The Affordable Care Act (ACA) is changing the traditional role of charity care programs as safety net providers. The ACA’s Medicaid expansion and subsidized marketplace plans are giving millions of uninsured Americans options instead of charity care.

This brief explores how four charity care programs in different states – CareLink (TX), Portico Healthnet (MN), Ingham Health Plan (MI), and Kaiser Permanente’s Charitable Health Coverage program (multiple states) – are responding to the changing health care environment. It examines their benefit packages; membership and eligibility; outreach and enrollment strategies; financial models; and new roles in providing consumer assistance.

The four organizations profiled in the brief are a small sample of the participants in the Charity Care Affinity Group (CCAG), a national initiative directed by CHCS through support from Kaiser Permanente Community Benefit. Based on CHCS’ interviews, five broad themes emerged:

  1. The role of charity care programs is evolving;
  2. Enrollment in charity care programs decreased, even in those located in states that are not expanding Medicaid;
  3. In many cases, income eligibility for charity care programs has changed, and although benefit redesign is being considered, benefits largely stayed the same;
  4. Community engagement and partnerships are of growing importance; and
  5. Charity care programs continue to be a needed and valued part of the safety net.