Financial aid guidelines recommended by CHA

Limit expectations, hospitals told

The California Healthcare Association (CHA) has adopted a new set of voluntary guidelines on financial aid, charity care, and discount payments for its member hospitals, including a recommendation that hospitals provide financial assistance for patients at or below 300% of the poverty level. The guidelines focus on low-income patients and the uninsured, says CHA spokeswoman Jan Emerson. CHA is encouraging hospitals to limit what’s expected of low-income or uninsured patients that qualify for these discounts, barring any Medicare prohibition.

The guidelines also suggest hospitals wait a minimum of 120 days before notifying collection agencies of overdue payments, work with collection agencies to develop clear policies for low-income and uninsured patients that align with the hospital’s mission, and that such policies not include wage garnishments or liens on a patient’s primary residence.

"To me, [the guidelines] are not really anything new," says Bret Kelsey, corporate director for patient financial services at Community Medical Center in Fresno, which serves a large indigent population. "A lot of those things we’re already doing." But Kelsey says he plans to stick with a financial assistance threshold of 150% of the federal poverty level — not the 300% recommended by CHA — unless mandated to do otherwise.

He notes, however, that Community Medical Center exercises leeway in its handling of financial aid, using "means testing" to make decisions, often on a case-by-case basis. A patient making as much as $50,000 a year, for example, still might qualify for help with a $300,000 hospital bill, Kelsey says. "Some miss the charity guidelines by a few thousand dollars, but they have a $20,000 bill," he adds. "We’ll look at the total picture. What is their credit history? What is their ability to make any type of payment? We might cut them a deal, say, Give us the [amount of the] Medicare DRG [payment].’"

Community Medical Center also offers prompt-pay discounts — typically between 10% and 20% — to patients who will settle their bill within 30 days of the discharge date, Kelsey points out. "We may increase that to 30%." That kind of flexibility would be lost, he notes, if bill AB232 becomes law. "If it passes, [the state] is going to mandate what we can charge. I don’t agree with that at all."

According to information on the Health Access California web site,, the proposed legislation would:

  • Require each hospital to post its policy for payment by self-pay patients.
  • Require each hospital to include in the self-pay policy what is required to qualify for charity or free care.
  • Limit the price paid for hospital care by low- to moderate-income self-pay to the price paid by large government payers, specifically Medicare, Medi-Cal or workers compensation.
  • Require hospitals to provide the uninsured with information about Medi-Cal, Healthy Families and other programs for which the uninsured person might be eligible.