Hospital pricing.

Schiavo’s measure would require California hospitals to establish a formal screening framework for eligibility in charity care and discounted-payment programs, with presumptive eligibility beginning on July 1, 2027. The core change shifts a portion of how patients access discounted charges from traditional applications toward an upfront screening process, accompanied by a public-facing written protocol and disclosures about the tools used to determine eligibility.

Under the new framework, “screening” is defined as a process that identifies whether a patient may be eligible for charity care or a discount, and “presumptively determine” denotes a hospital judgment of eligibility without a formal income application, subject to later verification. Beginning July 1, 2027, hospitals would screen patients to see if they meet specified criteria and, if so, presumptively determine eligibility for the hospital’s charity care or discount policy. Criteria include enrollment in certain public programs (such as CalFresh, CalWORKs, Tribal TANF, WIC, CARE, LIHEAP, and related programs reflected by the department or hospitals), a prior six-month eligibility determination for charity care or a discounted rate, or homelessness. If automatic verification is not possible, hospitals may require verification from the patient, with self-attestation acceptable for homelessness. Hospitals may not require patients to apply for Medicare, Medi-Cal, or other coverage before screening, though Medi-Cal screening may be requested when screening for discounted payment.

The measure also expands the pool of patients who would be screened for eligibility. In addition to uninsured individuals, hospitals would screen patients who are Medi-Cal beneficiaries with cost sharing or eligible for Hospital Presumptive Eligibility, and individuals enrolled in Covered California plans. Hospitals must inform patients of the screening and that information will be used solely for charity care or discount purposes, and patients have the right to opt out with a form to sign; the opt-out decision and the signed form must be preserved in the medical record. If the screening indicates financial qualification, the hospital shall determine eligibility for charity care or a discount without requiring a separate application, and may verify eligibility as part of or after screening. Verification may be conducted before billing, and if verification cannot be completed, a written request for documentation must be issued; information collected to verify eligibility may be gathered before discharge.

Additional provisions assign discretion to hospitals to extend presumptive determinations to individuals not meeting the exact criteria and preserve rural-hospital flexibility to set income-eligibility levels below 400 percent of the federal poverty level, consistent with existing rural policies. By the same June–July 2027 timeframe, each hospital must publish a written screening process within its charity care and discount-payment policies, make it publicly accessible, disclose the names of any software products or third-party services used for screening, and provide the process to the state department. Notices to patients who are presumptively eligible or eligible must precede billing, and billing statements must reflect any adjustments under the hospital’s charity care or discount policy. Notices must be available in English and the patient’s language.

The policy emphasizes use of existing patient information, voluntary data submission for screening, and documentation of screening methods. Hospitals may employ third-party tools or contractors provided that (1) no impact on a patient’s credit score occurs, (2) evaluations rely on the hospital’s written charity care or discount policy criteria and do not consider propensity-to-pay, (3) tools are used to produce reasonably accurate results, and (4) when data are missing, the hospital attempts a good-faith, alternative evaluation. Hospitals must document the screening methods and, if used, the third-party tools.

In the broader regulatory context, the new framework builds on current charity care and discount payment policies, eligibility procedures, and notice requirements, while adding a front-end screening mechanism and greater transparency about screening processes and vendors. Language-access requirements remain aligned with existing state law, ensuring notices are provided in the patient’s language. Enforcement would likely rely on the existing hospital-compliance framework, with the bill not specifying new penalties within the screening provision itself. transitional provisions indicate a multi-year runway for implementation prior to full mandatory screening, with ongoing operation under existing notice and policy requirements before July 2027.