Spot the shift from charity to community benefit

Sunlight streams through blinds onto a stack of paper at the desk of Alex, a hospital admin in charge of community benefits. Last month, the board asked Alex to increase reported charity-care to satisfy IRS guidelines under the “community benefit” standard. First, he posted the required policy on the website. Then he built a digital screening tool—the bare minimum to check presumptive eligibility. Meanwhile, his colleague manually reviews incomplete applications months later. The result: patients at 120% of poverty still never hear back, while the hospital boasts a 0.5% charity-care rate, safely meeting tax-exempt thresholds. Research in health policy shows this veneer of generosity hides real inaccessibility. While Alex can show meeting minutes and screen-tool reports, low-income families continue to delay care under fear of debt. The case illustrates how hospitals meet regulatory demands yet fail to serve the most vulnerable.

You can replicate Alex’s audit by downloading and timing your hospital’s assistance application. Then run a ZIP-code-based screening to see who qualifies automatically. Finally, call as a patient and note every hurdle and hold time—both for your report to leadership and as ammunition to demand real change. Give it a shot tomorrow morning.