MetroHealth considers cutting charity care for some uninsured patients

CLEVELAND, Ohio — In an effort to rein in spiraling spending on charity care, MetroHealth System is considering reducing free or discounted bills for some uninsured patients.

The proposed reductions would hit, as an example, individuals making $39,000 to $63,000 annually, or a four-person family making $80,000 to $128,000 annually.

The health system said it hasn’t decided when the changes would go into effect, or determined how much the cuts would help its bottom line.

The charity care reductions would be paired with a push to get more uninsured patients signed up for insurance, creating a two-pronged strategy of enrolling more patients in coverage while reducing the share of medical bills MetroHealth covers for those who remain uninsured.

MetroHealth began discussing the approach in a recent series of community forums and the board’s August meeting. The changes are still under discussion and have not been finalized.

Charity care costs have doubled since 2022 and now exceed $1 million a day, the health system said. The county’s safety net hospital has already laid off employees and closed outpatient offices to deal with financial headwinds that have been exacerbated by a sharp rise in uninsured patients and looming cuts to Medicaid.

The health system doesn’t yet know how much the proposed changes would reduce its current charity spending because the final tally would depend on how many uninsured patients could be enrolled, said Rita Andolsen, vice president communications and media relations.

MetroHealth’s mission to take care of everyone, regardless of ability to pay, won’t change, Andolsen said. But the rising costs of meeting that mission is unsustainable, she said.

“That’s why we’re taking these steps now — primarily the education and awareness around enrollment — so that people who have fallen off the rolls of the insured can get insurance again,” Andolsen said. “If people are enrolling (in health insurance), then that leaves charity care for those who really need it most.”

Lowest income, highest income patients less affected

MetroHealth uses a sliding scale, based on federal poverty guidelines, to determine who qualifies for charity care.

Under the proposed changes, uninsured patients earning the least and the most would largely be unaffected. But patients earning somewhere in the middle would see a reduction in what costs are covered.

Nothing would change for uninsured people earning 0% to 250% of federal poverty levels – up to $80,000 annually for a four-person household — for whom MetroHealth currently pays their full bill.

As long as they agree to participate in financial counseling, which would include a push to sign up for insurance, their bills would continue to be fully covered. If they don’t agree to counseling, MetroHealth would cover only 65% of their bill.

Nothing would change for uninsured families earning 400% or more of the federal poverty level, which is $128,000 or more for a family of four. MetroHealth would continue to cover 65% of the cost of their healthcare, as it does today.

Reductions would hit in-between earners

The proposed changes to the sliding scale would most impact uninsured households earning between 251% and 400% of the federal poverty level.

Those between 251% and 300% — or $80,000 to $96,000 for a four-person household — currently have all of their MetroHealth bill covered for free. Under the proposed policy, they would have 75% of their medical costs subsidized.

Uninsured households with incomes between 301% and 400% — or $96,000 to $128,000 for a four-person household — currently get a 75% reduction of their MetroHealth bills. Under the proposed policy, those families would get a 70% reduction.

For all income groups, financial counseling would be required to receive the full discount. If patients don’t participate, 65% of their care costs would be covered.

Once patients take part in financial counseling, they can qualify for other self-pay discounts based on their family size and income, Andolsen said.

MetroHealth wasn’t immediately able to answer questions about the share of patients who fall into each income bracket, or why those earning 400% or more of the poverty level would see no reduction in charity care.

Andolsen said the proposed changes would bring MetroHealth into line with discounts offered by other hospitals.

“Our goal is to make sure that we reserve our charity care for those with the greatest needs,” said Nikki Davis, vice president for revenue cycle.

Effects on other groups

The proposed changes would affect Cuyahoga County residents only.

The health system is considering updates to charity care policies for non-county residents, but the majority of charity care serves Cuyahoga County residents because it is the hospital’s core service area, Andolsen said.

Under a separate policy, MetroHealth helps some low-income patients pay their Affordable Care Act health insurance deductible or copay, or coinsurance. Eligibility is determined by family size and income level. This cost-sharing is not expected to change, Davis said.

Insurance sign-ups understaffed

To complement reductions in charity care, and persuade more people to enroll in insurance, MetroHealth is considering training community volunteers to guide uninsured patients through signing up for subsidized insurance via Medicaid, Medicare, or the Affordable Care Act marketplace, Davis said.

At any given time, MetroHealth’s 13-person in-house financial eligibility team — aided by 20 workers from an outside organization — has several thousand uninsured patients it is attempting sign up for insurance, Davis said.

These workers attempt to contact uninsured patients for up to 120 days — via phone, text or mail — beginning when the patient enters any MetroHealth facility as an outpatient or inpatient.

With its volume of charity care patients at a record high – about 99,000 in 2024, after the federal government ended pandemic-era Medicaid benefits — that team can’t reach every uninsured patient, officials said.

The remedy may be recruiting community volunteers, trained by the Centers for Medicare and Medicaid Services, to do that work, Davis said.