Document Type

Policy Brief

Publication Date



Cutler Institute, Population Health and Health Policy, USM Aging Initiative, Policy


This brief compares the charity care and bad debt activity of CAHs with other (non-CAH) rural and urban hospitals as well as their charity care, billing, and collection policies. It discusses the implications of these policies on CAH charity care and bad debt levels and tax-exempt status. It concludes by identifying opportunities for state Flex Programs to develop technical assistance and program interventions to support CAHs in managing these important areas of hospital activity

The findings of this study should not be construed to indicate that CAHs are not meeting their community benefit obligations or are not serving vulnerable lowincome uninsured or underinsured populations. Rather, they suggest that some portion of the higher rates of bad debt incurred by CAHs would likely be more accurately classified as charity care if the strategies discussed later in this brief were more widely implemented. It is also important to acknowledge that CAHs are often the only source of health care in vulnerable rural communities and serve a crucial safety net role for the elderly, lowincome, uninsured, and other underserved populations, many of whom may face financial and/or travel barriers that restrict their ability to seek care outside of their communities.


Policy Brief No. 38

Funding Organization or Grant

This study was conducted by the Flex Monitoring Team with funding from the Federal Office of Rural Health Policy (PHS Grant No. U27RH01080).