Hospital Community Benefits After the ACA: State Law Changes and Promotion of Community Health

A nurse examines a patient with a stethoscope.

Hilltop Hospital's Community Benefit Program examined state law changes that affected hospital community benefit regulation in five states to assess how state-level policy is evolving around the implementation of the Affordable Care Act.

The Issue

Media reports in the early 2000s of poor hospital billing and collection practices prompted some states to enact legislation and policies around financial assistance and billing. Hilltop Hospital's Community Benefit Program examined state law changes that affected hospital community benefit regulation in five states (Colorado, Illinois, Minnesota, New Hampshire and New York) that adopted changes in the four years before and after passage of the Affordable Care Act (ACA).

Key Findings

Approaches to changing community benefits and the actual changes achieved reflected each state’s community benefit regulations before the ACA, state bodies driving community benefit policy, and the goals of state health departments, hospital associations, and other advocacy and/or community groups.

To achieve change in community benefits, Illinois and Colorado used legislation, Minnesota used legally binding agreements, New Hampshire used community benefit reporting forms and its existing CON regulatory framework and New York linked its existing community benefit framework to its State Health Improvement Plan. New Hampshire and New York have community benefit frameworks that also address social determinants of health.

 

Conclusion

Using community health benefit policy to pursue community health improvement goals is most feasible in states with strong state health department leadership or strong collaboration and engagement among stakeholder groups.

About the Study

Hilltop compiled this report using previous reports, statutes, regulations and policies as well as by conducting a literature review and by interviewing key informants in each state.

About the Grantee

The Hilltop Institute is a non-partisan research organization at the University of Maryland, Baltimore County.