Seattle Hospital Charity Care 2026–27: Washington's Free and Discounted Care Law, Income Tiers, Documents and the 30-Day Appeal
Many Seattle patients pay hospital bills they could legally have had reduced or erased. Washington's charity care law, RCW 70.170.060, sets minimum free and discounted care levels that hospitals must offer. The strongest tier covers the hospitals most Seattle residents use.
This guide explains which tier applies, the income cutoffs in dollars, what documents a hospital can and can't demand, the protections against collections while you apply, and the appeal rules.
Insurance Doesn't Disqualify You
Washington law requires hospital bills and billing letters to state, on the first page, that "You may qualify for free care or a discount on your hospital bill, whether or not you have insurance." Charity care applies to the patient responsibility portion of the bill. That includes what's left after insurance, such as deductibles and coinsurance.
Two Tiers of Hospitals
RCW 70.170.060(5) sets two minimum standards.
Tier A: larger hospitals and systems. This tier includes hospitals owned or operated by a health system with three or more acute hospitals in Washington, and acute care hospitals with over 300 licensed beds in the state's most populous county. King County, home to Seattle, is that county.
Income (% of federal poverty level) | Minimum the hospital must provide |
Up to 300% | Free care: the full patient responsibility amount is charity care |
301% to 350% | 75% discount |
351% to 400% | 50% discount |
Tier B: all other hospitals.
Income (% of federal poverty level) | Minimum the hospital must provide |
Up to 200% | Free care |
201% to 250% | 75% discount |
251% to 300% | 50% discount |
These are minimums. A hospital's own policy can be more generous. To find out which tier your hospital uses, read its charity care policy, which must be posted on its website.
What Those Percentages Mean in Dollars
The table below applies the 2026 HHS poverty guidelines to the law's cutoffs. Hospitals may use the guideline in effect on your date of service, so treat these as estimates.
Household size | 200% FPL | 300% FPL | 350% FPL | 400% FPL |
1 | $31,920 | $47,880 | $55,860 | $63,840 |
2 | $43,280 | $64,920 | $75,740 | $86,560 |
3 | $54,640 | $81,960 | $95,620 | $109,280 |
4 | $66,000 | $99,000 | $115,500 | $132,000 |
For example, at a Tier A hospital, a family of four earning under $99,000 a year should qualify for free care on its patient share of the bill.
Assets: What Hospitals Can and Can't Count
The law doesn't require an asset test for the free care tier. Hospitals may reduce the 75% and 50% discounts based on assets, but only if they publish an asset policy. If they do consider assets, the law excludes:
the first $5,000 of monetary assets for an individual, or $8,000 for a family of two, plus $1,500 for each additional family member,
any equity in your primary home,
retirement plans other than 401(k)s,
one vehicle, plus a second if it's needed for work or medical reasons,
any prepaid burial contract or plot, and
life insurance with a face value of $10,000 or less.
One current account statement is enough to verify money in the bank. If there's no paperwork for an asset, the hospital must accept your signed written statement. Asset information can't be used for collections.
How to Apply, Step by Step
Ask early. Tell registration or billing you want to apply for charity care. Hospitals must post notices in admitting areas, emergency departments and billing offices. Their policy, plain-language summary and application must be on their website, in every language spoken by more than 10% of the service area.
Give your information. For the initial determination, the hospital must rely on what you tell it orally, though it may ask you to sign a statement that the information is accurate.
Send one income document. Under WAC 246-453-030, any one of these is enough:
a W-2,
pay stubs,
your most recent tax return,
a Medicaid or state medical assistance approval or denial,
an unemployment approval or denial, or
a written statement from an employer or welfare agency.
No paperwork? The hospital must rely on your signed written statement. It also can't demand duplicate verification.
Allow time. If you appear to qualify, you get at least 14 calendar days, or longer if your medical condition requires, to provide documents.
Get your answer. The hospital must notify you of its final decision within 14 calendar days of receiving your information, including the amount you will owe.
Medicaid screening. Hospitals must help you apply for Apple Health (Medicaid) or Exchange coverage if you might qualify. But it's an unreasonable burden to make you apply for a program you're obviously ineligible for, or were denied in the past 12 months.
Applying Late: The Two-Year Window
The law lets the hospital look at your income at the time of service, or at the time you apply if you apply within two years of service. To use that second option, you must have been making good-faith efforts to pay, and you must show you're eligible. Hospitals may also consider applications at any time at their discretion, such as after a job loss.
Collection Protections While You Apply
No collections until the hospital first screens you for coverage and charity care, as long as you cooperate.
If you might qualify, collections stay on hold until a final decision.
Hospitals can't require deposits from patients who appear to qualify under the charity care criteria.
If You're Denied: The 30-Day Appeal
Under WAC 246-453-020:
The hospital must tell you that you're denied and why.
You must be offered an appeal to fix missing documents or request a review. The review goes to the hospital's chief financial officer or equivalent.
You have 30 calendar days to appeal. During the first 14 days, the hospital can't send your account to an outside collection agency.
If you appeal after collections have started, the hospital must stop collecting until the appeal is decided.
If the denial is upheld, you and the Department of Health must get the decision in writing. DOH reviews denials and may seek penalties for inappropriate ones.
Appeal tips: send the missing document, point to the income tier in the hospital's own policy, and keep copies and dates.
Language Access and Billing Notices
Washington law treats language access as part of charity care:
The notice on billing statements must appear in English and the second most spoken language in the hospital's service area.
Hospitals must train registration, admissions and billing staff on the charity care policy and on using interpreter services.
Application procedures can't create an unreasonable burden for people with language barriers or physical, mental, intellectual or sensory disabilities.
If you need an interpreter to apply, ask for one. Hospitals have federal and state obligations to provide meaningful access for patients with limited English.
A Quick Checklist Before You Call Billing
Your itemized bill and the account number.
One income document: a W-2, pay stubs, your tax return, an Apple Health decision, an unemployment decision or an employer letter.
Your household size.
One current bank statement, but only if the hospital's posted policy considers assets for a discount tier.
A written note of who you spoke with, when, and what they said.
Emergency Care
RCW 70.170.060(2) bars hospitals from denying emergency care based on ability to pay. A hospital with an emergency department can't transfer a patient with an emergency condition or in active labor except at the patient's request or because of limited resources.
More Help
More help in Seattle: Seattle financial help guides
Related Guides
Sources
This guide gives general information, not legal advice. Check your hospital's posted charity care policy for its exact terms.
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