Hospitals have changed charitable care guidelines during the pandemic, a study shows

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diving letter:

  • A number of tax-exempt hospitals have expanded their charitable care policies during the COVID-19 pandemic, but unclear and undisclosed eligibility criteria remain common and deserve regulatory attention, according to a study published Tuesday in JAMA Network Open.
  • Researchers comparing charitable care policies at 151 tax-exempt hospitals for 2019 and 2021 found that 47 (31%) of providers expanded charitable care, while 12 (8%) made restrictive changes.
  • A total of 127 (84%) hospitals updated their policies and 77 (51%) made significant changes in categories such as income limits, asset limits, and benefit exclusions. Even so, vague selection criteria were common, the study noted.

Dive insight:

Hospitals are required to provide charitable care to maintain tax-exempt status. The Affordable Care Act also required tax-exempt hospitals to post their policies online with clear eligibility criteria and benefits covered.

In practice, the content of published charitable care guidelines varies widely, according to the JAMA Network Open study. The analysis follows a New York Times investigation into the Washington-based Providence health care system, which found that the provider plagued patients who should have been entitled to financial assistance.

California has increased its focus on charitable rights. State Attorney General Rob Bonta warned hospitals earlier this summer that failing to make patients aware of free or low-cost care violates state law. The warning followed complaints to Bonta’s office that hospitals were not providing communications in a language patients understood.

The JAMA investigation found that the most common changes to charitable policy statements between December 2019 and December 2021 were an expansion of eligibility criteria. Policy changes primarily established income limits for free and discounted care, residency status, presumed eligibility, length of insurance, and eligibility for underinsurance.

Despite the generally positive changes, researchers found cause for concern, including nearly 8% of hospitals restricting charity care through eligibility requirements and coverage changes and policies that continue to use vague language. Non-specific language is common in care policies for charities, the report said.

“Policymakers should consider calling for greater transparency and simplification of care policies for hospitals to ensure appropriate access to care for uninsured and underinsured patients,” the researchers concluded.

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