Low-income people without health insurance have new protections if they need hospital care, under state regulations governing charity care that most hospitals have been following for many months and that took effect yesterday.

“We think we have the most progressive charity care regulations in the nation,” said William J. Waters, deputy director of health. “We think we’re the national benchmark.”

The result of three years of negotiations among hospitals, the Health Department, and advocacy groups, the regulations require hospitals to provide free care to any uninsured person whose income is at or below 200 percent of the federal poverty level.

At the time the hospitals agreed to the rule, it was the highest threshold for charity care in the nation, said Edward J. Quinlan, president of the Hospital Association of Rhode Island.

The rules are also notable for requiring hospitals to inform the public of them in three languages, for requiring them to offer discounts to the uninsured that equal those offered to health insurance companies, for protecting low-income patients’ assets up to a point and for standardizing the process among all the hospitals, even the eligibility forms.

Hospitals in Rhode Island, which are all not-for-profit, have always provided millions of dollars in free care, as required by their charters and state and federal laws. The new regulations are not expected to affect the amount of charity care given, but they should make it easier for needy patients to navigate the system. They will also spare hospitals the expense of trying to collect money from lower-income patients who were never going to pay.

At the time the Health Department started developing the regulations, there were reports elsewhere in the nation of hospitals using aggressive practices, including foreclosures, to collect money from uninsured patients — who often were charged the “sticker price” on hospital services, much more than insurance companies pay for the same services.

The Health Department received no reports of such practices in Rhode Island, and the new regulations will prevent them.

In addition to requiring full free care for patients with incomes at or below 200 percent of poverty, the regulations also:

•Require hospitals to charge patients on a sliding scale if their income is between 200 percent and 300 percent of the federal poverty level. The rules allow each hospital to decide what that scale should be.

•Allow hospitals to consider a person’s assets in deciding whether to provide charity care. Quinlan said every hospital is doing so. If a patient’s assets (excluding one motor vehicle and the primary residence) exceed the “asset protection threshold” ($8,000 for singles and $12,000 for families, adjusted yearly based on the Consumer Price Index), the hospital can charge the patient for care, but the price has to equal the best price that the hospital offers insurance companies.

•Forbid hospitals to collect any more money from low-income patients than the difference between the patient’s assets and the asset protection threshold.

•Forbid hospitals to foreclose a patient’s primary residence for unpaid bills, although the hospitals can “attach” the residence, ensuring payment if the house is sold.

These are minimum standards. “Hospitals are free to do more,” Waters said. “We know for a fact that there are hospitals that will do more.”

As early as 2005, four hospitals were already compliant with at least the financial aspects of the rules, and by yesterday all were required to have the rules fully in operation.

Ana Novais, who heads the Health Department’s division of community health and equity, said that the department is moving to make sure the public, particularly the minority and non-English-speaking communities, are aware of their rights to charity care.

Quinlan said that before the regulations were devised, some hospitals had free-care thresholds as low as 100 percent or 125 percent of the poverty level. These hospitals would then bill the patients at their highest rate — but would rarely succeed in collecting the money. “The experience is that full payment is rarely received,” Quinlan said.

“Private hospitals in our state have become the public safety net,” Quinlan said. Hospitals always care for the sick regardless of their ability to pay, he said. “That makes hospitals unique in the health-care delivery system.”

ffreyer@projo.com