Community Health Association of Spokane

Washington charity care law, Tier 1 hospitals (RCW 70.170.060(5)(a))

Large Washington hospitals, mostly those in health systems with three or more hospitals, must give free care if your family income is at or below 300% of the federal poverty level. From 301% to 350% the law requires a 75% discount, and from 351% to 400% a 50% discount. These discounts apply to the part of the bill you owe, so they can help with deductibles and copays even if you have insurance. The law lets a hospital lower the 75% or 50% discount if you have savings above set limits, but it cannot count your home, one car, or most retirement plans. The Department of Health lists which hospitals are Tier 1. These are minimums, and many hospitals give more. You can apply for past bills, even ones sent to collections.

Income levels in the program are free up to 300%, discount up to 400% of poverty level.

Applies to Tier 1 hospitals on the Department of Health tier list: hospitals owned or operated by a health system with three or more Washington acute hospitals, plus large acute care hospitals in the most populous county and in a large county on the southern border.

Ask the hospital's billing or financial assistance office for a charity care application. Send it back with proof of income, such as pay stubs, W-2s, or a tax return. If you are denied, you have 30 days to appeal. Each hospital's approved policy is posted by the Department of Health: https://doh.wa.gov/data-and-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-policies. Questions: CharityCare@doh.wa.gov or 360-236-4210.

a hospital owned or operated by a health system that owns or operates three or more acute hospitals licensed under chapter 70.41 RCW

Program source, checked 2026-11-11

Washington charity care law, Tier 2 hospitals (RCW 70.170.060(5)(b))

Every other licensed Washington hospital, including small, rural, independent, for-profit, and private psychiatric hospitals, must give free care if your family income is at or below 200% of the federal poverty level. From 201% to 250% the law requires a 75% discount, and from 251% to 300% a 50% discount. These discounts apply to the part of the bill you owe, so they can help with deductibles and copays even if you have insurance. The law lets a hospital lower the 75% or 50% discount if you have savings above set limits, but it cannot count your home, one car, or most retirement plans. These are minimums, and many hospitals give more. You can apply for past bills, even ones sent to collections.

Income levels in the program are free up to 200%, discount up to 300% of poverty level.

Applies to Tier 2 hospitals on the Department of Health tier list: every licensed acute care and behavioral health hospital in Washington that is not in Tier 1.

Ask the hospital's billing or financial assistance office for a charity care application. Send it back with proof of income, such as pay stubs, W-2s, or a tax return. If you are denied, you have 30 days to appeal. Each hospital's approved policy is posted by the Department of Health: https://doh.wa.gov/data-and-statistical-reports/healthcare-washington/hospital-and-patient-data/hospital-policies. Questions: CharityCare@doh.wa.gov or 360-236-4210.

At a minimum, a hospital not subject to (a) of this subsection shall grant charity care per the following guidelines

Program source, checked 2026-11-11

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