All 97 community hospitals in Washington have agreed to provide free or discounted care to patients based on income, the first time a uniform...

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All 97 community hospitals in Washington have agreed to provide free or discounted care to patients based on income, the first time a uniform standard for charity care has been adopted.

For 40 percent of the hospitals, the voluntary agreement is less generous than policies already in place. Still, the pledge improves on state law, which requires hospitals to write off charges for indigent patients but has set no minimums.

The agreement comes as nonprofit hospitals across the nation are under increased scrutiny over the amount of charity care they provide under their tax-exempt status. And they have been criticized for charging uninsured patients higher rates than for people with insurance.

Under the new guidelines, anyone with income at or below the poverty level ($13,200 for a couple; $20,000 for a family of four) will receive free care. Those with incomes up to twice the poverty level will pay just the hospital’s cost.

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That will be calculated by subtracting the markup that every hospital is required to disclose to Medicare and the state Department of Health, said Cassie Sauer, spokeswoman for the Washington State Hospital Association, which led the efforts to standardize charity care.

People earning up to three times the poverty level, and who have no insurance and limited assets, will be charged no more than what a typical insured patient would pay. In Washington, Sauer said that averages about 30 percent over cost. The new guidelines do not apply to state-owned mental hospitals such as Western State Hospital or to military hospitals.

Many hospitals, including Seattle’s major ones, already have charity-care policies that exceed the new guidelines. They will keep them in place.

Seattle’s Virginia Mason, for instance, provides free care to people with incomes at double the poverty level. So do Swedish Medical Center and Harborview Medical Center.

For others, such as Kirkland’s Evergreen Hospital Medical Center and Auburn Regional Medical Center, the changes will mean financial breaks for more families than before.

“For most hospitals, our new pledge is an expansion,” Sauer said.

The hospitals also have agreed to provide written notice about the availability of charity care to all patients. Posters in nine languages will inform patients of how to get financial help if they can’t afford their bills.

Hospitals already are required by law to treat anyone with a medical emergency, regardless of the person’s ability to pay. But patients with non-urgent conditions typically must first see a doctor to get admitted to a hospital. Private doctors’ fees are not part of the charity-care pledge.

“Uninsured patients’ ability to get private physician care remains a serious concern,” Sauer said.

Kyung Song: 206-464-2423 or

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