The Hill-Burton Act: Increasing Access to Care for Seniors

In this article...
  • The Hill-Burton Act requires participating healthcare facilities to provide free or low-cost care to certain patients. Find out how this law helps older adults.

Congress passed the Hospital Survey and Construction Act, commonly known as the Hill-Burton Act, in 1946.

The main purpose of the law was to give nonprofit hospitals and other healthcare facilities access to loans and grants that could be used for construction and improvements. To receive the funds, participating hospitals had to agree to follow several requirements.

Keep reading to learn more about these requirements and find out how the law continues to affect Americans.

What Did the Hill-Burton Act Do?

Initially, the Hill-Burton Act provided funds to help hospitals and other healthcare centers update and modernize their facilities. One of the terms of the program was that a facility could not receive federal Hill-Burton funds if it didn't also get matching funds from the state and nearby municipalities.

In exchange for federal funds, participating hospitals had to agree to two provisions:

  • Each facility had to provide a "reasonable volume" of free care to local residents who didn't have the means to pay. This provision was initially set to last for 20 years.
  • Participating facilities weren't allowed to discriminate against patients on the basis of color, race, creed or national origin.

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Does the Hill-Burton Act Still Exist?

Although the Hill-Burton Act was originally written with good intentions, it didn't contain enough detail to ensure every participating healthcare facility complied with the directive regarding free care. For example, it didn't define a "reasonable volume" of free care, so there was nothing stopping hospitals from providing care to a few indigent individuals each year and then claiming that they'd met their obligation under the law.

Fortunately, the law has been updated to address this lack of detail. The Hill-Burton Act still exists today, but there are clear rules regarding the provision of free and low-cost care to community members.

Finding Hill-Burton Facilities

The Health Resources & Services Administration maintains a list of Hill-Burton facilities, making it easier for Americans to identify potential sources of low-cost care. As of May 2022, there are about 300 active facilities across 36 states. The following states, along with the District of the Columbia, Puerto Rico and all U.S. territories, have no Hill-Burton facilities:

  • Alaska
  • Delaware
  • Indiana
  • Maryland
  • Minnesota
  • Nebraska
  • Nevada
  • North Dakota
  • Ohio
  • Rhode Island
  • South Dakota
  • Utah
  • Vermont
  • Wyoming

Patient Financial Assistance Under the Hill-Burton Act

Participating facilities benefit from the federal funds they receive, but the Hill-Burton Act also helps patients by making free or low-cost care available to the people who need it most. To qualify for financial assistance, a patient must meet the program's income requirements, which are set at 200% of the Federal Poverty Level. Older adults in nursing homes may qualify for financial assistance if their incomes are as much as 300% of the FPL. 

Applying for Financial Assistance

Not every patient who meets the income requirements will ultimately be approved for financial assistance. Each person must fill out an application and provide documents to help the facility's billing or admissions department determine whether they qualify. Some facilities also require proof of residency before processing an application for financial assistance.

Covered Services

It's important to understand that a facility's financial assistance program may not cover all your medical costs. Many hospitals contract with outside groups to provide emergency care, anesthesia and other services. Hill-Burton financial assistance only applies to the facility's fees, so you may be responsible for any charges for care provided by third-party medical groups.

You should also know that Hill-Burton assistance isn't available to patients with Medicare or Medicaid coverage. The program is designed to help low-income people and people who are uninsured or underinsured. Patients enrolled in Medicare and Medicaid aren't considered to be underinsured, so they don't qualify for financial help under the Hill-Burton Act.

Patient financial assistance is available at the following types of facilities:

  • General and specialty hospitals
  • Rehabilitation centers
  • Nursing homes
  • Public health centers

Is the Hill-Burton Act Really Necessary?

Politicians, hospital administrators and community members continue to debate whether the Hill-Burton Act is still necessary today. Originally, the law only existed to help hospitals and other healthcare centers modernize their facilities. The United States was experiencing an economic boom due to increased production during World War II, increasing the demand for health services in communities all over the country.

Today, the United States has more than 6,000 hospitals, causing some people to believe that hospital construction is no longer important. The COVID-19 pandemic also pushed many facilities to introduce telemedicine options, making it less important for patients to visit a physical building to get the care they need.

The Hill-Burton Act has also been criticized for having a negative impact on certain groups of patients when it was first introduced. The main Hill-Burton Act negative impact was the use of "separate-but-equal" facilities for Black and White patients. Although the law prohibited race-based discrimination, it was introduced at a time when hospitals and other facilities were allowed to segregate patients by race.

The Importance of Free and Low-Cost Care

Although there are some legitimate concerns over how well the Hill-Burton Act protects patients, healthcare is a priority for American citizens. Until the law is modernized or replaced with something more comprehensive, the Hill-Burton Act is necessary to help low-income, uninsured and underinsured Americans access high-quality healthcare.

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