Washington State

Office of the Attorney General

Attorney General

Bob Ferguson


Attorney General Request legislation ensures that millions of Washingtonians will pay no deductibles or co-pays at Washington hospitals

OLYMPIA — The Washington Legislature has passed Attorney General Bob Ferguson’s bill to increase access to affordable health care for millions of Washingtonians. The measure now heads to the governor for his signature.

Ferguson worked with prime sponsor Rep. Tarra Simmons, D-Bremerton, and Reps. Eileen Cody, D-Seattle, and Nicole Macri, D-Seattle, on HB 1616 to strengthen Washington’s charity care law. Ferguson’s Attorney General Request legislation will expand charity care eligibility to more than 1 million Washingtonians, and guarantee free hospital care to an additional million Washingtonians who are currently eligible for discounted care.

The legislation requires large hospital systems to provide more financial assistance. Beginning July 1, approximately half of all Washingtonians will be eligible for free or reduced-cost care at hospitals that represent approximately 80 percent of the licensed beds in the state.

“Too many Washingtonians are just one hospital bill away from financial crisis,” Ferguson said. “Under current law, a single parent working two minimum wage jobs at 50 hours per week was not eligible for financial assistance at Washington hospitals — that’s not right and it needed to change. This bill ensures that help is there for those who need it.”

“No Washingtonian should be bankrupted by a trip to the emergency room,” Rep. Simmons said. “I am proud to have worked with the Attorney General to update and standardize Washington’s charity care law. Four million Washingtonians will now be eligible for free or reduced out-of-pocket hospital costs making our healthcare system fairer and more equitable.”

Ferguson and Simmons’ legislation establishes two tiers of financial assistance — one for large health care systems and another for smaller, independent hospitals. Once SHB 1616 takes effect, Washington will have the strongest protections in the country for out-of-pocket hospital costs.

Nationwide, about two-thirds of individuals who file for bankruptcy cite medical issues as a key contributor, and more than half of collection items on credit reports are for medical debts.

Access to care is also an equity issue, as communities of color are disproportionately underinsured, and especially vulnerable to catastrophic and unexpected medical expenses.

For example, according to 2019 data from the Federal Reserve, the median bank account balance for Black households is about $1,500, less than one-fifth the median balance for white households of $8,200. The median account balance for Latino households is about $2,000. One in five individuals in majority nonwhite zip codes have at least one medical debt in collections on their credit report.

Affordable Hospital Care tiersBill significantly expands eligibility for financial assistance

The bill significantly increases eligibility for full write-offs of out-of-pocket hospital costs, as well as expanding eligibility for discounts. The bill ensures all Washingtonians within 300 percent of the federal poverty level are eligible for financial assistance, with discounts up to 400 percent of the federal poverty level for the vast majority of Washington hospital beds.

Current law only provides full write-offs for those earning up to 100 percent of the federal poverty level — up to $17,420 a year for a two-person household — and sliding scale discounts up to 200 percent. Approximately 1.8 million Washingtonians are eligible for financial assistance under current law. Under current law, a single parent working two minimum wage jobs at fifty hours per week is not eligible for financial assistance at Washington hospitals.

SHB 1616 guarantees approximately 3 million Washingtonians access to free hospital care at Tier 1 hospitals, and discounted care at the Tier 2 hospitals generally located in rural communities. Approximately 4 million Washingtonians will have access to free or discounted hospital care at Tier 1 hospitals that represent approximately 80 percent of all licensed beds.

AGO enforcement of charity care law

Ferguson has filed lawsuits against three Washington hospitals for violating Washington’s Consumer Protection Act by preventing low-income patients from accessing charity care. 

Under state law, hospitals are required to:

  • Provide notice of the availability of charity care both verbally and in writing;
  • Screen patients for charity care eligibility before attempting to collect payment, and;
  • Only require patients to provide one income-related document to prove charity care eligibility.

Last month, Ferguson announced a consumer protection lawsuit against five Swedish hospitals and nine Providence-affiliated facilities for failing to ensure that eligible low-income Washingtonians receive the discounts to which they are legally entitled, and aggressively collecting money from charity care-eligible low-income Washingtonians.

As the result of a 2017 lawsuit, CHI Franciscan provided $41 million in debt relief and $1.8 million in refunds, in addition to rehabilitating the credit of thousands of patients who were not offered charity care when they were eligible at eight of its hospitals in Washington. CHI Franciscan also paid $2.46 million to the Attorney General’s Office to cover the costs of the investigation and enforcement of the Consumer Protection Act.

Ferguson also sued Capital Medical Center in Olympia in 2017 over its charity care practices. To resolve the lawsuit, Capital provided at least $250,000 in refunds and more than $131,000 in debt relief. In addition, Capital paid $1.2 million to the Attorney General’s Office.

Hospital list



Washington’s Attorney General serves the people and the state of Washington. As the state’s largest law firm, the Attorney General’s Office provides legal representation to every state agency, board, and commission in Washington. Additionally, the Office serves the people directly by enforcing consumer protection, civil rights, and environmental protection laws. The Office also prosecutes elder abuse, Medicaid fraud, and handles sexually violent predator cases in 38 of Washington’s 39 counties. Visit www.atg.wa.gov to learn more.

Media Contact:

Brionna Aho, Communications Director, (360) 753-2727; Brionna.aho@atg.wa.gov

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