LEGISLATIVE SERVICES AGENCY
OFFICE OF FISCAL AND MANAGEMENT ANALYSIS
FISCAL IMPACT STATEMENT
LS 6896 NOTE PREPARED: Dec 30, 2024
BILL NUMBER: SB 337 BILL AMENDED:
SUBJECT: Hospital Charity Care.
FIRST AUTHOR: Sen. Qaddoura BILL STATUS: As Introduced
FIRST SPONSOR:
FUNDS AFFECTED: GENERAL IMPACT: Local
DEDICATED
FEDERAL
Summary of Legislation: The bill specifies charity care that certain nonprofit hospitals and county hospitals
must provide concerning patients.
Effective Date: July 1, 2025.
Explanation of State Expenditures:
Explanation of State Revenues:
Explanation of Local Expenditures: In the model approved by the federal Centers for Medicare and
Medicaid Services, the HAF and incremental HAF pool of costs is allocated among hospitals based on a
formula involving the total inpatient revenue per inpatient day and equivalent outpatient days. If nonprofit
hospitals and county hospitals provide more inpatient and outpatient days to low-income or indigent
individuals, the fee rate for nonprofit hospitals could increase, while other hospitals' rates reduce.
Additional Information - Of the state's population not enrolled in Medicare or Medicaid, 9.5% is estimated
to qualify for no cost health care, 14.5% would qualify for reduced rates, and 12.3% would qualify for charity
care depending on family health care spending. This estimate is based on the state population under
65-years-old, the age qualification for Medicare, and income over 138% of the federal poverty level (FPL),
the income qualification upper boundary for the Medicaid expansion population. The overall hospital
utilization rate for people under 65-years-old is not available. The Indiana hospital utilization rate for those
65-years-old and older is 3,135 per 100,000 persons.
The 2022 CMS Hospital Cost report includes detailed financial information from Indiana hospitals, including
87 voluntary nonprofit short-term care and critical access hospitals, psychiatric hospitals, general long-term
care , and rehabilitation hospitals and 22 county hospitals. Of these nonprofit hospitals, the 30 short-term care
and critical access hospitals have qualifying total patient revenues and reported charity care costs. Of the
hospitals reporting, the average charity care expenditure was 1.6% of net patient revenue. However, the
definition of charity care used to develop this CMS report may not encompass all the care that would be
SB 337 1 provided under the bill, and a portion of costs that may be considered to meet the bill's requirements for
charity care are counted in the contractual allowances and discounts in different line of this report.
Explanation of Local Revenues: The provisions of the bill will have indeterminate impact on the revenues
of county hospitals. In 2022, the 22 county hospitals reported charity care at 2% of net patient revenues.
State Agencies Affected:
Local Agencies Affected:
Information Sources:
https://data.cms.gov/provider-compliance/cost-report/hospital-provider-cost-report/data;
https://data.census.gov/app/mdat/ACSPUMS1Y2023.
Fiscal Analyst: Karen Rossen, 317-234-2106.
SB 337 2