Access Denied

Columbia Legal Services (CLS) has authored a new report to document the health of Washington’s charity care safety net and to also suggest policies which will improve access to charity care statewide. The report, “Access Denied: Washington’s Charity Care System, its Shortfalls, and the Effect on Low-Income Patients,” discusses the history of charity care in Washington State, the right for low-income Washingtonians to access healthcare, and offers policy ideas that will improve the current system and standards. (En Español)

Hospitals in Washington have an affirmative duty to determine patient eligibility for charity care, but when eligible patients aren’t made aware of the benefit they may forego essential care or face crushing debt collection lawsuits after receiving care. Despite this requirement, provision of Charity Care across Washington State has been on a steady decline in recent years. The amount of charity care provided by Washington hospitals has fallen from about 3.0% of revenues in 2013 to just 0.92% in 2015, in large part due to Medicaid expansion. Yet there are an estimated 522,000 uninsured individuals in Washington, many of whom face barriers to receiving the hospital care they need and are legally entitled to receive.

Seeing this warning flag alongside potential federal health coverage repeal, CLS conducted an investigation to determine what barriers exist when it comes to accessing charity care and how they can be addressed.

  1. To answer these and other questions, CLS retained a nationally renowned research group, the Equal Rights Center (ERC), to conduct a comprehensive survey regarding access to charity care. The testing focused specifically on language access and charity care availability to Spanish-language speakers in hospitals throughout Washington State.[i] The ERC’s final report demonstrates widespread language barriers for non-English speaking individuals:
  • 28% of the Spanish-language calls failed to elicit any information from the hospital about financial assistance, although that information was relayed 90% of the time to English speakers.
  • Just 13% of the time, a Spanish-speaking caller received information regarding the application process for financial assistance or was offered an application for financial assistance, while that information was provided to English speakers more frequently in 40% of total tests.
  • 80% of the sites surveyed disconnected the calls at least once because the tester was trying to communicate in Spanish.  
  • Just 10% of the tests resulted in the Spanish-speaking caller being connected to an interpreter.

A thorough examination of hospital charity care policies also revealed numerous legal shortfalls when it comes to provision of charity care.

As part of our ongoing campaign to increase access to charity care, we authored 12 letters to hospitals that performed poorly in providing adequate language access, have charity care policies which violate state or federal law, or have unreasonably low provisions of charity care compared to other hospitals. Together, these policies, practices, and procedures prevent persons in great need from obtaining critical information regarding their health care, which can lead to unmanageable medical debt, bankruptcies, and long-term poverty.

The law in Washington is clear – low income residents of this state have a right to charity care. We urge these hospitals, which represent just a cross section of those across our state, to correct their illegal or insufficient practices immediately.

Find out more about our Fair Access to Hospital Care Campaign, including a factsheet and brochure, litigation, advocacy in the state legislature, media coverage, and a video of a press conference launching the campaign.

Note: The electronic version of the report above has been updated since the print version went to print in July 2017.

Media Coverage:


[i] Here is a list of all the hospitals tested and the hospitals receiving letters are linked: