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New York State hospital charity care programs.

Free or low cost medical care must be provided to New York residents per the Hospital Financial Assistance Law (HFAL). This assistance is often called charity care and is available for qualified uninsured or underinsured patients who also meet low income levels. Residents that are facing high hospital bills or who are in need of affordable or free medical care from their medical provider or hospital can benefit from this state of New York program.

While guidelines can change, in general the state of New York and the HFAL program have established a sliding fee scale rate for all patients without health insurance and whose total household income is at or below 300% of the federal government poverty level. State law requires that all New York hospitals need to administer financial assistance or grant programs. They must have policies for determining eligibility for discounted health care on file with the New York State Department of Health, so the process is formal and regulated. In addition, the HFAL program also limits and controls debt collection practices for all hospitals. As an example of this, hospitals are prohibited from issuing collection notices or bills while an application from the patient for financial assistance is still pending.

When determining eligibility, the HFAL program does allow hospitals to take the individuals and families resources and total assets into account when they are applying. This is reviewed on a case by case basis, and the law allows medical providers to reduce discounts for patients with significant assets, but only for patients with income below 150% of the FPL. There also needs to be prior approval from NYSDOH.

It is also important to keep in mind that each hospital's charity care and financial assistance program can be different. Anyone who is interested in learning more should be sure to obtain a copy of the current policy and regulations from your local hospital. The hospital's financial assistance policy should include information about debt collection practices as well if the person were to not pay their bills on time. A number of key elements and conditions are also required in all hospital financial assistance programs, and these are expanded upon below.




Conditions of the Hospital Financial Assistance Law

All hospitals across New York need to make financial assistance and installment plans available to qualified patients who are unable to pay the reduced rates on their bills all at one time. Interest rate levels and any fees will also be limited and cannot be increased based on the patient missing payments. Any monthly payments can’t be set at greater than 10% of the patient's total gross monthly income.  Another rule is around deposits, and although hospitals can charge the patient who is admitted a deposit up front on reduced rates, the deposits cannot in themselves be looked at as an undue obstacle to accessing services and they can’t prevent someone from getting what they need.

New York limits on hospital debt collection practices are in place as well, and they are as follows.

  • Collections can’t be commenced against any patient who was eligible for Medicaid or government care at the time services were provided. Overdue bills or an account also can’t be sent for collections if an application for financial assistance is pending.
  • Hospitals need to also require that any contracted third party debt collections agencies comply with the state’s and hospital’s financial assistance policy, so that process is regulated too.
  • Patients who received health care must receive notification that an account will be referred to the collections process at least 30 days prior to the referral occurring.
  • All information on how to apply for financial assistance and charity care needs to be readily available to the individual seeking help.
  • A legal action can’t be started without written consent of the hospital.
  • A person’s home can’t be foreclosed on. New York will not allow the forced sale or foreclosure of a patient's primary residence in order to collect on an unpaid or outstanding medical bill.

The state encourages medical bill advocates to ask hospitals to allow any uninsured or low-income patient, who can’t afford their bills, to apply for financial assistance or charity care. Often times what will happen is violations of the above requirements under HFAL will help extend the timeline for a financial assistance application.

The Hospital Financial Assistance Law only applies to patients who receive their care at a hospital. New York does not have in place any laws or regulations for other doctors, clinics, or health care providers that are not hospital facilities. Therefore patients who are billed by doctors or physicians who may be practicing at hospitals but who are not directly employed by the center will not be entitled to the HFAL program. So they will not be required to have access to charity care, there will not be restrictions on debt collection practices, no limits on charges, and the applicant is not guaranteed the right to apply for financial assistance for their bills.




By Jon McNamara

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