These are the legal provisions related to hospital financial assistance/charity care in the state of New York. This is intended for educational use and should not be treated as legal advice.
Is there a state charity care law?
Yes, New York has its own law.
Qualifications for charity care in New York
Does the law specify a minimum Federal Poverty Level (FPL) for charity care?
New York's law regarding minimum FPL is as follows: Under state law, a hospital must not charge out-of-pocket costs to patients with household incomes below 200% FPL. Uninsured patients between 200% – 300% FPL may not be charged more than 10% of the Medicaid rate. Underinsured patients between 201% – 300% FPL may not be charged more than 10% of what their cost-sharing would be per their insurance plan. Uninsured patients between 301% - 400% FPL may not be charged more than 20% of the Medicaid rate. Underinsured patients between 301% – 400% may not be charged more than 20% of what their cost-sharing would have been per their insurance plan.
Does the law specify a minimum deadline for applying for charity care?
New York's law regarding a minimum deadline is as follows: A patient may apply for charity care at any time during the collection process.
Does the law specify that having insurance disqualifies a patient for charity care?
New York Law requires insured patients to be eligible for charity care if their medical bills from the last 12 months exceed 10% of their gross yearly income.
Does the law specify that patients must be residents to be eligible for charity care?
Charity care policies must apply to all patients who received emergency hospital services, who reside in New York, and who receive medically necessary services and also reside within the hospital’s primary service area.
Does the law specify that patients must be US citizens or documented immigrants/lawful permanent residents to be eligible for charity care?
New York law specifically says that immigration status may not be considered by the hospital.
Does the law specify that patients must owe a minimum bill amount in order to be eligible for charity care?
New York 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 New York
Does the law specify that patients cannot be responsible for a copay if they are eligible for charity care?
If the patient’s medical bills from the past 12 months exceed 10% of their gross annual income then the hospital must apply charity care to the patient’s copays.
Does the law specify that hospitals cannot deny financial assistance to cover patient copays, coinsurance, or deductibles?
If the patient’s medical bills from the past 12 months exceed 10% of their gross annual income then the hospital must apply charity care to the patient’s copays.
Collections laws related to charity care in New York
Does the law specify that hospitals cannot deny financial assistance to cover patient copays, coinsurance, or deductibles?
For a hospital to participate in New York's indigent care pool, a hospital cannot send a bill to collections if there is a pending financial assistance application. Otherwise, a bill can be sent to collections if the patient has been provided written notification of the financial assistance program within 30 days of the bill being referred to a collector.
Length of time charity care can be applied to future bills in New York
Does the law specify that hospitals must honor a charity care decision for future bills for a specific length of time?
New York 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.