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CLEVELAND, Ohio — In an effort to stem its ballooning charity care costs, MetroHealth on Thursday launched a new financial assistance policy that eliminates 100% free charity care for some uninsured and underinsured Cuyahoga County residents, the health system said Thursday. MetroHealth is also encouraging such patients to enroll in health insurance during fall open enrollment periods. Under MetroHealth’s new financial assistance policy, now called its Healthcare Access and Assistance Plan, patients get higher discounts on their medical bills if they also seek counseling from MetroHealth’s financial counselors. Hardest hit by the changes are Cuyahoga County residents earning between 251% and 300% of the federal poverty level — or $80,000 to $96,000 for a four-person household. People in this category will no longer get fully free care, instead getting a 75% discount as long as they attend financial counseling. “These changes ensure that charity care is preserved for those with no other options, while encouraging those eligible for coverage to take advantage of it,” MetroHealth said. The rise in MetroHealth’s charity care costs -- which have doubled since 2022 and now amount to more than $1 million a day -- highlight patients’ need for greater access to insurance, the health system said. The new push to get more patients insured includes upcoming Health and Enrollment Fairs in Cleveland and Parma, where community members can receive health screenings, meet with MetroHealth’s financial assistance team and get help enrolling in health insurance. “We are proud of our legacy of compassion and access,” said MetroHealth CEO Dr. Christine Alexander-Rager. “To continue delivering high-quality care to everyone who walks through our doors, we must help our uninsured neighbors access the coverage they deserve. This initiative reflects MetroHealth’s unwavering promise: to care for our community with compassion, dignity and respect.” Discussions regarding charity care reductions and efforts to get more patients signed up for health insurance began in late summer. The safety net hospital’s financial outlook is troubling. Nationwide, safety net hospitals are bracing for deep cuts to Medicaid that threaten already thin margins, which were approved by Congress as part of President Donald Trump’s “One Big Beautiful Bill.” And amid the ongoing government shutdown, Democrats are pushing to preserve enhanced Affordable Care Act subsidies set to expire at year’s end, warning that their lapse would drive up premiums and leave millions without coverage. Locally, funds generated by Cuyahoga County’s Health and Human Services Levy cover only about 10% of the uncompensated care MetroHealth provides each year. Facing rising costs and slowing revenues, Cuyahoga County Executive Chris Ronayne has also proposed deep cuts to the county’s health and human services network — including $4.5 million from MetroHealth — in 2026 and 2027. MetroHealth earlier this month announced plans to close its new Psychiatric Emergency Department at the Cleveland Heights Medical Center on Dec. 31, after Cuyahoga County Council directed $7 million to support the construction of a new behavioral health crisis center that will be operated by The Centers. MetroHealth also closed six medical offices and laid off staff earlier this year. Updated financial assistance policy Under MetroHealth’s new policy, patients will be required to engage with MetroHealth’s financial counselors to qualify for financial assistance. Patients will get a self-pay discount of 65% off their bill when paying out of pocket unless and until they engage with MetroHealth’s financial eligibility team, which would unlock larger subsidies. Cuyahoga County residents earning up to 250% of the federal poverty level annually (up to $39,125 for an individual and $80,375 for a family of four) will continue to have all of their MetroHealth bill covered for free. This is not changed from the previous policy. Cuyahoga County residents earning between 251% and 300% of the federal poverty level — or $80,000 to $96,000 for a four-person household— and who speak with the financial team, will receive a 75% discount on their medical bill. Previously, they had all of their MetroHealth bill covered for free. Cuyahoga County residents earning between 301% and 400% of the federal poverty level — or $96,000 to $128,000 for a four-person household — and who speak with financial counselors, get a 70% discount on their bill. Previously, they received a 75% reduction of their bills. Discounts are for both the uninsured and the underinsured, the health system said. The financial team can also help with out-of-pocket costs such as deductibles and coinsurance. The health system considered cuts to charity care for non-county residents, but the majority of its charity care serves Cuyahoga County residents because it is the hospital’s core service area. The Internal Revenue Service (IRS) defines “charity care”, also known as “financial assistance”, as “free or discounted health services provided to persons who meet eligibility requirements and are unable to pay for all or a portion of their care, according to a report by KFF, a leading health policy organization. Nationally, hospitals may provide charity care to both uninsured and insured patients. Federal law requires that nonprofit hospitals provide some level of charity care as a condition of receiving tax-exempt status, the KFF report said. Health and Enrollment Fairs MetroHealth is sponsoring three upcoming Health and Enrollment Fairs where residents can get help enrolling in a health insurance plan, meet with financial counselors, get health screenings and schedule appointments. MetroHealth said it is working with local organizations, faith communities and neighborhood groups to reach uninsured residents and guide them through the insurance enrollment process. All Health and Enrollment Fairs are 11 a.m. to 3 p.m. To register, visit metrohealth.org/mtcc. Here are the upcoming events: Saturday, Nov. 15, Broadway Health Center, 6835 Broadway Ave., Cleveland. Saturday, Dec. 13,MetroHealth Main Campus, 2500 MetroHealth Dr., Cleveland. Saturday, Jan. 10, Parma Ukrainian Parish & Banquet Hall, 6812 Broadview Rd., Parma. Health Insurance Marketplace Open Enrollment at HealthCare.gov begins Saturday, Nov. 1. Plans on the Marketplace offer subsidies based on income and provide essential health benefits with no denials for pre-existing conditions, MetroHealth said. Medicare enrollment is open now through Dec. 7. Those who sign up by Dec. 15 will receive health insurance coverage beginning the first of the year.
