AUGUSTA — Saying state rules and federal law would soon be in conflict, Maine hospitals are supporting a resolve in the Legislature that could allow hospitals to do an income means test before providing a patient with free or "charity" care.
The resolve doesn't allow hospitals to refuse care, but it does allow them to determine if patients without health insurance can pay for all or part of their medical costs based not only on income but also assets.
The resolve directs the state's Department of Health and Human Services to make a rule change that permits hospitals to determine a person's ability to pay.
That rule change would also align the state with the federal Affordable Care Act, which requires all Americans to purchase health care, while providing subsidies for those ineligible for full federal health care coverage to do so.
The state's rule currently requires hospitals to provide charity care to any individual earning less than 150 percent of the federal poverty level — or $17,213 per year for 2013. The federal law will provide subsidies to anyone making more than 133 percent of the federal poverty level or $15,282 for 2013.
"There is now a federal law mandating that people buy insurance and corresponding to that there are significant federal subsidies to go buy that insurance," said Jeff Austin, a spokesman for the Maine Hospital Association. "So it just seems quizzical to us that someone, at say, 145 percent of the federal poverty level is covered by a federal law, they have to go buy this insurance and yet Maine law is out there saying you can go get free care at a hospital."
Austin said the resolve, LD 610, sponsored by state Rep. Deborah Sanderson, R-Chelsea, is looking to line up the two standards in state and federal law.
Austin also said hospitals currently do check to see if a uninsured patient is eligible for Medicaid and if they are they are able to help enroll the person and then get payment for the treatments they have provided.
He said they won't be able to help sign those eligible for insurance subsidies up on the spot the same way and won't be able to receive payment for those treatments.
Any insurance exchange set up under federal or state auspices to get coverage for those uninsured will still work like insurance policies paid for privately or through an employer.
"There will be an open enrollment period, and if you don't sign up in that period, you decide 'I don't care that I'm covered by a mandate, or I'm going to break federal law or I'm going to pay a penalty instead,' and then you show up at a hospital and you were eligible for significant subsidies, we can't sign you up for an insurance policy on the spot," Austin said. "So we need to encourage people to take advantage of these subsidies and obey federal law and take advantage of these subsidies for which we are all contributing."
He said the change would only apply to individuals who are eligible for the federal subsidies under the Affordable Care Act. "You would have to be eligible for the subsidies in order to not be eligible for charity care," Austin told the committee.
But Mitchell Stein, policy director of Consumers for Affordable Health Care, said they opposed the resolve for several reasons. He said his group was attempting to assemble the charity care policies for all 39 hospitals in Maine but only four of them have been provided to the group.
Stein's organization provides a statewide telephone helpline to assist people trying to find free or low-cost health care. His organization fielded 3,000 calls in 2012, Stein said.
He said state law requires those policies to be updated with the state each year but only four were made available after a Freedom of Access Act — Maine's open records law — request for them was filed with the state.
"Compliance with the existing law has been weak since there is no penalty for (not) complying with the filing requirement," Stein said.
Stein also said hospitals do not always advise patients that while they may not be eligible under the federal poverty guidelines, those guidelines are updated each February, and a patient may become eligible.
"Individuals who would be eligible under the new numbers are being turned away because the old numbers are still being used," Stein said.
He also noted that the new federal law included several related requirements for hospitals that operated under nonprofit and tax-exempt status.
To remain eligible for tax-exempt status under the the Affordable Care Act, hospitals will have to provide written financial assistance policies, admit what they charge for services, observe fair billing and debt collection practices and conduct a community needs assessment every three years, Stein told the committee.
The committee likely will vote on the resolve during a work session in the weeks ahead.