More hospitals tighten up charity care policies

Hospital systems are scaling back on charity care for uninsured patients, hoping to convince them to obtain insurance via Medicaid or the health insurance exchanges, the New York Times reported.

Among the providers to change their charity care policies are Barnes-Jewish Hospital in St. Louis, which now charges the uninsured co-payments, ranging from $50 for an office visit to $100 for a trip to the emergency room. Fletcher Allen Health Care in Vermont and Southern New Hampshire Medical Center also scaled back charity care for patients who are above the federal poverty line. The Times noted that many providers seem focused on rolling back charity care for patients who earn between 200 percent and 400 percent of the poverty level.

"Do we allow our charity care programs to kick in if people are unwilling to sign up?" Nancy M. Schlichting, chief executive of the Henry Ford Health System in Detroit, told the Times. "Our inclination is to say we will not, because it just seems that that defeats the purpose of what the Affordable Care Act has put in place."

Charity care policies range widely from hospital to hospital, although reports from other news organizations indicate that many more are demanding cash upfront from indigent patients or are using tough collection practices after care is delivered.

The practice has raised concern among patient advocates, who believe the efforts will actually discourage those in the lower-income brackets from obtaining care, according to the Times. One patient of Barnes' parent, BJC Healthcare, purchased insurance but is worried that her annual income of little more than $13,000 will prevent her from paying premiums.

Some states, such as California, are debating new laws that would mandate minimum levels of charity care to be provided by hospitals.

Missouri is also among the two dozen states that have yet to expand income-based Medicaid eligibility under the Affordable Care Act, a circumstance that is making it more difficult for hospitals operating in those states to cut back on their charity care.

To learn more:
- read the New York Times article