To make sure hospitals’ community benefit investments address community and state health goals, many states are working to ensure that hospitals are held accountable and their investments truly improve community health and advance equity.
In return for their tax exemptions, every three years nonprofit hospitals perform community health needs assessments (CHNA) and make investments to address the identified needs. These resources explain how these investments can be used to improve community engagement, increase accountability, and address social determinants of health. To learn more about NASHP’s workgroup of states working on community benefit issues, or to share your state’s efforts, contact Elinor Higgins.
Equity and Community Involvement Strategies
- State Requirements or Guidelines for Community Involvement in Community Health Needs Assessments, April 2019. Nonprofit hospitals are federally required to conduct CHNAs every three years and develop plans to meet those needs in exchange for their tax-exempt status. Many states have laws or guidelines that are more detailed than the federal requirements. This table documents 10 states’ guidelines for involving community members in the CHNA process, as well as their enforcement levers.
- How States Keep Community at the Center of Hospitals’ Community Health Needs Assessments, April 2019. States can work to make sure hospitals truly seek out and act on meaningful input from a wide range of community representatives. This blog and table identify state recommendations and requirements for community involvement, and identify which states have enforcement levers in place for ensuring that requirements are met.
- Lawrence, Massachusetts, Keeps the Community at the Center of Hospital Community Benefits, October 2018. This case study looks at Lawrence, Mass., a city that has struggled with poverty and poor health but that is now a Culture of Health Prize winner due in part to state policies that bolster the city’s efforts to advance health equity and address social needs. These supportive state policies include guidelines governing the local hospital’s community health needs assessments, its community benefits investments, and its determination of need spending.
- How 10 States Keep the ‘Community’ in Hospitals’ Community Health Needs Assessments, April 2019. This infographic depicts 10 states’ guidelines for involving community members in the community health needs assessment process, as well as their enforcement levers.
- States Explore Pivoting Hospital Community Benefit Requirements to Address Disparities Exposed by COVID-19, September 2020. This blog explores how states might use community benefit requirements to address disparities illuminated by the COVID-19 pandemic. One lever state officials have is to require nonprofit hospitals to address health inequities in the community investments they must make in exchange for their significant tax exemptions.
Opportunities for Oversight and Accountability
- Identifying Gaps in Federal Oversight of Hospitals’ Community Benefit Investments – Opportunities for State Policy. December 2019. The Affordable Care Act created additional community benefit requirements for non-profit hospitals, however opportunities exist for states to strengthen reporting requirements for more meaningful community benefit investments. This blog outlines community benefit federal laws and regulations including community health needs assessments (CHNAs), implementation strategies, activities and enforcement levers.
- States Use a Sharper Lens to Scrutinize Nonprofit Hospitals’ Community Benefit Spending March 2020. This blog highlights a reporting template tool for states to use to better track community benefit hospital expenditures and program outcomes. Reporting requirements from Connecticut, Massachusetts and Oregon are also highlighted.
- State Reporting Templates for Tax-Exempt Hospitals: Community Benefit Expenditures and Program Outcomes, March 2020. Non-profit hospitals are required to submit information on community benefit spending through the Internal Revenue Service’s Form 990 Schedule H. Hospital systems can report data in aggregate and are not required to tie their spending back to community health needs. This tool serves as a guide for states to collect hospital community benefit expenditures and program outcomes for more granular and actionable data.
- States Work to Hold Hospitals Accountable for Community Benefits Spending May 2018. In 2011, non-profit hospitals benefited from at least $24.6 billion in tax exemptions. This blog introduces NASHP’s work on community benefit and outlines how current workgroup states are holding hospitals more accountable for their investments through a variety of policy levers.
Case Studies and State Examples
- Lawrence, Massachusetts, Keeps the Community at the Center of Hospital Community Benefits, October 2018. This case study looks at Lawrence, a city that has struggled with poverty and poor health but is now a Culture of Health Prize winner due in part to state policies that bolster the city’s efforts to advance health equity and address social needs. These supportive state policies include guidelines governing the local hospital’s community health needs assessments, its community benefits investments, and its determination of need spending.
- Oregon and Connecticut Hold Hospitals Accountable for Meaningful Community Benefit Investment, August 2019. This blog highlights how Oregon and Connecticut go beyond the federal community benefit requirements and connect hospital investment to identified community need.
- Hospital Community Benefits Comparison Table for Six New England States, May 2018. This table presents key elements of state hospital community benefits requirements and related state law requirements of interest to states seeking to leverage the community benefits process to improve community health.
- How 10 States Connect their Health Improvement Goals to Hospital Community Benefit Investments November 2020. This resource highlights the goals of 10 states’ health and equity improvement plans, certificate/determination of need processes, and COVID-19 recovery and resilience plans. States can use these goals to connect their hospital community benefit spending to identified community needs.
- States Connect their Health Improvement Priorities to Hospital Community Benefits. November 2020. Community benefit spending by hospitals is estimated at more than $60 billion per year with $2.5 billion allocated to address social determinants of health. This blog addresses existing health improvement plans states can use to direct their hospital community benefit spending to community needs.