BL Special Report: Nonprofit says hospital’s charity program is little-known

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Hazel Hawkins Memorial Hospital has written off $3.93 million in patient charges since 2020 as part of its Charity Care and Discount Program, according to data provided by the hospital. But its policy and application process appear to be outdated.

The write-offs, which average about $655,000 per year, are part of a federal program that requires nonprofit and public hospitals to offer discounts and sometimes free care to patients who cannot afford to pay who are up to 400% above the federal poverty level.

According to data website Stacker, 12.96% of San Benito County residents have medical debt in collections.

But just because the programs exist doesn’t mean it’s well-known or accessible, according to Jared Walker, CEO of nonprofit Dollar For, a free resource for people who need help understanding or paying their medical bills.

“That’s why we exist,” he said. “Hospital charity care is not known, easy or fair.”

Dollar For’s Director of Communications Christy Snodgrass said the nonprofit has helped five people submit financial assistance applications at Hazel Hawkins since 2022. 

“So far, two were approved for full bill forgiveness in the amounts of $1,964 and $1,575,” she said.

Hazel Hawkins Director of Marketing and Community Relations Frankie Gallagher said the San Benito Health Care District meets and exceeds accessibility requirements adding that its board updated some of its policies as recently as December and is reviewing other policies to ensure it complies with law mandates. The policies reviewed by the board in December were not related to the Charity Care program.

“We also no longer deny an application for lack of information being provided,” Gallagher said. “We will reach back out to the patient and open the case back up after we receive the needed information.”

According to California Department of Health Care Access and Information Assistant Chief Counsel Melissa Ferkovich, the hospital submitted a revised policy and application for review in July 2024, but it was returned with requested revisions. She said those revisions are due to the state by March 27.

“Possible revisions may be requested after resubmittal,” she said. “You can see each revision as it is submitted on the policy lookup page.”

The statewide department oversees and enforces hospital laws and programs.

Walker said that while federal law requires hospitals to “widely” publicize it and make it “widely available,” some hospitals feel they meet the law by putting a poster about the program on the emergency room waiting area. 

According to Hazel Hawkins’ current policy, the hospital is required to provide information about the program “in designated areas of the hospital” such as the emergency and admitting departments, business office, and “other public places as the Hazel Hawkins Hospital may elect.” It reflects state law language.

It also states information will be included in the patient’s first bill of notice.

Gallagher said information about the program is in several places including  the Hazel Hawkins website, adding that it is also provided to patients when they call with concerns paying their bill and included in the patient’s bill.

Walker said the lack of information on the program can lead patients to go on payment plans or even bankruptcy for “bills they don’t have to pay.” 

He also said some hospitals don’t follow the law in their application process to determine a patient’s eligibility. Hazel Hawkins’ application requests the applicant’s value of assets and sets a deadline to apply, criteria which have been prohibited by state law since 2025.

Gallagher did not answer a question regarding when the hospital last updated its Charity Care policy and application form.

Walker said other issues he has noticed while helping people apply for financial assistance is that there is no standard process for applying, that hospitals ask “unnecessary questions” in the applications and create additional rules.

He said some hospitals require patients to fax or mail the application and require patients to attach “a lot” of income verification documents such as asking for the make and model of the vehicles they own, how much money is in their retirement account, how much livestock they own. He said normal income verification documents are copies of tax returns or three months of pay stubs.

“At the end of the day if hospitals can get some money out of a patient they would rather do that,” he said. “The default is to try to collect, and charity care is not a priority.”

Comparison

Two versions of Hazel Hawkins’ application, one obtained through a public records request and the other available on the hospital’s website, asks applicants to disclose income and assets. The version provided by the hospital goes on to request monthly expenses such as rent/mortgage, car payment, insurance premiums and clothing.

In comparison, Natividad Medical Center, Salinas Valley Health Medical Center and St. Louise Regional Hospital ask for pay stubs or income tax documents to verify household income information and other information on income and do not request asset information.

Like Hazel Hawkins, information about the other hospitals’ payment assistance programs is accessible directly from the homepage. 

According to California law Health and Safety Code 127405(b), hospitals cannot consider monetary assets of the patient, and documentation of income “shall be limited to recent pay stubs or income tax returns.”

It adds that though the hospital may accept other forms of documentation of income, it “shall not require those other forms.”

“A lot of times people disqualify themselves,” Walker said. “They say ‘Oh, that’s not for me. I make too much money.’ I would say there’s no harm in seeing if you’re eligible so definitely check it out.”

Walker, who is based in Washington state, said another challenge patients face is receiving wrong information on deadlines.

As an example, he said, “Hospitals have to legally give patients 240 days to apply. A lot of times hospitals will say ‘you have to do this in 30 days.’ So they cut the application window.”

The Hazel Hawkins website states patients have up to 180 days to apply after the initial bill. Walker said because Hazel Hawkins is a public entity, its requirements might differ from those of nonprofit hospitals.

According to state law, “A hospital shall not impose time limits for applying for charity care or discounted payments, nor deny eligibility based on the timing of a patient’s application.”

According to the Department of Health Care Access and Information, such laws took effect in January 2025.

Eligibility

The Department of Health Care Access and Information (HCAI) says patients’ eligibility “usually” depends on the household income and the number of people who live in the household. Patients can use HCAI’s federal poverty level calculator here.

According to the Hazel Hawkins policy, patients may be eligible for the program if “they have health care needs and are uninsured, under-insured, and ineligible for a government program, and are otherwise unable to pay for medically necessary care based on their individual financial situations.”

The policy states that patients with gross income below 300% of the poverty level are eligible for a full write-off and those above 300% and below 400% of the poverty level are eligible for rates that do not exceed what Medicare or Medi-Cal would pay for services. Patients above the 400% poverty level are eligible for “prompt payment discount.”

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