Charity care programs have long played a critical role in the health care safety net – providing access to low- or no-cost health care for individuals without access to affordable health insurance due to eligibility or affordability barriers. Although up to 33 million individuals could still gain health coverage following full implementation of the Affordable Care Act in 2014, 23 million or more will remain uninsured. Thus, the need for charity care programs will remain.

In response to the changing national health insurance landscape, charity care organizations must consider the implications of the size, health care needs, demographics, and expected utilization of the remaining uninsured population. This brief examines options that charity care programs across the country are currently considering. These include:

  1. Serving as a consumer assister in their state’s health insurance marketplace;
  2. Operating in a marketplace as a Consumer-Operated and Oriented Plan (known as CO-Ops);
  3. Continuing to provide the uninsured population in their regions with access to affordable care; and/or
  4. Providing complementary services to those newly eligible for health insurance.

The brief was informed by a Charity Care Program Affinity Group that is led by CHCS and supported by Kaiser Permanente Community Benefit with additional funding from the Robert Wood Johnson Foundation.