Charity Care: The Good, The Bad, and The Stigma

Posted on February 18, 2014

by Liz Jackson

In 2012 when my medical bills started piling in, so did my panic. I did the most conscientious thing possible, and put my bills in binders. Yes, I had binders full of bills. A 3-inch binder. Full. Of. Bills. I was beside myself. I was well insured, though I was off of work on disability. My time was spent trying to increase mobility. It was also spent coping, learning my new body, overthinking every new ache and pain. Bills came daily. When they came, I’d have a panic attack. To ease the anxiety, I would organize the bills. Prioritize them. Jot notes on them. Once I felt that my bills were sufficiently re-organized in exactly the same order they had previously been organized in, I would finally be able to relax. 
Oddly enough, I never read the writing on the bottom of the bill. Had I not been so scared, I probably would have poured through the fine print much sooner. But alas, by this time, I had already found myself in deep with a few different debt collection agencies. Perhaps I can look back understanding I may not have seen the help offered on the bill until I was ready to accept it. 

Help came in the form of Charity Care. Me? Charity? I was so ashamed. But I couldn’t fix things on my own. So I called. I filled out an application. And it wasn’t long until I found some relief. Ok, a lot of relief. And I was so grateful to my beloved hospital for offering this service. I thanked them profusely. I thanked them for something I later learned they hadn’t done out of charity or care. And it’s confusing. Because I now feel angry at this beloved hospital for not coming to the rescue sooner. This is the hospital that introduced me to my neurologist (aka SuperNeuro). They offer endless medical care. And some really bad hospital food. This hospital has truly been a safe haven for me. But knowing what I know now, I am allowed to be a little angry at them. They sent me to collections before living up to their end of the bargain. 

You see, Charity Care isn’t a gift from a hospital. There’s no fundraising, no private donors. Charity Care funds come from something called the Indigent Care Pool. The ICP is funded in large part by an 8.5% surcharge on the majority of hospital bills. A large part of this pool is intended for those who are too far over the poverty line to be eligible for medicare/medicaid but not far enough over the poverty line to cover unexpected and often times enormous hospital bills. Before 2014 it also provided a cushion to hospitals for those pesky unpaid hospital bills.

The ICP covers the insured, the underinsured, the uninsured. It operates on a sliding scale, covering those with income up to 300x the federal poverty level. So basically if you’re on disability like I was and continue to be, you probably fit somewhere on the sliding scale. 

When I needed financial assistance from this Indigent Care Pool in the form of Charity Care, I nearly succombed to the stigma. The wrath of the collection agencies felt preferable. In my experience, the stigma of the word charity is so much greater than the stigma of the word disability. And from time to time the realization that I am classified as disabled can take my breath away. Charity feels worse than that.

I looked up the definition of indigent, and this is what I found: 


I suppose it’s a bit better that its called Charity Care instead of Indigent Care. But when I looked up the definition of Charity, this is what I found: 


Charity Care, as a program doesn’t fit these definitions either. You see, Charity Care isn’t a charitable program, it’s a government program. A highly disorganized government program that is ripe for abuse. But a government program is what it has always been and will always be. To be clear, there’s no charity going on in Charity Care. The Indigent Pool Fund is not meant for the penniless indigent.

In submitting my application, I was told to write a letter detailing my need. I embraced the writing of this letter when I felt that I was applying to a charity. I wanted them to understand my burden and the good their gift will do (Wifey works in fundraising and believes we should all give so much that it hurts). I wanted them to know about my 3 inch binder. They needed to know they would be helping someone who had never thrown away a bill. When I later learned that Charity Care was a government program, I felt a bit demoralized by the concept of the letter. Logistically I would like to believe that these state allocated funds could not be coerced or increased in any monetary way through the groveling or begging of those in need.

So I wrote the letter. Submitted it along with my application and financial records. And then I received an adjusted bill. And I sobbed. I ugly cried. I was so relieved. But to this day, I don’t understand why I received the adjustment that I did. Was it my letter? It was a good letter. Was it purely financial? And if it was purely financial, how was it figured? I’m so curious. Out of gratitude I never questioned the process. What if they gave me more than I was eligible for? What if they gave me less? The application process doesn’t read like a government program. It doesn’t appear on the surface that I have rights. Did I have rights?

I suppose this is why I feel a bit torn. It bothers me that Charity Care is intended to keep patients out of debt collections, but hospitals have continued to put patients through debt collections, and then receive payment in the form of Indigent pool funds when they aren’t able to collect. They could do a quick screening of patients upon check-in. The funds are there. And with a little extra oversight, patients could receive more options, better treatment, more relief. Instead I worry this surcharge just finds itself further padding the pockets of these hospitals who so arbitrarily mark up the price of services. But I suppose that’s for another day.

Today I want to let my fellow New Yorkers know about a little but big program called Community Health Advocates. CHA helps patients navigate simple and tricky healthcare situations. Whether you are insured, underinsured or uninsured they are there and they know everything. It’s an office filled with lawyers, advocates and volunteers. And they honestly want to help (in my healthier days, I volunteered for them). If you live in New York state and need some assistance, give them a ring: 888.614.5400

Please Note: Information on Charity Care is hard to come by and differs in every state. This is simply my experience living in New York. I included information I gleaned from a few pieces in the The New York Times as well as a comprehensive 2-year study by Community Service Society. Please get in touch if you’re interested in teaching me a bit more about Charity Care. I’m truly fascinated.

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What Others Are Saying

  1. anon April 12, 2014 at 12:59 am

    Medical bills have been the major cause of bankruptcies with the possible exception of the housing bubble burst. Charity was given to the too-big-to-fail during the financial collapse, but they had an army of lobbyists and a mountain of campaign contribution cash working for them. Obamacare (ACA) should eliminate the 8.5% surcharge.

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