Under The Watch Of The Attorney General, Northwell Overhauls Charity Care Policy

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Dive Brief:

• Northwell Health, New York’s largest health system, is expanding its charity care program following a review from state Attorney General Letitia James.
• Uninsured or under-insured patients earning twice the federal poverty level or less will receive free medical care under the new program, while patients earning between three and five times the federal poverty level will receive discounted care, according to Tuesday’s joint statement from the nonprofit health system and the attorney general.
• The policy refresh follows years-long accusations that Northwell sued thousands of low-income patients with outstanding medical bills instead of offering them legally required financial assistance.

Dive Insight:

New York law and tax code requires nonprofit health systems like Northwell to provide financial assistance for low-income patients and prohibits health systems from engaging in “predatory” debt collection practices, according to the attorney general’s Tuesday statement.

However, Northwell has recently come under scrutiny for its collection practices. Northwell filed 15,896 lawsuits against patients between 2015 and 2019, according to a March 2020 report from the Community Service Society of New York, a nonprofit dedicated to policy issues impacting low-income New Yorkers.

In many cases, the health system did not offer financial assistance to the patients it was suing, according to the report.

Under Northwell’s revamped policy, the system will appoint a Medical Debt Ombudsperson to review accounts and ensure patients have the opportunity to apply for financial assistance before litigation commences.

The health system expects to transition to the new policy over the next six months, a Northwell spokesperson told Healthcare Dive. The attorney general and Northwell’s board of trustees will monitor Northwell’s compliance with the policies for five years.

Northwell isn’t the only health system updating its charity care policies.

Ensuring access to affordable medical care has taken on increased importance in state legislatures as medical debt continues to weigh on Americans, in some cases causing them to delay or skip care.

In recent years, Washington, Oregon and Minnesota have strengthened charity care protections in efforts to make care more accessible for residents. Now, New York health systems are also gearing up to comply with new requirements, which will go into effect in October as part of the state’s fiscal 2024-2025 budget. 

Under the new rules, health systems will be required to offer free care for patients earning less than 200% of the federal poverty level. However, the law only requires health systems to offer discounted care for those earning up to 400% of the federal poverty rate — short of the 5x Northwell will offer.

A spokesperson for Northwell said it isn’t new for the health system to exceed state minimums for charity care. 

“Prior to this agreement, Northwell policies met or exceeded state requirements,” the spokesperson said. “Northwell has had industry leading financial assistance policies for more than twenty years.”