Charity care programs (CCPs) are an integral part of the safety-net landscape for many low-income Americans. These programs have evolved over the past several years, particularly in the post Affordable Care Act (ACA) environment, where some CCPs moved from primarily offering free- or reduced-cost patient care to providing more indirect services, such as facilitating enrollment for those newly eligible for health insurance. As the focus of CCPs has shifted toward indirect health services, these organizations are also increasingly addressing the social determinants of health.

Cuts to the Centers for Medicare & Medicaid Services’ (CMS) navigator budget and the repeal of the tax associated with the ACA’s individual mandate have caused some CCPs to think about how they will need to evolve further. In early 2018, through support from Kaiser Permanente Community Benefit, the Center for Health Care Strategies (CHCS) surveyed a small number of CCPs to learn how these organizations anticipate changing in the next two years. There were three takeaways:

1. Charity care programs connect a diverse range of populations to a wide breadth of services beyond health care.

CCPs continue to provide services to a variety of client populations, including but not limited to: the uninsured and underinsured; individuals with disabilities or substance use disorders; and veterans. Besides providing direct medical care, CCPs are increasingly providing services to connect their client populations to a diverse range of services, such as employment training, food/nutrition, housing/shelter, domestic violence services, immigration support, and legal assistance.

2. Charity care programs predict policy changes will lead to an increased demand for charity care services.

Some CCPs expect the demand for both direct and indirect services to increase over the next two years due to the repeal of the federal tax penalty requiring individuals to either obtain insurance or pay a financial penalty. Since they no longer face a tax penalty, individuals may choose to eschew having health insurance and rely on health care services provided by CCPs.

3. Charity care programs will rely on largely the same funding sources, but are unsure about future levels of support.

CCPs characterized their concern about funding sufficiency for maintaining key services as being either “modest” or “major.” This level of concern is likely fairly typical since CCPs are often small, largely volunteer-based operations. However, several CCPs noted particular concerns over funding cuts to navigator budgets. Notably, after CHCS’ survey was released in March, CMS announced that the federal budget for navigation services would be decreased further from $36 million to $10 million in 2018, which were awarded on September 12, 2018. This represents a more than 80 percent decline in federal navigator funding since 2016 when the budget was $63 million.

CCPs play an important role in the safety-net landscape by connecting their diverse client populations to a wide range of health and human services. Due to recent federal changes to the individual mandate and navigator budgets, CCPs are now expecting an increased demand for their services while, at the same time, expressing elevated concern over whether or not they will have sufficient funding to maintain key services. It will be important for those interested in assuring the health and well-being of low-income Americans to monitor how CCPs respond to changing circumstances in the years ahead.

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