Hospital Community Benefits After the ACA: Addressing Social and Economic Factors that Shape Health

This report is the ninth in the series, Hospital Community Benefits after the ACA. Earlier reports address the requirements for tax-exempt hospitals established by §9007 of the Affordable Care Act (ACA) and assessed federal and state approaches to community benefit regulation. 

This report continues the program’s examination of state-level community benefit oversight by focusing on the 10 states that require hospitals to develop implementation strategies: California, Illinois, Indiana, Maryland, New Hampshire, New York, Rhode Island, Texas, Vermont, and Washington. It identifies specific social and economic factors that shape community health and thus are of great importance to state and local policy-makers.

The implementation strategy requirements of California, Illinois, Indiana, New Hampshire, Rhode Island, and Texas were enacted prior to the ACA. Whether, how, and when these states will reassess state requirements in response to the ACA is unknown. Certain aspects of the state implementation strategy requirements of Maryland, New York, Vermont, and Washington were adopted post-ACA.

This review provides a baseline of currently reported activities, many of which may have been initiated prior to enactment of the ACA.