50-state desk · WA
Washington
Statutory floorEvery licensed hospital must maintain a charity-care policy. Large systems (three or more acute hospitals, or large King County / Clark County hospitals) must write off the patient-responsibility portion at or below 300% FPL and discount to 400%. All other hospitals: full charity care at or below 200% FPL, with discounts above that. Screening and assistance applying for coverage are mandatory. Medical debt is barred from credit reports.
RCW 70.170.060 · compiled September 2026
| Rule | This state |
|---|---|
| Free-care floor | 200% FPL |
| Discount / eligibility floor | 400% FPL |
| Covers insured patients | Yes, if they otherwise qualify |
| Which hospitals | Generally all licensed hospitals |
| Medicaid expansion | Yes — adults to 138% FPL |
| Screen before collections | Yes |
| Credit reports | Statewide ban (FCRA-preemption fights ongoing) |
| Debt sales | Not banned |
| Home liens | Not banned |
| Wage garnishment | Federal CCPA cap (typically 25%) |
| Interest on medical debt | No special cap located |
| Collection hold | No extra state waiting period |
| Lawsuit clock | 6 years · RCW 4.16.040 |
2026 poverty line here
Alaska and Hawaii use their own HHS tables. Everyone else uses the 48-state and D.C. figures, effective January 2026.
| Household | 100% | Free floor | Discount floor |
|---|---|---|---|
| 1 | $15,960 | $31,920 | $63,840 |
| 2 | $21,640 | $43,280 | $86,560 |
| 3 | $27,320 | $54,640 | $109,280 |
| 4 | $33,000 | $66,000 | $132,000 |
| 5 | $38,680 | $77,360 | $154,720 |
| 6 | $44,360 | $88,720 | $177,440 |
What to do
- 01 Name RCW 70.170.060 in the first paragraph. This is not a courtesy write-off.
- 02 If the hospital is part of a three-hospital (or larger) system, 300% FPL is full charity care.
- 03 Smaller hospitals: 200% FPL is full. Still ask for the sliding scale above that.
- 04 Medical debt should not be on a Washington credit report. They must help you apply for coverage.
Appeals
Washington balance-billing law plus the No Surprises Act.
Insurance: Washington OIC — external review
Medicaid: HCA fair hearing (Apple Health).
Medicare is federal regardless of state: redetermination, reconsideration, ALJ, Appeals Council, then district court.
Cite this in a letter
I request charity care under RCW 70.170.060. If you are a large system or large hospital described in RCW 70.170.060(5)(a), full charity care is required at or below 300% of FPL and discounted care to 400%. Otherwise full charity care is required at or below 200% of FPL. Please screen this household and assist with Apple Health if we may qualify.
Put a Washington bill in the machine.
The estimate will use this state’s floors. The letters will cite RCW 70.170.060.
Start a Washington caseFederal overlay — every state
501(r)
501(c)(3) hospital organizations must publish a Financial Assistance Policy, a plain-language summary, and generally may not take extraordinary collection actions (selling the debt, reporting it, liens, lawsuits) until they have made reasonable efforts to determine FAP eligibility.
No Surprises Act
Emergency services, air ambulance, and many out-of-network clinicians at in-network facilities cannot balance-bill beyond in-network cost-sharing. Independent dispute resolution is between the plan and the provider — not a reason to pay the sticker rate.
FDCPA
15 U.S.C. § 1692g. Within 30 days of first collector contact, demand validation. Until validated, collection and credit reporting should stop. Partial payment can restart a state’s statute of limitations.
EMTALA
Emergency departments must screen and stabilize regardless of ability to pay. An ER bill is not an agreement that chargemaster rates are the cash price.
Medicare appeals
Five levels: redetermination (MAC, 120 days), reconsideration (QIC), ALJ at OMHA, Medicare Appeals Council, then federal district court. A remaining patient balance is often a claim the provider still needs to work.
Credit bureaus
The CFPB’s 2025 medical-debt reporting rule was vacated in July 2025. Industry practice still generally omits paid medical collections and unpaid balances under $500. Unpaid medical debt over $500 can appear after a delay unless a state ban applies. FCRA-preemption fights over those state bans are ongoing.