Can a hospital exclude a patient from charity care if that patient is eligible for the exchange plans or Medicaid?
Answer 1: We would not exclude a patient for this reason. When we identify a patient who may qualify for Medicaid, we offer them assistance in applying. Our experience is that nearly all of our patients cooperate because they understand the benefit of having insurance. And realistically, what is the benefit of refusing to classify patients as being eligible for charity if they meet the means test? Classifying their care as bad debt instead has no benefit that I can see.
This question was answered by: Brenda Loper, regional director of access services, Sentara Healthcare, Norfolk, Va., and a member of HFMA’s Virginia-Washington D.C. Chapter.
Answer 2: Part of our board-approved financial assistance/charity care policy is that the patient applies for Medicaid as a first step.
This question was answered by: Robert T. Hoover, director, revenue cycle, Meadville Medical Center Health System, Meadville, Pa., and a member of HFMA’s Western Pennsylvania Chapter.
Answer 3: In general, I would not exclude anyone from charity care because they did not apply for an exchange product. In the case of Medicaid eligibility, many patients are screened early in the patient access process, so they may qualify and gain coverage before other options, such as charity care, need to be considered.
State requirements may also be helpful in determining when to offer charity care. For example, in New York, we can require patients to apply for Medicaid, so Medicaid eligibility is known before charity care is considered.
Another consideration is that exchange plans are not retroactive, but charity care generally is retroactive, so excluding patients from charity care may preclude them from coverage for care already received.
This question was answered by: Kelly McGinnis, director of revenue cycle, HealthAlliance of the Hudson Valley, Kingston, N.Y., and a member of HFMA’s Hudson Valley New York Chapter.
Answer 4: We use analytics to determine if the patient would be approved for Medicaid. We only require it if they meet the criteria based on that review. If we know they will not qualify based on income, or other factors, then we don’t require Medicaid application to obtain charity care.
This question was answered by: Christine Fontaine, vice president of revenue cycle solutions, OptumInsight, Annapolis, Md., and a member of HFMA’s Maryland Chapter.
Answer 5: It depends on the healthcare organization’s financial assistance policy and state regulations. In facilities I have worked in, it has been allowed to exclude patients from charity care if they did not apply for other available payment options.
This question was answered by: Caswell Samms, network CFO, Generations+/Northern Manhattan health Network, New York.
Answer 6: Requiring patients to apply for exchange plans is complex. There are patients who have difficulty affording the premiums, even with subsidies. I would not automatically exclude patients because they haven’t signed up for exchange plans, but instead look at other options and patients’ incomes and other factors.
This question was answered by: Ruth Lande, vice president, patient revenues, Memorial Sloan-Kettering Cancer Center, New York, N.Y., and is a member of HFMA’s Metropolitan New York Chapter.
The information provided through the Forum’s Ask the Expert service does not constitute legal advice, even when the advice is provided by lawyers. You need to obtain your own legal counsel for legal advice, and consider the laws and regulations that govern your state. The content and opinions expressed are those of the Forum experts, and not that of their employers or of HFMA. HFMA does not endorse the material or warrant or guarantee its accuracy. The responses are based only on the specific facts or circumstances provided. Forum experts cannot be held liable for outcomes related to any information provided.
