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Free Care & Community Benefits
People who have special health care needs or who lack quality, affordable insurance coverage must often depend on services provided by local health care institutions, such as hospitals and health plans. Many of these health care institutions are not-for-profit. Subsequently, they are exempted from local, state and national taxes in exchange for their commitment to provide community benefits, which include free care and targeted health programs for those most in need of services. Because so many people lack access to affordable, comprehensive health coverage under our current health care system, community benefits programs - and free care in particular - often offer the only safety net for these families in times of crisis.
Although many hospitals voluntarily provide free care and other services to people who cannot afford to pay, the free care and community benefits system is a confusing patchwork of individual hospitals’ voluntary efforts and vague legal standards. The result is an unstable supply of essential health services for vulnerable populations that vary from community to community. Community Catalyst works with communities to establish enforceable community benefit standards that protect access to essential health coverage and services, ensuring that health care institutions are meeting their obligations to the communities they serve.
- October 09, 2012 FAQ: Does the ACA Help Families with Hospital Bills? Recently, the IRS released draft rules that will further regulate hospital behavior, with some real wins for patients and families. This FAQ answers some common questions about the draft rules.
- October 09, 2012 Summary of Proposed Rules for Non-Profit Hospitals' Financial Assistance, Billing and Collection Practices Low- and middle-income families can be financially devastated by medical debt. The Affordable Care Act requires hospitals fufill certain requirements to protect low- and middle-income patients from medical debt. Community Catalyst outlines the rules IRS has proposed to hold hospitals accountable.
- October 05, 2012 Comments to the IRS and Treasury on the Notice "Additional Requirements for Charitable Hospitals" Community Catalyst and other organizations weigh in with the IRS and Treasury on requirements for charitable hospitals that help patients address the financial toll hospital bills can take.
- September 23, 2011 Comments on Community Health Needs Assessment Requirements for Tax-Exempt Hospitals Community Catalyst, along with 56 other organizations, submitted comments regarding the community health needs assessment for tax-exempt hospitals to the Internal Revenue Service
- June 23, 2011 Community Catalyst Letter to the Treasury regarding making Schedule H Optional for 2011 Community Catalyst was disappointed to learn of the IRS decision to make reporting on compliance with consumer protections in the Affordable Care Act optional for tax-exempt hospitals for Tax Year 2010. These protections, found in Section 9007 of the Affordable Care Act, offer significant relief from medical debt and improve access to health care for low- and middle income families.
- October 14, 2010 Testimony to the Massachusetts Public Health Council Regarding the Determination of Need for the Transfer of Ownership of the Caritas Christi Hospitals Community Catalyst testified about the proposed sale of the nonprofit Caritas Christi hospital system to a for-profit entity, recommending additional conditions be attached to its approval.
- September 10, 2010 Protecting Consumers, Encouraging Community Dialogue: ACA Requirements for Non-profit Hospitals This summary analyzes the ACA requirements private non-profit hospitals must meet and the increased reporting and oversight mechanisms to ensure compliance and transparency.
- September 01, 2010 Community Benefits: Protect Consumers and Strengthen Dialogue between Hospitals and Communities This brief outlines the ongoing importance of the safety net, and gives advocates steps to promote stronger standards for hospital community benefits programs to strengthen both consumer protections and relationships between hospitals and their communities.
- July 23, 2010 Comments to the IRS on New Requirements for Tax Exempt Hospitals Community Catalyst and 66 other organizations' letter to the IRS providing comments on the new requirements for hospitals.
- May 05, 2010 Best Kept Secrets: Are Non-Profit Hospitals Informing Patients About Charity Care Programs? This report from The Access Project and Community Catalyst show that many non-profit hospitals are not doing enough to meet AHA guidelines to have clear, written policies to help patients determine if they qualify for charity care and to make these policies available to patients and the public.
- May 05, 2010 Summary of Hospital Accountability Provisions in National Health Reform This outlines the provisions in national health care reform focused on non-profit hospitals, and how advocates can engage in making them effective.
- March 22, 2010 Protect and Target Federal Funding for Safety Net Hospitals Despite the historic national health care reform, millions of immigrants and other people will remain uninsured and will continue to rely on the safety net for their care. Advocates must ensure that Medicaid DSH funds for safety-net hospitals are actually serving the uninsured.
- May 30, 2008 Comments to IRS on Draft Instructions to Form 990, Schedule H A response to the proposed guidance on completing Schedule H, the new tax form nonprofit hospitals must file to describe their free care and community benefit activities
- November 09, 2007 Compendium of Community Benefit Laws The report analyzes requirements regarding provision of community health care services in 18 states.
- October 30, 2007 Congressional Testimony on Free Care and Community Benefit Standards Statement of Community Catalyst at the Roundtable on the Senate Finance Committee Minority Staff Discussion Draft on Tax-Exempt Hospitals
- September 27, 2007 Comments to Senator Grassley's Staff on Proposed Standards for Nonprofit Hospital Community Benefits (September 2007) A response to the July 2007 'Discussion Draft' regarding free care and community benefit standards for tax-exempt hospitals
- September 13, 2007 Comments to IRS on Draft Form 990, Schedule H A response to the proposed Schedule H, the new tax form nonprofit hospitals must file to describe their free care and community benefits
- November 01, 2004 Triad's New Market Strategy: A Threat to Community Hospitals Winter 2004 edition of Community Catalyst newsletter "States of Health."
- May 01, 2004 The Patient Financial Assistance Act and Commentary "Free Care Model Act" This model act and commentary can serve as a baseline for policymakers and stakeholders as they develop legislation to establish standards and oversight procedures for hospital financial assistance programs. It can be used side-by-side with the interactive Hospital Free Care Web Tool
- February 01, 2004 The ABC's of Negotiation: An Advocate's Guide to Negotiating with Providers to Improve Access to Health Care Services This guide was written as an information resource to familiarize advocates with some of the foundational concepts of effective negotiation. The ultimate goal is to help advocates become more comfortable with the practice of negotiation so that it can be a useful skill when striving to improve health care access.
- November 01, 2003 Look at the Full Picture: Analyzing the Community Health Impact of Hospital and Insurer Transactions This publication includes baseline questions to ask when analyzing how proposed hospital and insurer transactions (e.g., conversions) will impact the health of a community
- October 01, 2003 A Conversion Model Act In the last few years, legislators and communities have been successful in introducing improved conversion laws that address some of the more recent trends in conversions. We have included in this Model Act those more recent and enhanced examples of conversion laws throughout the country. We hope you will use this Model Act as a tool to craft a conversion law in your state.
- October 01, 2003 Holding On: Fighting to Preserve Essential Services at a Community Hospital The goal of this manual is to help you organize your community when your local hospital is either going to discontinue individual services or units or close entirely. We use our experience in Massachusetts as a model.
- October 01, 2003 Not There When You Need It: The Search for Free Hospital Care A report on the challenges uninsured and underinsured patients encounter in getting information about hospital financial assistance programs
- August 01, 2003 Conversion FYI A brief by Community Catalyst and Consumer Union
- April 01, 2003 Hospital Free Care Programs: A Study of Sixteen Long Island Hospitals This report is a sequel to our first study “Hospital Community Benefits and Free Care Programs” which was released in March, 2001. The original study contains background information, the survey protocol and a review of N.Y. State’s laws and regulations that pertain to hospital community benefits and charitable care. None of this information is repeated herein.
- January 01, 2003 Hospital Care Assurance Program in Ohio A brief on the hospital care assurance program in Ohio
- August 01, 2002 Neglected and Invisible: Understanding the Unmet Healthcare Needs of People on Long Island With a contract from The Access Project and with technical assistance from Community Catalyst, several surveys were developed. Monitoring Project members conducted a free care survey and performed an analysis of community benefits. The recommendations developed formed the basis of an earlier report, “Hospital Community Benefits and Free Care Programs”, published in March 2001. This second report focuses on the results of a survey of healthcare needs.
- December 01, 2001 Defending Community Benefits in a Changing Health Care World This report examines the progress made by Columbus hospitals and community members in strengthening the hospital free care safety net. Many uninsured and under-insured residents of Columbus rely upon hospital free care to meet critical health needs.
- July 01, 2001 Mending the Safety Net: A Hospital-Community Collaboration Improves Access to Free Care in Columbus
- March 01, 2001 Hospital Community Benefits and Free Care Programs: An Initial Study of Seven Long Island Hospitals Based on the findings of this initial pilot study, this report has developed recommendations that hospitals, state government, and community members will be encouraged to use in order to improve the quality and responsiveness of hospital free care and community benefits programs.
- October 01, 2000 Conversion Foundations: Ensuring Community Participation Conversion foundations have a particular responsibility to ensure community participation in all aspects of planning,development and operation. The public has a significant interest in how nonprofit assets are used following a health care conversion and community participation should be a key commitment, incorporated in its structure and ongoing operations.
- October 01, 2000 Getting Health Care When You Are Uninsured: A Survey of Uninsured Patients at Four Hospitals in Cleveland, Ohio This report summarizes national data on the impact of health insurance on access to care and health outcomes, and presents the results of the survey in one community, Cleveland, Ohio.
- January 02, 1999 The Health Care Institution Responsibility Model Act A brief on the Health Care Institution Responsibility Model Act
- January 01, 1999 Commentary to the Health Care Institution Responsibility Model Act Commentary on the Health Care Responsibility Model Act