of their own. They analyzed thousands of IRS filings from nonprofit hospitals, and compared what they found to a study from the state of Maryland based on even more precise data.
Their conclusion: "We found that only 29% of patients with hospital bills they cannot afford are able to learn about, apply for, and receive charity care." None of which surprised Jared. Dan: Jared envisioned patients getting evaluated for charity care, and getting referred to Dollar For for help applying, before they check out. He thought
Dan: Jared talked to a lot of hospitals. He went to conferences for hospital revenue-department administrators. He didn’t get a lot of traction Jared: How do you, how do you do that? You know, how do you implement that? I mean, it’s a pain in the ass. And these hospitals, and more so, hospitals are not motivated to figure this out.Dan: North Carolina. In 2023, North Carolina expanded Medicaid. In July 2024, Governor Roy Cooper announced a program that would use Medicaid money to reward hospitals for forgiving Medical debt.
Jared: I’m very excited to see how that looks in the future. Because if you remember, the big four, like our shit list, is Texas, Florida, Georgia, North Carolina. This law essentially says that they have to identify them early. So that’s like - on paper, you know, it sounds amazing. Dan: They raised a stink. And claimed the whole thing would be illegal, the feds shouldn’t approve it.
Dan: Lose OUT on a ton of NEW federal money. A ton. According to KFF’s reporting, a single hospital system stands to gain like 800 million dollars a year for participating. An Arm and a Leg is a co-production of Public Road Productions and KFF Health News — that’s a nonprofit newsroom covering health issues in America. KFF’s reporters do amazing work — you just heard one of them breaking down how North Carolina put that deal together. I’m honored to work with them.
Related StoriesJared: In Oregon, they had that law that was like, Oh, you can’t sue patients without first checking to see if they’re eligible for charity care. . And then you find all these people that are being sued that were never screened. Some hospitals around the country already use automated systems for this: They check your credit, pull other data. Some of them use AI.Jared: Some hospitals that are using presumptive eligibility tools will use that as a way to say, Oh, we already screened you. You can’t apply, but the patient is sitting there going, well, I’m eligible.
Jared: We are trying to figure that out. Um, obviously the election will play into that, but I think that if I had to guess where we would land, um, I think that we will double down on our patient advocacy work. And we just heard Jared say they're not backing away from that work, even as they aim to influence policy.Jared: We think that we’re going to get a little bit more feisty, uh, moving forward. So I’m, I’m excited about that.
Dan: So, she went and found her hospital’s financial assistance policy online. Saw that her family met their income requirements. Found the form. Submitted it. Got offered a discount… that still left her family on the hook for more than they could comfortably pay.But she didn’t find all of the information she needed online. The process wasn’t quick.
Her persistence paid off. In the end, the hospital reduced that 1800 dollar bill to just 500 dollars. Clara: In the event that it’s not, I think we just put it on like the longest payment plan we can. Maybe we would ask family for help. Dan: Clara thought it might be useful because part of the application and appeal process — not all of it was just facts and figures and pay stubs. There was also an opportunity to write a letter. Which opened up questions.
A big lesson here is, don’t take no for a final answer. Don’t take “We’ll help you this much” for a final answer. Clara discovered one other thing: Don’t give up if it looks like you may have missed a deadline. She missed one.
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