These are the legal provisions related to hospital financial assistance/charity care in the state of California. This is intended for educational use and should not be treated as legal advice.
Is there a state charity care law?
Yes, California has its own law.
Qualifications for charity care in California
Does the law specify a minimum Federal Poverty Level (FPL) for charity care?
California's law regarding minimum FPL is as follows: Individuals within 400% of the FPL or underinsured patients who have experienced out-of-pocket costs exceeding 10% of their income in the last 12 months are eligible for free or reduced care.
Does the law specify a minimum deadline for applying for charity care?
No, California law does not specify a minimum deadline, so federal law would apply.
Federal law specifies a minimum application deadline of 240 days from the date the hospital sent the first post discharge statement/bill.
Does the law specify that having insurance disqualifies a patient for charity care?
California's charity care law applies to uninsured patients within 400% FPL or insured patients who are either within 400% FPL or who have faced out-of-pocket medical expenses in the last 12 months exceeding 10% of their annual income.
Does the law specify that patients must be residents to be eligible for charity care?
California law explicitly requires hospitals to provide assistance regardless of residency.
Does the law specify that patients must be US citizens or documented immigrants/lawful permanent residents to be eligible for charity care?
California law explicitly requires hospitals to provide assistance regardless of immigration status.
Does the law specify that patients must owe a minimum bill amount in order to be eligible for charity care?
California law does not address this matter, so federal law would apply.
Federal law says that non-profit hospitals may not require a minimum bill amount for a patient to qualify for charity care. All emergency and medically necessary care conducted at a non-profit hospital is eligible for charity care.
How the law applies to copays in California
Does the law specify that patients cannot be responsible for a copay if they are eligible for charity care?
California prohibits requiring a copay for emergency services.
Does the law specify that hospitals cannot deny financial assistance to cover patient copays, coinsurance, or deductibles?
California prohibits requiring a copay for emergency services.
Collections laws related to charity care in California
Does the law specify that hospitals cannot deny financial assistance to cover patient copays, coinsurance, or deductibles?
However, you can still apply for (and are entitled to) charity care after you have been referred to a collection agency. A debt cannot be referred to a debt collector until 120 days after the hospital sent the first post-discharge bill. They cannot sell the debt to a debt buyer until the hospital finds a paitent ineligible or the patient has not responded for 180 days.
Length of time charity care can be applied to future bills in California
Does the law specify that hospitals must honor a charity care decision for future bills for a specific length of time?
California law does not address this matter, so federal law would apply.
Federal law does not directly address this. Nonprofit hospitals are simply required to follow their financial assistance policy.