Washington's Department of Health proposed new rules in July 2026 that will strengthen how hospitals screen patients for charity care and manage their documentation. The updates affect all 103 hospitals across the state and align existing regulations with laws passed in 2018 and 2022. For patients facing large medical bills, understanding current eligibility is critical—it's often the difference between getting free care and owing thousands.
Hospitals in Washington are already required to provide free medically necessary care to patients below certain income thresholds. The proposed rule tightens accountability by requiring hospitals to maintain detailed records and follow consistent procedures. These updates formalize protections that have grown out of broader legislative reforms to state charity care policy.
Table of Contents
- What the Proposed Rule Requires
- Current Charity Care Eligibility in Washington
- How to Find Your Hospital's Charity Care Policy
- Timeline and How to Stay Updated
- Residency Requirements May Change
What the Proposed Rule Requires
The Department of Health's proposed rule requires hospitals to retain all records related to charity care screening and eligibility determination for at least six years. The updated regulations also establish clearer procedures for handling violations and penalties when hospitals fail to comply. This documentation mandate creates an audit trail that lets regulators verify hospitals are actually screening and assisting qualifying patients.
The proposal updates Washington's administrative code (Chapter 246-453 WAC) to align with Substitute Senate Bill 6273 (2018) and Substitute House Bill 1616 (2022). HB 1616 replaced sliding-fee discount schedules with fixed percentages tied to specific income levels—a change that made charity care more predictable for patients. The proposed rule now ensures those processes are documented consistently across all hospitals.
Current Charity Care Eligibility in Washington
Washington uses a two-tier system based on hospital size. Larger hospitals (Tier 1) must provide free care to patients earning up to 300 percent of the federal poverty level, while smaller hospitals (Tier 2) extend free care to 200 percent of the federal poverty level. Both tiers must offer discounted care to patients up to 400 percent of the federal poverty level.
To check if you qualify, you need your household income and the current federal poverty guidelines. For 2026, the federal poverty level is approximately $15,000 for a single person and $31,000 for a family of four. At a Tier 1 hospital, a single person earning up to $45,000 qualifies for free care; at a Tier 2 hospital, the threshold is $30,000.
Under current law, hospitals must provide non-emergency charity care without requiring state residency. Emergency care is always available regardless of residency. Pending legislation (House Bill 2250) could change this for non-emergency care by limiting eligibility to residents—see the final section below.
How to Find Your Hospital's Charity Care Policy
Every Washington hospital must have a written charity care policy available to patients. Contact your hospital's financial assistance or billing department and request: Many hospitals screen patients for charity care at admission or during billing. If you have an upcoming procedure or recent bill, apply immediately. The updated rules will require hospitals to document their screening and eligibility decisions more carefully, which should help ensure consistent treatment.
- The written charity care policy
- Confirmation of whether the hospital is Tier 1 or Tier 2
- The application form and required documents (typically tax returns, pay stubs, or benefit statements)
- A pause on bill collection while you apply, if you've already received a bill
Timeline and How to Stay Updated
The Department of Health published the proposed rule on July 30, 2026. The state is accepting public comment so hospitals, patient advocates, and patients can weigh in before the rule becomes final. You can review the full proposed rule text on the Department of Health's policy review documents page. Check the Department of Health's charity care rules progress page for the comment deadline and expected implementation date. New administrative rules typically take several months from proposal to final adoption.
Residency Requirements May Change
While current rules allow non-emergency charity care without state residency, House Bill 2250 (pending for the 2025–26 legislative session) would limit non-emergency free care to residents only. Emergency charity care would remain available to anyone regardless of residency. This bill remains under consideration and is separate from the DOH's proposed rule. If you're planning to apply for charity care, confirm your eligibility under current rules. Pending legislative changes may affect non-residents seeking non-emergency care.
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