SPOKANE — The Washington State Hospital Association filed suit Monday against the state Department of Health over a proposed rule allowing out-of-state patients to receive charity care, claiming such a policy would make medical care harder to access and more expensive for Washington residents.
“It requires hospitals to provide free or discounted care to anyone from anywhere. The new approach would make Washington State a medical tourism destination,” Taya Briley, the association’s lawyer, said in a statement.
First created in 1989, Washington’s charity care law requires hospitals to make financial assistance available to patients within 300% of the federal poverty level for their out-of-pocket medical bills. That creates an upper limit of $43,000 a year for an individual and a limit of $90,000 or less for a family of four. Those within 400% of the poverty level are eligible in some hospitals.
Four million Washingtonians qualify for free or discounted hospital care under an expanded charity care program passed by the Legislature last year.
“Approximately half of all Washingtonians are eligible for free or reduced-cost care at Washington state hospitals,” the Attorney General’s office noted last year upon implementation of the expanded program. “These protections apply to out-of-pocket hospital costs, including co-pays and deductibles, regardless of insurance status. Washington law now provides the strongest protections in the country for out-of-pocket hospital costs.”
Advocating on behalf of their member hospitals, the hospital association disputed the Department of Health interpretation of the updated law, which extends benefits to patients who live out of state but are being treated in Washington.
“Using geographic boundaries to determine charity care eligibility is not supported under current law,” the Department of Health determined last month.
“Hospitals may not adopt policies that exclude patients from eligibility for charity care if they are otherwise income-eligible,” the department wrote. It claimed a “small number” of hospitals had been restricting eligibility to people within a geographic boundary — either the state as a whole or smaller boundaries like the county or ZIP code of the hospital.
The Department of Health required any hospital in violation of its interpretation of the law revise their charity care policy to be in compliance by Jan. 16.
Rather than comply with the administrative rule, hospitals across the state sued.
“The Department’s new (and erroneous) interpretation of the Act will result in the exact opposite of the Legislature’s intent in enacting the Charity Care Act: By requiring Washington hospitals to provide free or discounted care to indigent persons from anywhere in the world, the Department will decrease access for Washingtonians, and will increase the costs of care for Washingtonians who will inevitably subsidize the costs of free care to others from outside of the State,” reads the lawsuit filed in Thurston County Superior Court Monday.
A spokesperson for the Department of Health declined to comment on the lawsuit but provided a statement on the agency’s responsibilities for the charity care program.
“The agency is tasked with supporting the charity care statutes, and ensuring patients who meet the program’s criteria have access to care regardless of their financial standing. The department’s mission is to support the health and well-being of patients,” the Department of Health statement reads.
According to the hospital association, increased expenses based on the administrative rule will be passed on to in-state patients who pay for their hospital stays.
“There is no such thing as free care. Nurses, physicians, pharmacists, housekeepers and other staff who care for charity care patients still must be paid,” Cassie Sauer, CEO of the hospital association, said in a statement. “Under the department’s interpretation, people living in Washington will subsidize charity care services to people from outside of the state.”
Washington hospitals provided $370 million worth of free or discounted medical care in 2021 through charity care policies.
