The bill creates a new residency-based eligibility rule for hospital charity care and changes existing law by adding a new section to chapter 70.170 RCW and by reenacting and amending RCW 70.170.020 to revise key definitions. It limits charity care to Washington state residents, revises definitions of "charity care," "indigent persons," and "third-party coverage," declares the act necessary for immediate preservation of public peace, health, or safety, and makes the act effective immediately upon enactment. The new residency rules define a "resident" as a person who currently lives in Washington and either intends to reside in Washington indefinitely (including persons without a fixed address), entered Washington looking for a job, or entered with a job commitment; no minimum period of residence is required. Special rules cover children under 18 (residents if they live in Washington or if a custodial parent or caretaker is a resident), residents who leave the state for more than a month but intend to return, and certain recipients of emergency care under 42 U.S.C. §1395dd, state supplemental payments, or federal foster or adoption assistance. The bill also specifies that a person who enters Washington for the purpose of obtaining health care is not a resident and that immigration status may not be considered when determining residency for indigent persons. The definition of charity care requires exhaustion of third-party coverage and explains that pending settlements do not suspend a hospital’s obligation to consider a patient for charity care. The bill directly affects the Department of Health, hospitals licensed under RCW 70.41.020 and behavioral health hospitals under chapter 71.12 RCW, indigent patients and their guarantors, and entities providing third-party coverage. The text references RCW 70.170.060(5) for eligibility criteria but does not include that subsection here, and the bill does not include specific enforcement mechanisms, procedures for hospitals to verify residency, or administrative appeal processes in the provided text.

If passed, hospitals would be allowed to provide charity care only to people who meet the bill’s Washington residency rules, so people who travel into the state specifically for treatment would generally lose access to hospital charity discounts after any insurance or other third-party payments are used up. That change most directly affects indigent patients who are not Washington residents (who would likely face larger bills), while hospitals may see fewer charity-care claims for nonresidents but will also need to start verifying and applying the new residency rules and rely on the Department of Health to determine inability to pay, which could raise administrative work and disputes over eligibility. The bill preserves charity access for emergency patients treated under federal EMTALA, children who live in Washington or whose custodial parent is a resident, people getting state supplemental payments, and foster/adoption recipients physically living in Washington, and it bars using immigration status to deny residency—so those groups are likely unaffected in practice. The law takes effect immediately, but the bill does not include the detailed residency verification process, enforcement steps, or the full interaction with the referenced RCW 70.170.060(5) eligibility criteria, leaving implementation details uncertain.