Rep. Andrew Engell proposes bill to restore residency focus for hospital charity care while protecting emergency access
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Rep. Andrew Engell proposes bill to restore residency focus for hospital charity care while protecting emergency access
State Rep. Andrew Engell, R-Colville, has introduced legislation to clarify eligibility for hospital charity care in Washington state by ensuring the program prioritizes low-income Washington residents while fully preserving emergency care for anyone who needs it.
House Bill 2250 responds to a recent reversal in the Department of Health’s interpretation of charity care law that removed long-standing residency provisions from hospital policies. For more than 30 years, hospitals were permitted to focus charity care resources on Washington residents while continuing to treat all patients in emergency situations.
“Charity care exists to help Washington residents who are struggling to afford medically necessary care,” Engell said. “This bill restores that original intent while making it absolutely clear that emergency care remains available to everyone.”
Washington hospitals provide hundreds of millions of dollars in charity care each year. Supporters of the bill argue that removing residency requirements for nonemergency care risks straining already limited hospital capacity, increasing wait times, and shifting additional costs onto local patients.
HB 2250, which has bipartisan support, defines residency broadly to ensure legitimate ties to Washington are recognized. Eligible residents include people without a fixed address, individuals who recently moved to Washington for work or job-seeking, children living in the state, and others who call Washington home. Immigration status may not be considered when determining eligibility.
At the same time, the bill specifies that individuals who travel to Washington specifically to receive nonemergency health care are not eligible for charity care. Emergency care eligibility is explicitly preserved regardless of residency, consistent with federal law.
“This is about fairness and sustainability,” Engell said. “Our hospitals are facing real capacity constraints and rising costs. Charity care resources should be focused on the communities they are intended to serve.”
Because of ongoing staffing shortages, hospital bed limitations, and cost pressures across the health care system, the legislation includes an emergency clause and would take effect immediately.
Engell also raised concerns about unintended consequences if the law remains unchanged.
“We know that people respond to incentives. The current charity care structure creates incentives for non-Washington residents to travel to our state for expensive care like a joint replacement they would otherwise have to pay for where they are a resident,” said Engell. “If it becomes well known that people under 300% of the federal poverty level can come to Washington for free nonemergency care, it would be devastating to the financial health of our health care system. Washington is not equipped to fund the health care needs of non-residents.”
House Bill 2250 is scheduled for a public hearing in the House Health Care and Wellness Committee on Jan. 27, at 1:30 PM.
