Starting in January, Delaware's hospitals will have expanded levels of financial assistance offered for care, set by the state.
Federal law says nonprofit hospitals must have financial assistance, but doesn't set specific thresholds. Delaware's legislature passed Senate Bill 13 this session.
It says for Delawareans at or under 300% of the federal poverty level, hospitals; costs should be completely covered. For a two-person household that’s an income of $64,920.
And it says hospital charity care programs will cover 50 to 75% of costs for people under 300 to 400% of the FPL. For a two-person household, it's an income range between $64,920 to $86,560. The federal poverty level is re-adjusted annually in January, and those new income levels will be reflected in the state's standards.
The new law also requires hospitals to communicate its policies on access to discounted care clearly with patients.
While the state-required thresholds take effect in the new year, the Diamond State Hospital Cost Review Board still has decisions to make on how charity care will work.
Those include what documentation of Delaware residency and household size hospitals can ask for to verify someone qualifies for discounted care and how much. These will influence how the board counts household size or residential status.
Eva Stahl, Vice President of Policy Engagement and Research for Undue Medical Debt, spoke at the latest Diamond State meeting. She said the process for verifying someone qualifies for aid is more straightforward if those who already qualify for federal aid.
"Hospitals don't have access to IRS data or income data in the same way that a Medicaid agency does," Stahl said. And the board will need to consider that as it sets requirements, "it's just reminding yourself that you don't have those tools when you move into those higher income brackets, and they largely rely on predictive analytics."
The new law says patients must use their private insurance or Medicaid before charity care And a hospital can ask someone seeking charity aid to apply for Medicaid if it thinks they’re eligible and not registered.
The new law also asks the board to establish groups that have presumptive eligibility and won’t need to apply to receive discounted care.
Several states, such as Illinois, Colorado, Oregon, and Washington, already have standards for this – like if someone is homeless. Stahl said Delaware included provisions in its own law that draw from lessons these states learned during their rollout.
Setting the rules here helps create uniformity and predictability for patients and hospitals, she said.
Hospitals already have processes to screen applicants, which will continue to be applied until the board adopts its regulations by July 2027.
