To blunt the growing cost of charity care, MetroHealth is proposing changes to how it decides who qualifies for free or reduced cost care and is pushing to get more residents enrolled in health insurance.
Charity care is the free or reduced-cost medical care that Cuyahoga County’s public hospital system gives away. Residents qualify based on income: the lower your income, the deeper your discount.
The cost of charity care is becoming unsustainable for MetroHealth, said Rita Andolsen, vice president of communications and media relations at MetroHealth. It more than doubled between 2022 and 2024. The hospital is on track to dole out more than $350 million in free or reduced medical care this year, if trends continue – hundreds of millions dollars more than it receives from the county’s health and human services levy.
“The cost of our charity care is skyrocketing, right? It’s a million dollars a day,” Andolsen said. “That’s not sustainable for anybody, especially us. And so in order to stay true to our mission – to care for everybody – we have to think about ways that we can be creative and ways that we can be proactive.”
The effort to cut charity care costs is just one of several efforts to stabilize finances at MetroHealth, which had a $50 million operating loss last year. In July, the system laid off 125 employees, and it recently closed six outpatient facilities.
The hospital is pitching several methods to bring the cost of charity care down. One is an all-out community effort to enroll more residents in health insurance. More residents enrolled in health insurance – whether it’s Medicaid, Medicare or the marketplace – means MetroHealth is more likely to get reimbursed for the care it provides.
The second proposal would tweak the hospital’s policy on which patients can receive financial aid and how much. Residents would have to get counseling on health insurance options to qualify for charity care. And some people with higher incomes would see a smaller discount on their healthcare.
“The plan we’re working on includes a new partnership between our healthcare system, our patients and the wider community,” said Dr. E. Harry Walker, the board’s chair, at a board meeting Wednesday night. “We also need to work together to get as many people as possible into insurance programs — that’s gonna be very key to this. More equitable sharing of costs, so that MetroHealth’s generous financial aid program can focus on those with the biggest and deepest needs.”
The proposed financial aid changes would not change the hospital’s commitment to treating any person who needs care regardless of ability to pay, Andolsen said.
The hospital system has met with community groups to get feedback on its proposed plans. But it does not have a timeline to implement them, said Nikki Davis, the hospital’s vice president of revenue cycle.
MetroHealth sees fewer insured patients
Insurance – whether public (think Medicare or Medicaid) or private – is one of the main ways that medical providers are reimbursed for their services. When fewer people are insured, hospitals typically bring in fewer dollars.
That’s the challenge MetroHealth is facing: the number of uninsured patients is rising. That number rose from 5,400 Metro patients a month to 6,700 a month between April 2023 and December 2024.
That’s partially due to the end of a COVID-era policy that allowed more people to remain on Medicaid. After the policy ended in March 2023, the number of people enrolled in Medicaid in Ohio dropped significantly, according to KFF.
“That is one of the other major reasons that we saw an increase in self-pay over the last year, year and a half,” Davis said.
Changes to financial aid policy
MetroHealth currently has one of the most generous financial aid policies of any hospital in Ohio, the system said. The changes the hospital is proposing would bring it more in line with other healthcare systems, Andolsen said.
Under the current policy, MetroHealth can give a resident charity care even if they don’t engage with the hospital’s financial counseling team, Davis said.
But the proposed policy would require residents wanting charity care to speak with the hospital’s financial counseling team about insurance options like Medicare, Medicaid or the federal healthcare marketplace.
“We can show them that they’re eligible, and we will at that point help them complete those applications and work with ODJFS [Ohio Department of Jobs and Family Services] to get them approved onto the coverages that they are entitled to,” Davis said.
The other change MetroHealth is considering relates to how much residents’ care is discounted depending on their income. Currently, residents of Cuyahoga County who make under 300% of the federal poverty level – about $96,000 for a family of four – can get their care for free.
The hospital is proposing lowering that income limit to 250% of the federal poverty level, which is in line with the levels offered at University Hospitals and the Cleveland Clinic.
MetroHealth would still offer significant discounts for residents making above 250% of the federal poverty level, though some would be slightly lower under the proposed changes.
“We have people that come from outside of Cuyahoga County and outside of the state that come here to receive free care,” said Tamiyka Rose, MetroHealth’s senior vice president, chief of staff and board liaison. “So that is one of the other reasons that we are trying to put a little bit of guard rails around our policy.”
Community-wide healthcare enrollment effort
In recent weeks, hospital system officials have met with patients, faith-based residents and other community members to share the proposed financial assistance plans.
In the meetings, MetroHealth asked for residents’ support to help get more community members enrolled in health insurance. In a meeting with clergy members, the hospital system suggested hosting enrollment events, making announcements from the pulpit, inviting MetroHealth officials to speak at church and distributing MetroHealth flyers at events.
“What we heard was a resounding desire to help,” Andolsen said. “They get it. They see these patients. They see people in their communities and in their neighborhoods and in their churches who are in need of health care.”
“The clergy are like, ‘Bring it on.’”
Open enrollment for the federal healthcare marketplace opens Nov. 1. Andolsen said the hospital will work with community members to get as many Cuyahoga County residents signed up for insurance during that period as possible.
“The more people that we get enrolled … that’s fewer people that are then relying on charity care,” Andolsen said. “And that means the charity care, then, can be reserved for the people who need it most.”