When it comes to Washington's charity care laws, NoHLA has been advocating for consumer access and protections since 1989. We recently joined Columbia Legal Services and Washington Physicians for Social Responsibility in filing an amicus brief (also known as a friend-of-the-court brief) in the case of Preston v. SB&C, Ltd., aka Skagit Bonded Collectors, LLC.
This case raised the question: do Washington's charity care rules apply to a collection agency attempting to collect on hospital debt?
Background: What is Charity Care?
Charity care is financial aid that helps with hospital bills. Depending on a patient's income, it can make their care free or reduced cost. About half of all Washingtonians may be eligible for some charity care.
Find additional resources under "Learn More" below.
The Court's Opinion
The Washington Supreme Court's slip opinion, filed in April 2026, states:
We answer yes and hold that they do. Collection agencies collecting on hospital debt are required to provide patients with notice of charity care under the plain language of RCW 70.170.060(8)(a) and the policy of the charity care act.
A slip opinion can be changed before it becomes official. But, as it stands now, this preliminary response is a win for anyone who may need hospital care in WA.
Charity Care Laws Apply to Collections, Too
Hospitals in WA have a legal obligation to notify patients and screen for charity care. The court's opinion says that a collections agency cannot collect on a debt for which the hospital failed to meet those requirements. It also means that hospitals cannot evade their legal charity care obligation by assigning the debt to a collections agency.
Protections and Enforcement are Important
NoHLA filed an amicus brief to highlight the importance of charity care to Washington consumers. Led by senior attorney Vanessa R. Saavedra, the brief added context about the health care affordability crisis and impacts of medical debt being felt across the nation. The brief also highlighted patterns of hospital noncompliance when it comes to charity care.
Many Washington hospitals have a history of failing to follow charity care notice and screening laws. In recent years, the state Attorney General's Office has led multiple investigations of noncompliance -- resulting in millions of dollars refunded and unlawful debts forgiven for patients.
Hopefully the outcome of Preston v. SB&C, Ltd. will help reinforce the importance of charity care access and protections for patients in Washington.