Charity care residency

AN ACT Relating to protecting access to health care services for 1
Washington state residents through limiting charity care to those 2
individuals that meet Washington state residency requirements; 3
reenacting and amending RCW 70.170.020; adding a new section to 4
chapter 70.170 RCW; creating a new section; and declaring an 5
emergency. 6
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:7
NEW SECTION. Sec. 1. (1) The legislature finds that Washington 8
hospitals provide significant benefits to their communities in the 9
form of charity care for both emergency services and nonemergency 10
services. In 2022, hospitals statewide provided $483,000,000 in 11
charity care services to patients.12
(2) For over 30 years, the department of health approved hospital 13
charity care policies that included clauses restricting charity care 14
eligibility to residents of the state of Washington and out-of-state 15
patients in need of emergency care. This has ensured that hospitals 16
have sufficient resources to serve and care for the residents of 17
their local communities before providing free care to patients from 18
around the globe. In 2022, the department of health reversed this 19
decades-long policy and began sending letters to individual hospitals 20
requiring policy updates to remove these restrictions. In September 21
H-2442.2
HOUSE BILL 2250
State of Washington 69th Legislature 2026 Regular Session
By Representatives Engell, Rule, Jacobsen, Barnard, and Schmick
Prefiled 01/05/26. Read first time 01/12/26. Referred to Committee
on Health Care & Wellness.
p. 1 HB 2250
2023, the department issued an interpretive statement requiring all 1
remaining hospitals with geographic restrictions to update their 2
policies by removing the restrictions by January 2024.3
(3) The legislature finds that this new approach taken by the 4
department has the potential to make Washington state a medical 5
tourism destination, drawing patients from other states and countries 6
for free care ranging from routine procedures to state of the art, 7
specialized treatment. The consequences of this would be delays in 8
care, challenges for Washingtonians in accessing care, and an 9
increase in the cost of care for Washingtonians. 10
(4) Washington hospitals are already facing significant capacity 11
constraints. Washington has the fifth-fewest hospital beds per capita 12
of all the states in the nation. Additional people coming to 13
Washington for care will put a further strain on capacity in 14
Washington's hospitals, limiting local residents' access to care and 15
impacting patient well-being. 16
(5) Without legislative intervention, the department's new 17
interpretation would also increase the cost of care for 18
Washingtonians. Expenses for the additional delivery of free care 19
will be passed along to other patients who do pay. People living in 20
Washington will be forced to subsidize charity care services for 21
people from outside of the state and outside of the country.22
(6) The legislature therefore clarifies and declares that, while 23
hospitals may exceed any of the requirements of the charity care law, 24
including serving those from outside the state, the purpose of 25
charity care is to provide a standardized approach in law addressing 26
affordable medical care to low-income Washingtonians and those from 27
outside the state in need of emergency care. 28
NEW SECTION. Sec. 2. A new section is added to chapter 70.170 29
RCW to read as follows: 30
(1) Eligibility for charity care is limited to Washington state 31
residents. 32
(2) For purposes of this chapter, a resident is a person, 33
including an emancipated person under age 18 and a married person 34
under age 18 who is capable of indicating intent, who currently lives 35
in Washington and: 36
(a) Intends to reside here indefinitely, including persons 37
without a fixed address; or 38
(b) Entered the state looking for a job; or 39
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(c) Entered the state with a job commitment. 1
(3) A person does not need to live in the state for a specific 2
period of time prior to meeting the requirements in subsection (2) of 3
this section before being considered a resident. 4
(4) A child under age 18 who is not covered by subsection (2) of 5
this section is a resident if: 6
(a) The child lives in the state, with or without a fixed 7
address, including with a custodial parent or caretaker; or8
(b) The child's parent or caretaker is a resident as defined in 9
subsection (2) of this section. 10
(5) A resident who leaves the state for over a month does not 11
lose their residency if the person: 12
(a) Intends to return to the state once the purpose of his or her 13
absence has been accomplished and provides adequate information of 14
this intent after a request by the hospital; and 15
(b) Has not been determined eligible for medicaid or state-funded 16
health care coverage in another state other than coverage in another 17
state for incidental or emergency health care. 18
(6) A person who enters Washington state for health care is not a 19
resident and is not eligible for charity care. 20
(7) A person receiving emergency care under 42 U.S.C. Sec. 21
1395dd, or that patient's guarantor, will be considered a resident 22
for purposes of receiving charity care. 23
(8) A person of any age who receives a state supplemental payment 24
is considered a resident of the state that is making the payment.25
(9) A person who receives federal payments for foster or adoption 26
assistance is considered a resident of the state where the person 27
physically resides even if: 28
(a) The person does not live in the state that is making the 29
foster or adoption assistance payment; or 30
(b) The person does not live in the state where the adoption 31
agreement was entered. 32
(10) Immigration status may not be taken into account when 33
determining an indigent person's residency. 34
Sec. 3. RCW 70.170.020 and 2024 c 121 s 28 are each reenacted 35
and amended to read as follows: 36
As used in this chapter: 37
(1) "Charity care" means medically necessary hospital health care 38
rendered to indigent persons when third-party coverage, if any, has 39
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been exhausted, to the extent that the persons are unable to pay for 1
the care or to pay deductibles or coinsurance amounts required by a 2
third-party payer, as determined by the department.3
(2) "Department" means department of health. 4
(3) "Hospital" means any health care institution which is 5
required to qualify for a license under RCW 70.41.020(((8))) (9); or 6
as a behavioral health hospital under chapter 71.12 RCW.7
(4) "Indigent persons" are those patients or their guarantors who 8
qualify for charity care pursuant to RCW 70.170.060(5) based on the 9
federal poverty level, adjusted for family size, ((and)) who have 10
exhausted any third-party coverage , and who meet the residency 11
requirements established in section 2 of this act.12
(5) "Secretary" means secretary of health. 13
(6) "Special studies" means studies which have not been funded 14
through the department's biennial or other legislative 15
appropriations. 16
(7) "Third-party coverage" means an obligation on the part of an 17
insurance company, health care service contractor, health maintenance 18
organization, group health plan, government program, tribal health 19
benefits, or health care sharing ministry as defined in 26 U.S.C. 20
Sec. 5000A to pay for the care of covered patients and services, and 21
may include settlements, judgments, or awards actually received 22
related to the negligent acts of others which have resulted in the 23
medical condition for which the patient has received hospital health 24
care service. The pendency of such settlements, judgments, or awards 25
must not stay hospital obligations to consider an eligible patient 26
for charity care. 27
NEW SECTION. Sec. 4. This act is necessary for the immediate 28
preservation of the public peace, health, or safety, or support of 29
the state government and its existing public institutions, and takes 30
effect immediately.31
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