Charity care in Washington: who gets free or discounted care
Washington has a law that requires hospitals to give free or discounted care to people with income up to 400% of the federal poverty level (the exact level depends on the hospital and your situation).
Charity care means free or discounted care for people with low income. Hospitals also call it financial assistance.
Checked against official sources: October 30, 2026.
What the law says in Washington
| Income (% of poverty level) | What you get | Details |
|---|---|---|
| Up to 300% | Free care | If your family income is not more than 300% of the federal poverty level, the hospital must treat your whole share of the bill as charity care (free). Tier 1 hospitals: hospitals owned or operated by a health system with three or more acute hospitals in Washington, acute care hospitals with over 300 beds in King County, and acute care hospitals with over 200 beds in a county of at least 450,000 people on the southern border (Clark County) |
| 301% to 350% | Discount | If your family income is between 301% and 350% of the federal poverty level, you get a 75% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 1 hospitals |
| 351% to 400% | Discount | If your family income is between 351% and 400% of the federal poverty level, you get a 50% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 1 hospitals |
| Up to 200% | Free care | If your family income is not more than 200% of the federal poverty level, the hospital must treat your whole share of the bill as charity care (free). Tier 2 hospitals: all other hospitals |
| 201% to 250% | Discount | If your family income is between 201% and 250% of the federal poverty level, you get a 75% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 2 hospitals |
| 251% to 300% | Discount | If your family income is between 251% and 300% of the federal poverty level, you get a 50% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 2 hospitals |
These are the income levels written in the law. Each hospital decides using its own policy.
- The law
Washington hospital charity care law
Law: RCW 70.170.060 and WAC 246-453; RCW 70.170.020, 70.170.060; WAC 246-453-010 to 246-453-090
- Which hospitals
All hospitals licensed in Washington, including for-profit hospitals and behavioral health hospitals. Larger hospital systems (Tier 1) must give more help than other hospitals (Tier 2).
- Who can get help
Patients and their guarantors with incomes up to the levels below, whether or not they have insurance, for the part of the hospital bill that insurance or another payer does not cover. Help covers medically necessary hospital care. A lawsuit settlement that has not been paid yet cannot hold up a decision.
- Rural hospitals
Smaller hospitals that are not part of a large system (Tier 2) have lower required income levels: free care up to 200% of the poverty level and discounts up to 300%.
- Savings and other assets
Limited. Assets cannot be used to deny free care. For the 75% and 50% discounts, a hospital may reduce the discount based on assets only if it has a public asset policy. It must ignore the first $5,000 in money for one person ($8,000 for two, plus $1,500 for each additional family member), any equity in your home, retirement plans other than 401(k) plans, one car (two if needed for work or medical care), a prepaid burial plan or plot, and life insurance of $10,000 or less. One current account statement is enough proof, and asset information may not be used to collect the bill.
- Who counts as your family
A family is two or more people related by birth, marriage or adoption who live together.
Law: RCW 70.170.020, 70.170.060; WAC 246-453-010 to 246-453-090
How to apply in Washington
- Deadline to apply
The hospital must look at your income at the time of care, or at the time you apply if you apply within two years of the care, have been making good faith efforts to pay, and show you qualify. A hospital may also choose to consider an application at any time, for example if your finances change.
- Screening for help
Before collecting from you, the hospital must make an initial check of whether insurance, another payer or charity care might cover the bill. If that check shows you may qualify for charity care, the hospital may not collect from you until it makes a final decision, as long as you cooperate. You must get at least 14 days to gather your documents. The hospital may not ask you for a deposit if the first check shows you may qualify.
Law: RCW 70.170.060(10); WAC 246-453-020(1), (3), (6); RCW 70.170.020, 70.170.060; WAC 246-453-010 to 246-453-090
- Applying for coverage first
The hospital must help you apply for Apple Health (Medicaid) or Washington Healthplanfinder coverage. If you qualify for retroactive Apple Health and do not make reasonable efforts to cooperate with that application, the hospital does not have to give charity care. The hospital may not make you apply for a program you are clearly not eligible for, or one that denied you in the last 12 months.
- Notice you must get
Hospitals must post notices about charity care where patients register, in the emergency department and in billing areas, in every language spoken by more than 10% of people in the service area. The policy, a plain-language summary and the application must be on the hospital's website. Every hospital bill and collection letter must say on the first page, in English and the area's second most spoken language: "You may qualify for free care or a discount on your hospital bill, whether or not you have insurance."
- If you disagree
The hospital must decide within 14 days after it gets your documents and tell you in writing how much you owe. If it denies you, it must tell you why. You have 30 days to appeal, and the hospital's chief financial officer (or equivalent) reviews the appeal. The hospital may not send your account to a collection agency during the first 14 days of that period, and must stop collecting if you appeal. If the denial is upheld, the hospital must tell you and the Department of Health in writing. You can also contact the Department of Health's charity care program.
- Refunds
If you paid and are later found eligible for charity care for that care, the hospital must refund what you paid above the amount you owe within 30 days.
- Find a hospital's policy
Law: RCW 70.170.020, 70.170.060; WAC 246-453-010 to 246-453-090
Check your income level
Find out what percent of the federal poverty level your household income is, and compare it with the income levels in Washington law.
Free tools, letters and checklist
Where to complain in Washington
- Hospital bills and financial assistance: Washington State Department of Health, charity care program · 360-236-4210
A hospital is not following its charity care policy, unfairly denied you charity care, or refused to give you an application. - Hospital licensing: Washington State Department of Health, complaints about providers and facilities · 360-236-4700
Other complaints about a hospital or a licensed health care provider. - Health insurance: Washington State Office of the Insurance Commissioner · 1-800-562-6900
A surprise bill, ground ambulance bill or claim denial under a state-regulated health plan. - Attorney general: Washington State Attorney General, Consumer Protection · 1-800-551-4636
A collection agency or business broke consumer protection rules, including medical debt collection and credit reporting rules.
Questions about medical bills in Washington
Does Washington require hospitals to give free or discounted care?
Washington has a law that requires hospitals to give free or discounted care to people with income up to 400% of the federal poverty level (the exact level depends on the hospital and your situation).
Who counts as family for charity care in Washington?
A family is two or more people related by birth, marriage or adoption who live together.