Washington state has one of the strongest hospital financial assistance laws in the country. Under RCW 70.170, every licensed hospital in Washington must offer free care to patients earning up to 300% of the Federal Poverty Level (FPL) and discounted care to patients earning up to 400% FPL. As of 2026, that means a family of four with income up to $99,000 per year can receive completely free hospital care at a Tier 1 hospital, with no obligation to pay. You do not need to be uninsured, undocumented, or facing bankruptcy to qualify.
Quick Answer: Washington's charity care law covers all residents at hospitals statewide. Tier 1 hospitals (most major systems) must provide 100% free care up to 300% FPL and at least 50% discounts up to 400% FPL. In 2026, 300% FPL for a family of four is $99,000 and 400% FPL is $132,000. Apply directly with your hospital's billing department. Before you apply, run your bill through the CoveredUSA Bill Analyzer to spot overcharges and confirm what you legally owe.
What Washington's Charity Care Law Requires in 2026
Washington's charity care statute (RCW 70.170) was substantially expanded in 2022, making it one of the most generous in the country. The law splits hospitals into two tiers based on size.
Tier 1 hospitals are large systems that account for roughly 80% of hospital beds in Washington. These include major health systems like UW Medicine, Providence, MultiCare, CHI Franciscan, and Swedish. Tier 1 hospitals must:
- Provide 100% free care for patients with household income up to 300% FPL
- Apply a 75% minimum discount for patients with income between 301% and 350% FPL
- Apply a 50% minimum discount for patients with income between 351% and 400% FPL
Tier 2 hospitals are smaller independent and rural facilities, representing about 20% of beds. They must:
- Provide 100% free care for patients with household income up to 200% FPL
- Apply a 75% minimum discount for patients with income between 201% and 250% FPL
- Apply a 50% minimum discount for patients with income between 251% and 300% FPL
The Washington State Department of Health maintains a current hospital tier listing at doh.wa.gov. You can look up your specific hospital before applying.
2026 Washington Charity Care Income Limits by Household Size
The income thresholds below use the 2026 Federal Poverty Guidelines published by HHS at aspe.hhs.gov.
Tier 1 Hospitals: Free Care Threshold (300% FPL), 2026
| Household Size | 2026 Annual Income Limit (Free Care) |
|---|
| 1 | $47,880 |
| 2 | $64,920 |
| 3 | $81,960 |
| 4 | $99,000 |
| 5 | $116,040 |
| 6 | $133,080 |
| 7 | $150,120 |
| 8 | $167,160 |
| Each additional person | + $17,040 |
Tier 1 Hospitals: Discount Care Threshold (400% FPL), 2026
| Household Size | 2026 Annual Income Limit (Discounted Care) |
|---|
| 1 | $63,840 |
| 2 | $86,560 |
| 3 | $109,280 |
| 4 | $132,000 |
| 5 | $154,720 |
| 6 | $177,440 |
| 7 | $200,160 |
| 8 | $222,880 |
| Each additional person | + $22,720 |
Tier 2 Hospitals: Free Care Threshold (200% FPL), 2026
| Household Size | 2026 Annual Income Limit (Free Care) |
|---|
| 1 | $31,920 |
| 2 | $43,280 |
| 3 | $54,640 |
| 4 | $66,000 |
| 5 | $77,360 |
| 6 | $88,720 |
| 7 | $100,080 |
| 8 | $111,440 |
| Each additional person | + $11,360 |
Note: 100% FPL for 2026 in the 48 contiguous states is $15,960 for a single person and $33,000 for a family of four. All dollar thresholds above are annual income figures.
Who Qualifies for Washington Charity Care
Washington's charity care law is broader than most people assume. You may qualify even if:
- You have health insurance (copays, deductibles, and coinsurance all count)
- You are not a U.S. citizen or permanent resident
- You already received treatment and are facing collection on an old bill
- Your income is variable or irregular (hospitals must consider your current situation)
- You have received charity care at the same hospital before
Hospitals are required under RCW 70.170.060 to screen every patient for charity care eligibility before sending a bill to collections. They must also notify patients both verbally and in writing that financial assistance is available. If a hospital sent your bill to a collection agency without first screening you, that may be a legal violation.
The Washington State Attorney General's Office (atg.wa.gov) accepts complaints from patients who were denied charity care or not informed about it.
Washington's Medical Debt Credit Reporting Ban (2025)
In addition to charity care, Washington enacted Senate Bill 5480, signed by Governor Bob Ferguson on April 22, 2025. The law took effect July 27, 2025, and prohibits collection agencies from reporting medical debt to credit bureaus. Reporting medical debt to a credit agency is treated as an unfair or deceptive practice under Washington's Consumer Protection Act.
This means that even if you owe a Washington hospital bill you cannot fully pay, the debt cannot legally lower your credit score in Washington. Combined with charity care, Washington residents have more medical debt protections than residents of almost any other state.
How to Apply for Washington Charity Care in 2026
Hospitals are required to accept applications for at least 240 days after your first post-discharge bill. Do not wait for a collection notice before applying.
Enrollment is year-round. There is no open enrollment period for charity care.
Step-by-Step Application Process
-
Identify your hospital's tier. Check the DOH tier listing at doh.wa.gov to confirm whether your hospital is Tier 1 or Tier 2. This determines your income threshold.
-
Contact the billing department. Call the hospital's financial counseling or patient billing office. Ask specifically for the "charity care" or "financial assistance" application. You can request it while still in the hospital or after discharge.
-
Gather your income documents. You will need to document your household income. Collect the items listed below before submitting.
-
Complete and submit the application. Fill out the form and attach your income documentation. Submit by mail, in person, or by the method the hospital specifies.
-
Track your application status. Hospitals must respond in writing. If you are approved, you will receive a letter stating the percentage of assistance awarded. If denied, you have 30 days to appeal.
-
Appeal if necessary. Submit a written appeal within 30 days of a denial, along with any additional documentation. Include a brief explanation of your circumstances. The hospital must review it.
For questions, contact the Washington State Department of Health charity care team at CharityCare@doh.wa.gov or (360) 236-4210.
Documents You Will Need
- Recent federal tax return (most recent year filed)
- Recent pay stubs (last 2 to 4 weeks) or employer statement of wages
- Bank statements (last 1 to 3 months)
- Proof of other income: Social Security award letters, unemployment records, child support documentation
- Self-employment income statement or Schedule C if self-employed
- Proof of household size (tax return listing dependents or birth certificates)
- Proof of Washington residency (utility bill, lease, or driver's license)
Common Reasons Applications Are Denied
- Household income exceeds the applicable FPL threshold for your hospital's tier
- Missing or incomplete income documentation
- Application submitted after the 240-day window (though some hospitals extend this)
- Failure to list all household members (hospital calculates income per the entire household, not per individual)
- Unverifiable income (hospitals may request additional documentation)
If your application is denied for documentation reasons, you can re-submit with the correct paperwork within the appeal window.
Check Your Bill Before You Apply
Even if you qualify for charity care, hospitals can make billing errors. Duplicate charges, incorrect billing codes, and charges for services not received are common on hospital bills. Before you submit your charity care application, it helps to know exactly what is on your bill and whether each charge is legitimate.
The CoveredUSA Bill Analyzer compares each line on your bill to the Medicare rate and flags charges that are unusual. Uploading your bill takes about 30 seconds and can reveal errors worth hundreds or thousands of dollars. If a charge is wrong, you can dispute it separately from the charity care process. If the charge is legitimate, you will have a clearer picture of what the final discounted amount should be after charity care is applied.
Upload your hospital bill to the free CoveredUSA Bill Analyzer to find errors, overcharges, and charity care options in 30 seconds.
Washington Apple Health as a Companion Protection
If your income is at or below 138% FPL (roughly $22,000 for a single adult or $45,540 for a family of four in 2026), you may qualify for Apple Health, Washington's Medicaid program. Apple Health covers ongoing medical costs at no or very low cost, while charity care covers past hospital bills. Many Washington residents qualify for both simultaneously.
Apple Health applications go through Washington Healthplanfinder or by calling 1-800-562-3022. Enrollment is open year-round for Apple Health because Washington is a Medicaid expansion state.
Comparing Washington Charity Care Tiers
| Factor | Tier 1 Hospitals | Tier 2 Hospitals |
|---|
| Free care income limit (2026) | Up to 300% FPL ($99,000 for family of 4) | Up to 200% FPL ($66,000 for family of 4) |
| 75% discount income range (2026) | 301% to 350% FPL | 201% to 250% FPL |
| 50% discount income range (2026) | 351% to 400% FPL ($132,000 for family of 4) | 251% to 300% FPL ($99,000 for family of 4) |
| Examples | UW Medicine, Providence, MultiCare, CHI Franciscan, Swedish | Rural and independent hospitals |
| Share of hospital beds statewide | ~80% | ~20% |
Frequently Asked Questions
Does my immigration status affect charity care eligibility in Washington?
No. Washington's charity care law explicitly does not require proof of citizenship or immigration status. Undocumented residents qualify for charity care on the same income terms as citizens.
Can I apply for charity care if I already have insurance?
Yes. Insurance coverage does not disqualify you. Charity care applies to your remaining out-of-pocket costs after your insurance pays its share. Copays, deductibles, and coinsurance balances are all eligible.
How far back can I apply for charity care on an old bill?
Hospitals must accept applications for at least 240 days from the date of your first post-discharge bill. If your bill was sent to a collection agency before this window closed, the hospital may still be required to accept your application. Contact the hospital billing department or the Attorney General's Office for help with older bills.
What if the hospital sent my bill to collections before I applied?
Under Washington state law, hospitals are required to screen patients for charity care eligibility before placing accounts in collections. If yours was not screened, you can file a complaint with the Washington Attorney General's Office at atg.wa.gov or call 1-800-551-4636. You may still be able to retroactively apply.
Do I have to pay anything if I qualify for 100% charity care?
No. A 100% charity care award eliminates your balance owed. You should not receive any further bills for covered services, and the hospital cannot send the covered amount to collections.
What is the difference between charity care and a payment plan?
Charity care forgives or discounts the balance based on your income. A payment plan does not reduce the amount owed; it just spreads payments over time. If you qualify for charity care, you should apply before agreeing to a payment plan, since you may owe nothing or far less than the billed amount.
Can a Washington hospital charge me for an emergency room visit if I cannot afford it?
Hospitals cannot impose copays for emergency services on patients who qualify for charity care. Under RCW 70.170, qualifying patients receive full protection from out-of-pocket costs for medically necessary emergency care.
How do I know if my hospital is Tier 1 or Tier 2?
The Washington State Department of Health publishes an updated hospital tier listing. You can access it at doh.wa.gov or call (360) 236-4210 to ask about a specific hospital.
