{"id":9227,"date":"2026-05-11T09:48:50","date_gmt":"2026-05-11T09:48:50","guid":{"rendered":"https:\/\/www.healthoptibody.com\/?p=9227"},"modified":"2026-05-11T09:48:50","modified_gmt":"2026-05-11T09:48:50","slug":"as-ranks-of-uninsured-grow-minnesotas-hospitals-are-among-least-charitable-in-nation","status":"publish","type":"post","link":"https:\/\/www.healthoptibody.com\/?p=9227","title":{"rendered":"As Ranks of Uninsured Grow, Minnesota\u2019s Hospitals Are Among Least Charitable in Nation"},"content":{"rendered":"<p> <br \/>\n<\/p>\n<div>\n<aside class=\"wp-block-kff-shared-sidebar alignright \">\n<\/aside>\n<p>ST. CLOUD, Minn. \u2014 Cori Roberts was living in a rented basement four years ago when she was diagnosed with early-stage cervical cancer.<\/p>\n<p>Recently divorced, the former stay-at-home mother had started working again in her mid-40s, taking a human resources job that paid $41,000 a year. Then, despite having insurance, she was hit with more than $8,000 in medical bills.<\/p>\n<p>\u201cI had my car and a basket of clothes,\u201d Roberts recalled. \u201cMedical bills were not something I could have afforded.\u201d<\/p>\n<p>Roberts sought financial assistance from CentraCare, the St. Cloud-based health system that treated her. It\u2019s a nonprofit charity that receives millions of dollars in federal, state, and local tax breaks. In exchange, it\u2019s obliged to offer charity care to patients who can\u2019t afford their medical bills. But Roberts said CentraCare told her she made too much to qualify.<\/p>\n<p>Roberts instead scrimped on groceries and Christmas gifts for her kids and paid off more than $6,000 over two years. Then CentraCare sued her last year because she hadn\u2019t paid off all the debt.<\/p>\n<p>\u201cThey\u2019re supposed to be a nonprofit,\u201d Roberts said. \u201cIt\u2019s like, \u2018Come on!\u2019\u201d<\/p>\n<p>CentraCare earmarks a tiny fraction of its budget for helping patients with medical bills they can\u2019t pay, but it\u2019s not alone, a Minnesota Star Tribune-KFF Health News investigation found.<\/p>\n<p>Minnesota\u2019s hospitals and health systems are among the least charitable in the country, the investigation found, providing less financial aid as a percentage of their operating budgets on average than hospitals in almost every other state, including Illinois, Iowa, Nevada, and Texas.<\/p>\n<p>The investigation drew on a detailed review of every hospital charity care program in the state, an analysis of five years of hospital financial data, and dozens of interviews with patients, hospital executives, and state officials.<\/p>\n<p>Nationally, hospitals spend an average of about 2.4% of their operating budgets on charity care, according to federal hospital data compiled by Hossein Zare, a researcher at Johns Hopkins University. Minnesota hospitals spend about a third of that, on average.<\/p>\n<div id=\"datawrapper-embed-PmWSD\" class=\"datawrapper-embed block--datawrapper-embed\">\n<p>\t\t\t<img decoding=\"async\" class=\"datawrapper-embed__print-img\" src=\"https:\/\/datawrapper.dwcdn.net\/PmWSD\/full.png\" alt=\"Charity care remains minimal at most Minnesota hospitals (Column Chart)\"\/>\n<\/div>\n<p>Some spend considerably less. Of Minnesota\u2019s 123 general hospitals, 62 devoted less than 0.5% of their operating budgets to charity care from 2020 through 2024, the Star Tribune-KFF Health News investigation found.<\/p>\n<p>\u201cThe system is not working,\u201d said Erin Hartung, director of legal services at Cancer Legal Care, a Minnesota nonprofit that helps patients with medical debt and other financial challenges. \u201cAnd the burden is falling hardest on the people who are least able to bear it.\u201d<\/p>\n<p>CentraCare\u2019s flagship St. Cloud Hospital spent less than 0.25%, according to the analysis. That works out to $25 in patient aid for every $10,000 spent on hospital operations.<\/p>\n<p>Charity care will become even more vital in coming years as Minnesotans lose health coverage or can\u2019t afford rising copays and deductibles. The state\u2019s uninsured rate rose sharply last year, hitting its highest level since 2017, and it\u2019s expected to increase further as budget cuts pushed by President Donald Trump force states to pare Medicaid and other safety net programs. Charity care is also critical to many people with health insurance who can\u2019t afford their bills.<\/p>\n<p>Hospital officials say it\u2019s unfair to expect them to solve this affordability problem when many of their facilities are financially strained. \u201cNo amount of charity care from hospitals will ever fully meet the needs of uninsured or underinsured Minnesotans. The need is simply too great,\u201d Minnesota Hospital Association spokesperson Tim Nelson said in a statement.<\/p>\n<p>But state Attorney General Keith Ellison said hospitals have a duty to boost charitable help for all needy patients in exchange for the tax breaks they receive.<\/p>\n<p>\u201cThere is a benefit you get from being a nonprofit hospital in the state of Minnesota,\u201d he said. \u201cBut do the people get the benefit?\u201d<\/p>\n<p>Several small Minnesota hospitals give financial aid to fewer than two dozen patients a year. Mahnomen Health Center, which recently converted to a rural emergency center, didn\u2019t provide any charity care in eight years, despite serving one of Minnesota\u2019s most impoverished regions. Other hospitals serving large low-income populations were among those providing the least charity care, the analysis found.<\/p>\n<p>Several factors help explain why Minnesota hospitals provide so little financial aid. For one, job-based insurance and an expanded Medicaid program offer broad coverage. Hospitals in states with less government assistance and more uninsured people typically spend more on charity care.<\/p>\n<p>But Minnesota patients also face significant barriers accessing financial aid at many hospitals, including inconsistent eligibility standards and extensive applications, the Star Tribune-KFF Health News investigation found.<\/p>\n<p>To qualify at many hospitals, patients must submit detailed personal information, including bank statements, retirement accounts, mortgage documents, and estimates of other assets such as cars, homes, or livestock.<\/p>\n<p>And because Minnesota has not standardized the criteria for charity care, patients might receive aid at one hospital but not another. The investigation found that some hospitals give free care to patients with an annual household income of $47,000, while others cap it at about $15,000.<\/p>\n<p>Had Roberts driven 30 miles east to Princeton or 35 miles north to Little Falls, she would have found medical providers with more generous financial aid policies than CentraCare. But she didn\u2019t know to look.<\/p>\n<p>Roberts, now 49, has remarried and lives in a split-level home in St. Cloud decorated with inspirational plaques such as \u201cFaith, Family, Friends.\u201d CentraCare recently dropped the lawsuit against her, but only after she took out a loan against her retirement plan to pay off the medical debt. \u201cIt just feels very unfair,\u201d she said.<\/p>\n<div class=\"wp-block-kff-shared-side-by-side block--side-by-side-photo alignfull \">\n<div class=\"wp-block-kff-shared-side-by-side__columns\">\n<div class=\"wp-block-kff-shared-side-by-side__column\" style=\"\">\n<figure class=\"wp-block-image wp-block-kff-shared-side-by-side__image wp-block-kff-shared-side-by-side__image--left\">\n\t\t\t\t\t<img fetchpriority=\"high\" fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg\" class=\"wp-image-2235404 size-full attachment-full\" alt=\"A hand holds at least four sheets of paper printed with the date and amounts of payments. There are 10 payments listed on the clearest page.\" sizes=\"(max-width: 781px) 100vw, 768px\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg 3600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=600,400 600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=834,556 834w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care02_3600x2400web.jpg?resize=1668,1112 1668w\"\/><!-- image-left --><figcaption>\n\t\t\t\t\t\t\tRoberts thumbs through copies of her payment records at home.\t\t\t\t\t\t (Anthony Souffl\u00e9\/The Minnesota Star Tribune)<\/figcaption><!-- image-left --><br \/>\n\t\t\t\t\t\t\t\t\t<\/figure>\n<\/p><\/div>\n<div class=\"wp-block-kff-shared-side-by-side__column\" style=\"\">\n<figure class=\"wp-block-image wp-block-kff-shared-side-by-side__image wp-block-kff-shared-side-by-side__image--right\">\n\t\t\t\t\t<img decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg\" class=\"wp-image-2235405 size-full attachment-full\" alt=\"The Emergency Department entrance to a hospital.\" sizes=\"(max-width: 781px) 100vw, 768px\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg 3600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=600,400 600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=834,556 834w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care03_3600x2400web.jpg?resize=1668,1112 1668w\"\/><!-- image-right --><figcaption>\n\t\t\t\t\t\t\tCentraCare\u2019s flagship hospital in St. Cloud earmarks only a fraction of its budget for helping patients who can\u2019t pay their medical bills.\t\t\t\t\t\t (Anthony Souffl\u00e9\/The Minnesota Star Tribune)<\/figcaption><!-- image-right --><br \/>\n\t\t\t\t\t\t\t\t\t<\/figure>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n<p class=\"has-heading-5-font-size\"><strong>\u2018We Have To Defend Being Paid\u2019<\/strong><\/p>\n<p>CentraCare spokesperson Karna Fronden said medical privacy laws prevented her from discussing Roberts\u2019 case. She also declined interview requests about the health system\u2019s charity care spending.<\/p>\n<p>In a statement, Fronden said CentraCare provides assistance in addition to charity care, such as helping enroll patients in insurance. \u201cThis helps provide broader, longer-term protection for patients,\u201d she said.<\/p>\n<p>Other hospital leaders said they serve their communities in ways besides forgiving medical bills, including training doctors and nurses and preserving money-losing services such as obstetrics and mental health care.<\/p>\n<p>\u201cRural hospitals like ours are often portrayed as though we are sitting on piles of cash and simply choosing not to spend it on charity care. That is far from the reality,\u201d said Robert Pastor, chief executive of Rainy Lake Medical Center in International Falls.<\/p>\n<p>\u201cWe are the second- or third-largest employer in town, running on razor-thin margins while navigating escalating labor and supply costs and routine underpayment by public programs,\u201d Pastor said. \u201cMeanwhile, many health insurers post billions in profits.\u201d<\/p>\n<p>Hospitals typically are paid less for care provided to Medicare and Medicaid patients. More than 80% of Rainy Lake\u2019s patients are on one of those government programs.<\/p>\n<div class=\"wp-block wp-block-kff-shared-newsletter  wp-block-kff-shared-newsletter--background-white\" data-type=\"kff-shared\/newsletter\" data-align=\"center\">\n<div class=\"wp-block-kff-shared-newsletter__container\">\n<div class=\"wp-block-kff-shared-newsletter__content\">\n\t\t\t<img decoding=\"async\" src=\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\" alt=\"Newsletter Icon\" class=\"wp-block-kff-shared-newsletter__img\"\/><\/p>\n<div class=\"wp-block-kff-shared-newsletter__text\">\n<h4 class=\"newsletter__title\">\n\t\t\t\t\tEmail Sign-Up\t\t\t\t<\/h4>\n<p class=\"newsletter__description\">\n\t\t\t\t\tSubscribe to KFF Health News&#8217; free Morning Briefing.\t\t\t\t<\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n<p>Minnesota hospitals collectively write off about $200 million of what\u2019s deemed bad debt every year after trying unsuccessfully to collect unpaid bills from patients through calls, letters, and even lawsuits. By comparison, they devote about $163 million annually to charity care, state figures show. In 2024, hospitals collectively posted $2.4 billion in net income.<\/p>\n<p>\u201cI feel like I\u2019m put in the position, being the hospital, where we have to defend being paid,\u201d said Patti Banks, the head of Ely-Bloomenson Community Hospital and a senior Minnesota Hospital Association board member.<\/p>\n<p>Some hospitals face intense financial pressures. Thirty-one have lost money on operations in four of the past eight years. HCMC in Minneapolis \u2014 the state\u2019s largest safety net hospital, which provides the most charity care \u2014 is losing so much money that, without additional taxpayer support, it could close.<\/p>\n<p>But larger health systems such as Mayo Clinic, Essentia Health, and Sanford Health have remained financially sound. And the operating margins at most CentraCare hospitals exceeded 10% in 2024, state data shows.<\/p>\n<p class=\"has-heading-5-font-size\"><strong>Medical Debt\u2019s High Toll<\/strong><\/p>\n<figure class=\"wp-block-image alignright size-large is-resized\"><img decoding=\"async\" height=\"1270\" width=\"870\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?w=870\" alt=\"\" class=\"wp-image-2235406\" style=\"width:500px\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg 2467w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?resize=103,150 103w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?resize=343,500 343w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?resize=768,1121 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?resize=870,1270 870w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?resize=1053,1536 1053w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?resize=1403,2048 1403w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care04_web.jpg?resize=120,175 120w\" sizes=\"(max-width: 870px) 100vw, 870px\"\/><figcaption class=\"wp-element-caption\">Abby Kelley-Hands is a special education coordinator in St. Paul with a rare immune condition that causes frequent, severe allergic reactions. She says that after she lost health coverage for a month because of an insurance snafu a few years ago, she was hit with more than $20,000 in bills from Mayo Clinic and denied financial aid. (Jeff Wheeler\/The Minnesota Star Tribune)<\/figcaption><\/figure>\n<p>Nationwide, health care debt \u2014 much of it from hospitals \u2014 burdens an estimated 100 million people, increasing their stress and even leading to premature deaths, studies show.<\/p>\n<p>Abby Kelley-Hands, a special education coordinator in St. Paul, has a rare immune condition that causes frequent, severe allergic reactions. Her illness can be controlled only with a costly drug, which a Mayo Clinic doctor prescribed.<\/p>\n<p>When Kelley-Hands briefly lost health coverage in 2021 in an insurance mix-up, she was hit with more than $20,000 in bills. And although she and her husband earned less than $100,000 a year, Kelley-Hands said Mayo denied her financial assistance because she earned too much.<\/p>\n<p>\u201cI was in tears,\u201d Kelley-Hands said. \u201cIt was so scary and so hard. And it causes all of this additional stress, which then makes you sicker and less able to even figure things out.\u201d<\/p>\n<p>Kelley-Hands and her husband sold a car and agreed to a payment plan before Mayo would resume her treatment, she said. Her husband now bikes 5 miles to work. They have no dishwasher. And she and her husband took a honeymoon only last fall, seven years after their wedding. \u201cWe live very simply,\u201d she said.<\/p>\n<p>Mayo spokesperson Kristyn Jacobson declined to discuss Kelley-Hands\u2019 case.<\/p>\n<p>In 2024, state lawmakers banned hospitals from denying care to patients with outstanding debt. And in 2025, Attorney General Ellison reached an agreement with Mayo to overhaul its charity care program after an investigation found the multibillion-dollar institution was systematically discouraging patients from applying.<\/p>\n<p>After the state began investigating Mayo, the system\u2019s charity care spending nearly doubled, topping 1.5% of operating expenses in 2024.<\/p>\n<p class=\"has-heading-5-font-size\"><strong>\u2018Optimized To Get Payment\u2019<\/strong><\/p>\n<p>Complying with a 2023 state law, Minnesota hospitals now post their financial aid policies online, although several, including CCM Health in Montevideo and Northfield Hospital, did so only after being contacted by the Star Tribune or KFF Health News.<\/p>\n<p>But many hospitals make financial aid more difficult to find than information about paying bills, said Jared Walker, founder of Dollar For, a nonprofit that helps patients nationally apply for charity care.<\/p>\n<p>\u201cHospitals have optimized to get payment,\u201d he said. \u201cIf you want to get on a payment plan, if you want to get on a credit card, it\u2019s so easy.\u201d<\/p>\n<p>Glacial Ridge Health System in Glenwood posts a \u201cBill Pay\u201d tab at the top of its homepage. But it takes several clicks to find the hospital\u2019s financial assistance plan. The information couldn\u2019t be found on the site searching for \u201ccharity care\u201d or \u201cfinancial assistance.\u201d The public hospital 130 miles northwest of Minneapolis devoted less than 0.7% of its operating budget to charity care from 2019 to 2024.<\/p>\n<p>Patients in interviews frequently said they weren\u2019t told about charity care.<\/p>\n<p>Joe Robling, 29, was treated at St. Francis Regional Medical Center in Shakopee for a broken pelvis and fractured spine after a 2024 motorcycle accident. His mother, Janet, who helped him navigate the bills, said the hospital never informed him about financial aid.<\/p>\n<p>\u201cThey didn\u2019t offer any of that,\u201d she said.<\/p>\n<p>Robling, a construction worker in Henderson, was between jobs and uninsured. \u201cHe had zippo,\u201d Janet Robling said. \u201cWhat he had in reserves were all depleted.\u201d<\/p>\n<p>The Allina Health-affiliated hospital billed him more than $19,000, the Roblings said.<\/p>\n<p>An internet ad connected the family to Dollar For, which helped Robling qualify for charity care five months after his accident.<\/p>\n<p>Allina spokesperson Jennifer Steingas declined to comment on the case, citing medical privacy restrictions, but said the health system has since reached out to the family.<\/p>\n<p>In another case, M Health Fairview\u2019s University of Minnesota Medical Center didn\u2019t offer financial aid to an unemployed and uninsured man from Idaho while he was hospitalized for two months for psychiatric care and amassed $150,000 in bills.<\/p>\n<p>Attorney Margaret Henehan, who represented the man, said the hospital instead offered him a two-year payment plan at $6,500 a month. \u201cHe had no income, which he told Fairview,\u201d Henehan said.<\/p>\n<p>The man, who is not identified because of his mental health condition, eventually received charity care after his sister, a doctor, reached out to Henehan for help.<\/p>\n<p>Aimee Jordan, a Fairview spokesperson, said she couldn\u2019t comment on the case because of patient privacy laws, but she said patients who are offered payment plans can always apply for charity care, even after a hospitalization.<\/p>\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" loading=\"lazy\" decoding=\"async\" height=\"847\" width=\"1270\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?w=1270\" alt=\"A large brick building with large white letters at its top reading &quot;University of Minnesota Medical Center Fairview&quot;\" class=\"wp-image-2236576\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg 3840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=600,400 600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=834,556 834w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care-05.jpg?resize=1668,1112 1668w\" sizes=\"auto, (max-width: 1270px) 100vw, 1270px\"\/><figcaption class=\"wp-element-caption\">M Health Fairview University of Minnesota Medical Center in Minneapolis, pictured in March 2013. (Joel Koyama\/The Minnesota Star Tribune)<\/figcaption><\/figure>\n<p class=\"has-heading-5-font-size\"><strong>A Maze of Standards<\/strong><\/p>\n<p>State law prohibits hospitals from making \u201cunreasonable\u201d demands of patients when they apply for charity care. But the law sets few specific standards.<\/p>\n<p>The result is a dizzying array of policies, including 11 income thresholds used by Minnesota hospitals to determine whether patients qualify for free care, the Minnesota Star-Tribune-KFF Health News review found.<\/p>\n<p>HCMC parent company Hennepin Healthcare in Minneapolis and Olmsted Medical Center in Rochester offer the highest threshold for free care, at 300% of the federal poverty level \u2014 almost $48,000 a year for an individual.<\/p>\n<p>Sometimes standards vary even between neighboring hospitals. Madelia Health in south-central Minnesota limits financial assistance to patients who make less than twice the federal poverty level. About 13 miles away at Mayo\u2019s hospital in St. James, patients earning twice as much can qualify for aid.<\/p>\n<div id=\"datawrapper-embed-N4bDx\" class=\"datawrapper-embed block--datawrapper-embed\">\n<p>\t\t\t<img decoding=\"async\" class=\"datawrapper-embed__print-img\" src=\"https:\/\/datawrapper.dwcdn.net\/N4bDx\/full.png\" alt=\"Most hospitals limit charity care to those in poverty (Bar Chart)\"\/>\n<\/div>\n<p>To determine eligibility, some Minnesota hospitals consider only income, but most demand information about patients\u2019 bank accounts as well. More than two-thirds require even more information, including the value of retirement accounts, life insurance policies, property, and vehicles. Madelia\u2019s policy states patients \u201cmay be required to sell recreational vehicles.\u201d<\/p>\n<p>Stringent requirements ensure that limited resources go to patients who need them, said Travis Olsen, chief executive of Hendricks Community Hospital, near the South Dakota border. \u201cWe don\u2019t feel it\u2019s fair for someone with lower annual income but yet owns numerous acres of land, debt-free, to be able to qualify for charity care.\u201d<\/p>\n<p>In addition to copies of tax returns, W-2 forms, pay stubs, and bank statements, Hendricks asks aid applicants 53 questions about their finances. These include questions about the make, model, and value of vehicles; the current market value of farm equipment, livestock, and land; and the purchase price and square footage of homes.<\/p>\n<p>Other hospital applications ask patients to detail their monthly spending on food, utilities, and other medical bills.<\/p>\n<p>Olsen said community pressure is more of a deterrent to applying for aid than the application: \u201cPeople are too proud to pick up an application. We all know each other.\u201d<\/p>\n<p>But Walker at Dollar For said the biggest barrier is complexity. \u201cThe drop-off rates are much higher the more questions you ask and the more documentation you have to provide,\u201d he said.<\/p>\n<p>Arleen Mullenax had a cancerous tumor removed from her neck at Mayo in Rochester. Assembling her aid application and following up with the hospital billing department amid her \u201ccancer fog\u201d was almost more than she could take, she said.<\/p>\n<p>\u201cI knew as a former office manager I had to stay on top of it,\u201d she said. \u201cBut it was the most daunting thing I had to do as a patient.\u201d<\/p>\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" loading=\"lazy\" decoding=\"async\" height=\"847\" width=\"1270\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?w=1270\" alt=\"\" class=\"wp-image-2235408\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg 3840w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=600,400 600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=834,556 834w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care06_3840x2560web.jpg?resize=1668,1112 1668w\" sizes=\"auto, (max-width: 1270px) 100vw, 1270px\"\/><figcaption class=\"wp-element-caption\">The Mayo Clinic campus in Rochester, Minnesota. Last year, the multibillion-dollar institution overhauled its charity care program after an investigation found it was systematically discouraging patients from applying. (Aaron Lavinsky\/The Minnesota Star Tribune)<\/figcaption><\/figure>\n<p class=\"has-heading-5-font-size\"><strong>Fixing the System<\/strong><\/p>\n<p>Ellison and several state lawmakers say Minnesota\u2019s hospitals should make it simpler for patients to access charity care.<\/p>\n<p>They\u2019ve called for, among other things, common eligibility standards and a standard application across hospitals. New York and Maryland already have both.<\/p>\n<p>\u201cEliminating as many barriers as possible for people is really important,\u201d said state Sen. Liz Boldon, who also said she hopes lawmakers can enact these standards next session.<\/p>\n<p>The Minnesota Hospital Association has opposed standardizing financial assistance, saying hospital boards are in the best position to assess the need for charity care in their communities. \u201cAdding mandates for providers across the state will not close that gap, and will only increase bureaucratic and procedural barriers to patient care,\u201d spokesperson Nelson said.<\/p>\n<p>Ellison also has pushed to require hospitals to use a process that automatically screens and qualifies low-income patients for financial aid without requiring an application.<\/p>\n<figure class=\"wp-block-image alignwide size-large\"><img loading=\"lazy\" loading=\"lazy\" decoding=\"async\" height=\"849\" width=\"1270\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?w=1270\" alt=\"\" class=\"wp-image-2235409\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg 1616w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=500,334 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=768,513 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=1270,849 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=1536,1027 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care07.jpg?resize=600,400 600w\" sizes=\"auto, (max-width: 1270px) 100vw, 1270px\"\/><figcaption class=\"wp-element-caption\">Minnesota Attorney General Keith Ellison says Minnesota hospitals should provide more financial assistance to patients to justify their tax-exempt status.  (Alex Kormann\/The Minnesota Star Tribune)<\/figcaption><\/figure>\n<p>Some hospital systems, including South Dakota-based Sanford Health, already use software that checks patients\u2019 eligibility based on information such as their credit history, said Nick Olson, the system\u2019s chief financial officer. At Sanford Health\u2019s 10 hospitals in Minnesota, about a quarter of the patients who receive financial aid get it this way, he said.<\/p>\n<p>Nearly all Sanford hospitals devote more than 1% of their operating expenditures to charity care \u2014 higher than most hospitals in the state.<\/p>\n<p>Screening software can be costly. Several executives at small Minnesota hospitals said they can\u2019t afford it. But there are other options. In California, Los Angeles County is developing a public system to allow hospitals to quickly assess patients\u2019 eligibility so they don\u2019t have to buy a system themselves.<\/p>\n<p>Other states \u2014 including Texas and Nevada \u2014 have laws requiring hospitals to provide minimum amounts of charity care.<\/p>\n<p>Back in St. Cloud, Roberts said that when she drives past CentraCare\u2019s $200 million expansion at its Plaza campus in St. Cloud, she wonders why Minnesota hospitals don\u2019t live up to higher standards themselves.<\/p>\n<p>\u201cThey have all the money,\u201d she said. \u201cBut they can\u2019t grant a good person some grace?\u201d<\/p>\n<figure class=\"wp-block-image alignwide size-large\"><img loading=\"lazy\" loading=\"lazy\" decoding=\"async\" height=\"847\" width=\"1270\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?w=1270\" alt=\"\" class=\"wp-image-2235403\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg 3600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=150,100 150w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=500,333 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=768,512 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=1270,847 1270w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=1536,1024 1536w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=2048,1365 2048w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=120,80 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=300,200 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=600,400 600w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=834,556 834w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2026\/05\/charity-care01_3600x2400web.jpg?resize=1668,1112 1668w\" sizes=\"auto, (max-width: 1270px) 100vw, 1270px\"\/><figcaption class=\"wp-element-caption\">Roberts incurred more than $8,000 in medical bills after she was diagnosed at CentraCare with early-stage cervical cancer. She says the health system told her she made too much \u2014 about $41,000 a year \u2014 to qualify for financial aid. (Anthony Souffl\u00e9\/The Minnesota Star Tribune)<\/figcaption><\/figure>\n<\/div>\n<p><br \/>\n#Ranks #Uninsured #Grow #Minnesotas #Hospitals #Among #Charitable #Nation<br \/>\nAs Ranks of Uninsured Grow, Minnesota\u2019s Hospitals Are Among Least Charitable in Nation<\/p>\n","protected":false},"excerpt":{"rendered":"<p>ST. CLOUD, Minn. \u2014 Cori Roberts was living in a rented basement four years ago when she was diagnosed with early-stage cervical cancer. Recently divorced, the former stay-at-home mother had started working again in her mid-40s, taking a human resources job that paid $41,000 a year. Then, despite having insurance, she was hit with more<\/p>\n","protected":false},"author":1,"featured_media":9228,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[3654,770,3653,3655,3666],"class_list":{"0":"post-9227","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthy","8":"tag-graphics","9":"tag-investigation","10":"tag-midwest-bureau","11":"tag-multimedia","12":"tag-uninsured"},"_links":{"self":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/posts\/9227","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=9227"}],"version-history":[{"count":0,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/posts\/9227\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=\/wp\/v2\/media\/9228"}],"wp:attachment":[{"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=9227"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=9227"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.healthoptibody.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=9227"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}