Hospital charity care percentages are public but scattered across three separate federal reporting systems, each with different definitions. As a result, the same hospital can report different charity care percentages to Medicare, the IRS, and state regulators for the same period, and no federal law sets a minimum amount hospitals must provide. Because definitions vary—charity care means "care a patient cannot afford" to Medicare, but the IRS and states apply their own standards—transparency exists but doesn't equal consistency. Patients and advocates looking for this information must know which agency's figures they're reading and what each one actually counts.
Table of Contents
- Why There's No Single "Correct" Percentage
- How to Find Charity Care Percentages
- What These Percentages Actually Show
- The Reporting Problem Is Known But Unresolved
- What These Numbers Don't Tell You
- Frequently Asked Questions
Why There's No Single "Correct" Percentage
Three federal agencies require hospital charity care reporting under different definitions: CMS (Medicare cost reports), the IRS (Form 990 Schedule H), and state regulators. No unified standard exists, enabling hospitals to report different charity care percentages to different agencies for the same period. Medicare defines charity care as "health services a hospital's policies determine the patient is unable to pay," valued at full-established rates and excluding contractual write-offs.
Individual hospitals set their own thresholds for who qualifies. Meanwhile, tax-exempt hospitals report charity care to the IRS on Form 990 Schedule H, but the IRS does not mandate a minimum percentage—only that a Financial Assistance Policy must exist. State agencies add a third layer: Washington State hospitals provided $1.608 billion in charity care charges in FY 2024, equal to 1.48% of total hospital revenue, using Washington's own standards.
This definitional fragmentation is not accidental. HCA Healthcare reported $1 billion more in charity care to Medicare's reporting worksheet than in its shareholder financial statements for the same period, illustrating how gaps between agencies allow hospitals to claim different amounts to different audiences.
How to Find Charity Care Percentages
Tax-exempt hospitals file publicly searchable returns. Tax-exempt hospital 990 returns, including Schedule H charity care figures, are searchable through ProPublica Nonprofit Explorer, available for filings processed in 2012 and later, where you can see what a hospital reported to the IRS about its financial assistance policy and charity spending. For state-level reporting, contact your state health department.
Washington State Department of Health publishes annual Charity Care in Washington Hospitals reports showing system-wide percentages and trends. State reports often provide more detail than federal summaries—Washington's data breaks out charity care as both a percentage of total revenue and adjusted revenue, giving a fuller picture of how charity spending compares to cash income. Medicare cost report data (Worksheet S-10) exists but is less accessible to patients. You can request it through CMS regional offices or ask a hospital's billing department directly.
What These Percentages Actually Show
Charity care percentages measure generosity, not capability. A hospital reporting 2% charity care is not necessarily providing twice as much assistance as one reporting 1%—the definitions, patient populations, and eligibility thresholds differ. Each hospital's own charity care policy determines what qualifies, so two hospitals with identical charity budgets might report different percentages. These numbers also don't capture care that hospitals never bill for, contractual discounts from insurance companies, or how aggressively a hospital pursues unpaid debt.
A hospital with a low charity care percentage but lax collection practices may harm fewer patients than one with a high percentage but strict debt pursuit. Recent enforcement has exposed gaps in voluntary reporting. Following a Minnesota Attorney General settlement with Mayo Clinic requiring Mayo to screen patients for presumptive eligibility at 200% of the federal poverty line and banning the system from suing most indebted patients, Mayo's charity care spending doubled to $130 million in 2024 from approximately $58 million previously. The increase suggests Mayo had underprovided charity care previously—not a change in reporting, but a change in actual practice.
The Reporting Problem Is Known But Unresolved
Transparency advocates and Congress have flagged that hospital charity care data is unreliable. Senator Chuck Grassley has criticized CMS charity care reporting standards, stating "the reporting instructions and definitions are unclear, so we're not getting good data." Federal audits of Worksheet S-10 continue, but even audited figures don't mean comparable figures across hospitals. The Mayo settlement shows that enforcement action can move the needle faster than voluntary reporting. No hospital admitted wrongdoing in the settlement, but Mayo's charity care obligations increased substantially, and the settlement required presumptive eligibility screening at 200% of the federal poverty line—a standard other states may use to evaluate their own hospitals' practices.
What These Numbers Don't Tell You
Charity care percentages published by hospitals or agencies don't answer whether you personally qualify. Federal law does not mandate a minimum percentage for tax exemption—only that nonprofits maintain a Financial Assistance Policy covering emergency and medically necessary care. Every hospital sets its own income thresholds, application process, and coverage rules. If a hospital publishes 3% charity care, that doesn't mean 3% of patients who ask receive it, or that the income limits fit your situation.
The percentage reflects what the hospital chose to provide to those who already qualified under its policy. Before relying on a published percentage, ask the hospital's billing department directly: What are your eligibility income limits? What documentation do you require? What services does your charity care cover? Published percentages matter because they show transparency and set expectations, but they are a starting point, not an answer to your own case.
Frequently Asked Questions
Can I compare one hospital's charity care percentage to another's?
Only within the same reporting system. A hospital reporting 2% to the IRS may not be comparable to one reporting 1.5% to Medicare because the definitions differ. State reports are most comparable within one state, using the same standards.
Where do I find my hospital's charity care percentage?
Search ProPublica Nonprofit Explorer for the hospital's Form 990 Schedule H if it's tax-exempt. Check your state health department website for state-level data. Call the hospital's billing office directly to ask about income limits and eligibility.
Does a low charity care percentage mean a hospital denies assistance?
Not necessarily. It may reflect a different patient population, stricter eligibility rules, or aggressive collection practices. The percentage alone doesn't show how many applicants qualify or how the hospital pursues unpaid debt.
What changed after the Mayo Clinic settlement?
Mayo agreed to presumptive eligibility screening at 200% of the federal poverty line and stopped suing most indebted patients. Its charity care spending doubled afterward. The settlement doesn't apply to other hospitals but may guide state regulators evaluating their own institutions.