A TikTok video from January told people that most hospitals are required to provide financial assistance, including free care, to people whose income falls under a certain level.
The video went viral. It earned 1.5 million views to date and a repost of the video from the same account gained 3.4 million views. The video has been viewed over 7 million times on Twitter and is gaining traction again thanks to a July 6 repost that has been retweeted more than 15,000 times.
THE QUESTION
Are most hospitals required to provide financial assistance, including free care, to people with incomes under a certain level?
THE SOURCES
THE ANSWER
Yes. The Affordable Care Act mandated nonprofit hospitals provide financial assistance to people with low levels of income and many for-profit hospitals do the same.
However, the exact policy and eligibility requirements vary by state and by hospital, so it’s important to check a hospital’s exact financial assistance policies. For example, not every hospital provides financial assistance for people with incomes up to $38,000, like some reposts suggested.
WHAT WE FOUND
A provision of the Affordable Care Act mandates hospitals must provide a “financial assistance policy” that must “must apply to all emergency and other medically necessary care provided by the hospital facility” in order for the hospital to maintain its tax-exempt status as a nonprofit.
According to the American Hospital Association’s 2021 fast facts, about 57% of community hospitals are nonprofits. So this provision applies to most hospitals.
To receive this financial assistance, also called charity care, a patient must receive medically necessary or emergency care at the hospital. The federal government defines “medically necessary” care as “health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.”
But there are no eligibility requirements the ACA outlines aside from that. Each state can set its own definitions of what’s medically necessary, and there is no income limit the federal government sets.
The Hilltop Institute, which provides guidance to policymakers regarding community benefit policy, charts state laws on community benefit policies, which charity care is a part of. The chart shows some states don’t specify eligibility requirements at all, while others specify different requirements from each other.
For example, in Colorado, patients making up to 250% of the federal poverty line can receive charity care, but in Illinois, only patients making up to 200% of the poverty line can receive full assistance and patients making up to 600% of the poverty line can receive discounts.
Of course, hospitals can offer financial assistance to a broader group of people than they’re required to. A report by the Lown Institute, a think tank that advocates for healthcare reform, found that for-profit hospitals — which don’t have the same requirements to provide charity care — spent just as much on it as nonprofit hospitals do.
Some nonprofit hospitals have made financial assistance difficult to access or not apparent to patients in the past. One nonprofit hospital system in Washington state lost a lawsuit to the state’s attorney general in 2019 that required the hospital to reform its charity care practices and pay restitution because the state found it withheld charity care from eligible patients.
"Hospitals are required to inform low-income patients about the availability of charity care,” Washington Attorney General Bob Ferguson said at the time. “St. Joseph failed to live up to its duty, and imposed obstacles on vulnerable Washingtonians trying to access affordable care. Today’s resolution rights a wrong committed against thousands of patients across Washington.”
Hospitals are required by federal law to make financial assistance information available on their websites. The law mandates hospitals include clear eligibility requirements and application resources within the online information.
That means the best way to check if a hospital has financial assistance options available, and what the requirements are to receive it, is to go online — just as the original TikTok video recommended.
Generally, to be eligible for charity care a patient needs to be uninsured, without access to other programs that would cover the care and have an income below a certain level relative to the federal poverty line.
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