Many hospitals expanded charity care in COVID-19 pandemic, but some didn't

Many hospitals adjusted their charity care policies during the COVID-19 pandemic, and some health systems revised their rules to make it easier for patients to get help, a recent study found.

In an analysis of 151 tax-exempt hospitals that had publicly available charity care policies, 77 hospitals (51%) made substantial changes, according to a study published by Jama Network Open.

Many of the hospitals expanded charity care; the study found 47 hospitals (31%) offered more help in the pandemic.

However, 12 hospitals (7.9%) opted to impose more restrictive policies, the study found.

Researchers from the University of South Carolina and Johns Hopkins University examined hospital policies from 2019 through 2021.

“Tax-exempt hospitals appear to have updated their policies with mostly positive changes during and after the onset of the COVID-19 pandemic; however, some hospitals restricted charity care in 2021 documents,” the authors wrote.

Hospitals offering more generous charity care policies typically expanded income eligibility for patients, the authors found. The expanded charity care involved more generous income cutoffs for free and discounted care, the duration of coverage, and assistance for those who are underinsured.

“These expansions are remarkable given the lack of federal requirements to do so,” the authors wrote.

However, the authors also noted policies limiting assistance.

Among hospitals that tightened their charity care policies, most opted to impose more restrictive residency requirements, the study found. Some limited eligibility for the hospital’s service area, but some imposed restrictions based on immigration status.

“Some hospitals added unusual service restrictions such as exclusion of coverage for services while in the custody of law enforcement and exclusion of birth control,” the authors said.

Researchers said hospital consolidations, which some would presume would create more resources, didn’t necessarily lead to expansions of charity care.

Also, the study didn’t find a link between broader charity care policies and states that expanded Medicaid, even though those states would have fewer uninsured residents.

The authors did suggest hospitals should be more open with their charity care policies to ensure people in need can get assistance.

“Policy makers should consider requiring greater transparency and simplification for hospital charity care policies to ensure adequate access to care for uninsured and underinsured patients,” the authors wrote.

Some critics have assailed hospitals for not providing more charity care.

The Alliance for Integrity and Reform of 340B contends most hospitals participating in the federal 340B program offer charity care at a lower rate than the average hospital. The 340B program offers discounts on some outpatient drugs for hospitals serving a high number of patients from underserved communities.

Many hospitals have reported substantial losses in the COVID-19 pandemic. Hospitals have lost billions of dollars this year, and more than half of all hospitals are projected to finish the year with negative margins, according to a report from the American Hospital Association.