More hospitals are moving to technology-driven, front-end screenings that automatically identify patients who qualify for charity care, according to new outreach from Undue Medical Debt. The shift reflects the growing pressure on health systems to support uninsured and underinsured patients while managing rising uncompensated care costs.
Eva Stahl, vice president of policy engagement and research at Undue Medical Debt, said in a published report that hospitals are increasingly exploring predictive analytic tools earlier in the revenue cycle. “More and more we hear it’s becoming more common, and hospitals are beginning to think through how they can deploy these predictive analytic tools farther upstream in the workflow, where they might have traditionally just used them downstream as a part of their debt collection process,” Stahl said.
The need for earlier identification is expected to rise. With millions projected to lose coverage due to federal policy changes, demand for financial assistance programs is likely to swell.
The American Hospital Association recently recommended that hospitals incorporate presumptive eligibility practices into financial assistance programs. Using readily available financial data to approximate a patient’s need can reduce administrative workload and help hospitals make quicker determinations.
Traditional financial assistance applications remain a challenge for patients who are overwhelmed by paperwork or who never engage with billing communications. Technology-driven screenings aim to close that gap and help hospitals reclassify some potential bad debt as charity care, which is treated more favorably for community benefit reporting.
Several states are also moving toward mandated screening. North Carolina will require hospitals to implement presumptive eligibility policies beginning in January for patients up to 300% of the federal poverty level. Nearly all hospitals in the state opted into the Medicaid-funded program that also eliminated up to $4 billion of medical debt.
Despite those efforts, adoption across the country remains uneven. Studies show that while most tax-exempt hospitals updated financial assistance policies between 2019 and 2021, only a minority expanded presumptive eligibility.
Undue Medical Debt notes that better screening not only connects patients to needed assistance but may also identify uninsured patients who qualify for Medicaid. “Using predictive analytics to presumptively screen uninsured and underinsured patients for eligibility for financial assistance or public coverage programs are critical steps in connecting patients to timely care,” the group wrote.
Hospitals in Colorado offer one preview of the trend. After the state imposed income-based charity care requirements, charity care costs nearly doubled between 2022 and 2025, according to the Colorado Hospital Association.
