Washington

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.

What to do

1. 01 Name RCW 70.170.060 in the first paragraph. This is not a courtesy write-off.
2. 02 If the hospital is part of a three-hospital (or larger) system, 300% FPL is full charity care.
3. 03 Smaller hospitals: 200% FPL is full. Still ask for the sliding scale above that.
4. 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.

Federal 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.

  Official source

• 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.

  Official source

• FDCPA

  15 U.S.C. § 1692g. Within 30 days of first collector contact, demand validation. Until it is validated, the collector should stop collecting. Partial payment can restart a state’s statute of limitations.

  Official source

• 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.

  Official source

• 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.

  Official source

• 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.

  Official source

Sources

Official government sources for the Washington information on this page. UNDUE does not represent any government entity.

• RCW 70.170.060 (hospital charity care; 300%/400% FPL for large systems in subsec. (5)(a))
• WAC 246-453 (charity care rules)
• RCW 4.16.040 (lawsuit clock, 6 years written contracts)
• RCW 19.182.040 (medical debt excluded from consumer reports)
• ESSB 5480, Laws of 2025 ch. 145 (medical debt credit reporting ban)
• RCW 19.52.020(4) (9% cap on prejudgment interest on medical debt)
• Chapter 48.49 RCW (balance billing protection act)
• Washington Office of the Insurance Commissioner (complaints, external review)
• Washington Health Care Authority (Apple Health fair hearings)
• Washington Attorney General (file a complaint)
• 2026 federal poverty guidelines (U.S. Dept. of Health and Human Services, published on HealthCare.gov)
• Medicaid and CHIP by state (HealthCare.gov)
• 15 U.S.C. § 1673 federal wage-garnishment cap (GovInfo)