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A P R I L | M AY | J U N E 2 0 2 0 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 5 MARYLAND D espite significant opposition by Johns Hopkins Health System's administration, Maryland Delegate Robbyn Lewis' House Bill 1420, legislation that was championed by a coalition of Hopkins nurses, doctors, patients, and community allies, will become Maryland law on Jan. 1, 2021. The ultimate success of this legislation was due to tireless patient advo- cacy by those who testified, sent letters, and lobbied legislators in Annapolis in order to ensure patients are cared for not only at the bedside, but after they leave the hospital. "If this law would have been in place when I was experiencing medical debt, things probably would have turned out very differently," said Kesha Spence, member of Coalition for a Humane Hopkins and a Johns Hopkins patient. "Before they sued me and emptied my bank account, Johns Hopkins never told me about financial assis- tance I later found out I qualified for. The notification requirements in this new law will help a lot of people like me. Just know- ing about financial assistance can be the difference between a lawsuit against you or not, the difference between being able to pay for other essential things or not." Nurses who are first and foremost con- cerned that their patients receive the care they need regardless of ability to pay, cheered the victory. "When I heard that my own hos- pital was suing their patients—patients I care for every day—I was horrified," said Josh Pickett, a Johns Hopkins RN. "This legisla- tion doesn't put an end to that completely, but we will keep up the fight to end the prac- tice. Patients all over Maryland will have better access and support to the medical financial assistance programs they need because we took action. This new law is more important than ever during the pandemic." Here are some highlights of the new law: • Patients with incomes at or below 200 percent of the federal poverty level (FPL) are eligible for free care and with incomes between 200 percent and 500 percent are eligible for reduced-cost care. This is an increase from 150 percent of the FPL that was previously in place. • Hospitals must include information about the availability of financial assistance, in the patient's preferred language, in every written communication regarding collection of that patient's bill. • Patients who already have proven eligi- bility for food-assistance programs like WIC or SNAP should presumptively qualify for free care. • Hospitals cannot consider the value of a person's primary vehicle to determine eligi- bility for financial assistance. Previously, people had been denied assistance because their car was "too expensive." • Hospitals cannot deny financial assis- tance to anyone on the basis of a patient's citizenship or documentation status. • Patients can file complaints against hospitals through the Maryland attorney general's office and/or the Maryland Health Services Cost Review Commission. Previ- ously, patients had no recourse if they were unfairly or unlawfully denied assistance. "When our coalition first started talking about proposing legislation as part of our campaign to reform medical debt, we were told that legislation in Maryland takes years to pass and most of it goes nowhere," said Charles Eubanks, also a Coalition for a Humane Hopkins member. "But we were determined to act immediately because this legislation can have a huge impact on patients and their families. I'm so proud of what we were able to accomplish with nurses, patients, and community members working together in solidarity." —Cara Bates Charity care reforms become state law