At times because of insufficient guidance and at times as a result of questionable performance, many non-profit hospitals are having a hard time meeting the Affordable Care Act’s requirements governing the provision of charity care as a condition of retaining their tax-exempt status.

According to a study published in the New England Journal of Medicine and based on 2012 data, the vast majority of hospitals now have mandated written charity care policies yet fewer than a third of them were charging uninsured patients the same fees they charge insured patients. While most stopped reporting unpaid bills to credit agencies, fewer than half made a regular practice of letting patients know they might qualify for charity care before they took steps to collect unpaid bills.

Some of the problems stem from the regulations implementing the reform law’s requirement. Hospitals are required, for example, to perform community health assessments but not required to act based on what those assessments find.

The study also found that the communities with the worst health outcomes were located in states that have not expanded their Medicaid programs and in which hospitals have the least generous charity care policies.

For a closer look at the challenges non-profit hospitals face in their efforts to comply with the Affordable Care Act’s charity care requirements, see the article “Hospital Charity Care – Effects of New Community-Benefit Requirements” here, on the web site of the New England Journal of Medicine.