This bill reenacts and amends RCW 70.170.020 and adds a new section to chapter 70.170 RCW to limit hospital charity care to Washington state residents and to define residency for charity care purposes. It declares that people who enter Washington solely to receive health care are not residents and therefore not eligible for charity care, with a specific exception that a person receiving emergency care under 42 U.S.C. § 1395dd (EMTALA) or that patient’s guarantor is treated as a resident for charity care. The bill also expressly prohibits consideration of immigration status when determining an indigent person’s residency and takes effect immediately as an emergency measure. The bill supplies statutory definitions and scope for charity care, the department (Department of Health), hospitals (those licensed under RCW 70.41.020(9) and behavioral health hospitals under chapter 71.12 RCW), indigent persons (patients or guarantors who meet poverty-based criteria in RCW 70.170.060(5), have exhausted third-party coverage, and meet the residency rules), and third-party coverage (insurers, HMOs, government programs, tribal benefits, health care sharing ministries, and related settlements or awards). The added residency rules say a resident is someone who currently lives in Washington and intends to reside here indefinitely (including people without a fixed address), or who entered the state seeking or with a job; no minimum prior residence period is required. Special rules include residency for emancipated or married minors capable of expressing intent, residency for children based on the child’s or custodial parent’s residence, preservation of residency for people who leave over a month if they intend to return and have not become eligible for another state’s Medicaid or state-funded coverage, and residency status tied to receipt of state supplemental payments or the physical residence where federal foster or adoption assistance is received. This is a statutory eligibility and procedural change that modifies existing law and adds a new statutory section to define who qualifies as a resident for charity care. The provided facts do not show any new criminal penalties or specific enforcement, verification procedures beyond a hospital’s ability to request adequate information of intent to return, reporting requirements, or the text of RCW 70.170.060(5) that is referenced for poverty-eligibility standards.

If enacted, hospitals in Washington will limit charity care to people who meet the bill’s residency definition, so visitors who come into the state for medical treatment generally will no longer qualify for charity care and are more likely to receive full hospital bills; the main exception is people who get emergency care under federal EMTALA rules, who will still be treated as residents for charity care purposes. Immigration status cannot be used to deny residency for indigent patients, and certain payment situations (state supplemental payments and federally funded foster or adoption assistance tied to the person’s physical residence) are explicitly treated as establishing residency. The practical burden falls most on hospitals and indigent patients: hospitals will need to revise eligibility policies and may reduce uncompensated care for out-of-state patients but could face more billing disputes, while nonresident patients lose a key option for free care and may face higher costs or collections. The department of health and hospitals will carry out the changes, but the law does not spell out how residency must be verified, the exact income thresholds from RCW 70.170.060(5), or enforcement and reporting steps, leaving those procedural details unclear.