Oregon's bold move to make hospital financial aid automatic is paying off. A 2024 law requiring hospitals to proactively screen patients for financial assistance more than doubled charity care spending statewide. Now California, Delaware, and North Carolina are following suit, even as hospitals warn of growing financial strain from federal Medicaid cuts.
Oregon passed a sweeping 2024 law requiring hospitals to automatically screen patients for financial assistance — no lengthy application needed. The results have been striking: at Oregon Health & Science University, the share of patients receiving financial aid jumped from 12% to 64%. Statewide, hospitals more than doubled their charity care spending on average in their first full year under the law, bringing Oregon closer to the national nonprofit hospital average of 2.4% of operating expenses.
The policy, known as "presumptive eligibility," bypasses the traditionally burdensome application process — which can require bank statements, pay stubs, and even divorce records — and screens patients upfront. Research supports the approach: financial aid delivered early is linked to better health outcomes, including higher rates of diagnosis and follow-up care. The Texas experience offers a cautionary contrast — nearly half of nonprofit hospitals there bill patients before screening them, and two-thirds won't issue full refunds to patients who paid before qualifying for free care.
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Why it matters: With millions set to lose insurance coverage under federal Medicaid cuts, automatic hospital financial aid screening could serve as a critical safety net. Oregon's early success offers a proof of concept — but hospitals caution they can't absorb the added costs alone, raising questions about how broadly and sustainably this model can scale.
