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Residency limits on hospital charity care split supporters and advocates at committee hearing
Summary
House Bill 2,250 would restrict nonemergent charity care to Washington residents using Medicaid‑style residency rules; rural hospital leaders said out‑of‑state charity care threatens sustainability, while legal and immigrant‑rights groups warned the measure could deter eligible patients and lack clear verification safeguards.
Olympia — The House Health Care and Wellness Committee heard extensive, sometimes sharply contrasting testimony on House Bill 2,250 on Jan. 27, a measure that would limit eligibility for hospital charity care to individuals who meet residency criteria similar to Washington’s Medicaid rules.
Staff explained the bill narrows charity care for nonemergent services to persons who ‘‘intend to reside in Washington indefinitely’’ or meet specified residency criteria while preserving EMTALA protections for emergency care.
Representative Andrew Engel, the bill’s sponsor, said feedback from border communities and Newport Hospital suggested a dramatic increase in out‑of‑state nonemergent charity care after Department of Health policy changes. He urged prioritizing charity care for state residents while working with DOH on technical amendments.
Rural hospital officials and local leaders described steep financial impacts. Justin Peters, CFO at Newport Hospital, said that in 2025 ‘‘49% of our total charity care — over $550,000 — was provided to residents outside of Washington state’’ and reported a 427% increase in nonemergent charity care from 2022 to 2025. Robert Rosenkrantz, a Ponderay County commissioner, said returning to historical residency standards would help sustain critical access hospitals.
Hospital association witnesses and some policy analysts argued the bill restores historical charitable expectations and protects safety‑net operations; Lisa Thatcher noted a 1989 Charity Care Act history and said DOH’s 2023 notification led hospitals to change policies.
Opponents, including legal and immigrant‑rights groups, said the bill would create barriers, chilling effects and inconsistent outcomes. Niyura Hasso (Colonial Health Services) said the residency standard is vague and ‘‘will lead to inconsistent and discriminatory outcomes.’’ Rebecca Guardia of Q Law Foundation warned the bill could conflict with protections for people fleeing bans on care and said the measure ‘‘changes what it means to be a welcoming state.’’
Policy analysts and patient‑advocacy organizations questioned the premise of large‑scale medical tourism. Eli Rush said his organization’s report found only about 29% of eligible patients receive charity care and that expanding coverage to all eligible patients would reduce hospital net revenue by about 0.7%, arguing the bill addresses a problem that may be overstated.
Committee members asked about verification, Medicaid interactions and the risk of deterring eligible patients; sponsor Engel indicated willingness to work on language with DOH. No formal vote occurred at the hearing; testimony reflected competing stewardship and access priorities.
