Charity care programs at Minnesota hospitals provide minimal aid to low-income patients

A Minnesota Star Tribune-KFF Health News investigation of hospital data and charity care programs shows most Minnesota hospitals provide little financial aid to patients and often make assistance difficult to get.

Objective Facts

A Minnesota Star Tribune-KFF Health News investigation of hospital data and charity care programs shows most Minnesota hospitals provide little financial aid to patients and often make assistance difficult to get. Minnesota's hospitals and health systems are among the least charitable in the country, 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. Minnesota hospitals spend about a third of that on average, of the national average of 2.4%. Patients must submit detailed personal information, including bank statements, retirement accounts, mortgage documents and estimates of other assets such as cars, homes or livestock. Rep. Steve Elkins, DFL-Bloomington, introduced legislation to help hospitals with their own tax contributions, saying hospitals have an obligation to do something more than they are doing.

Left-Leaning Perspective

Minnesota Attorney General Keith Ellison said hospitals have a duty to increase charitable help for all needy patients in exchange for the tax breaks they receive. After investigating irregularities in charity care at Mayo Clinic, Ellison recommended the state set a minimum floor for charity care eligibility across all hospitals and recommended all hospitals adopt presumptive eligibility systems that assume patients need financial help until proven otherwise. Rep. Steve Elkins, DFL-Bloomington, introduced legislation to redirect money from an existing health care tax back to hospitals to cover costs of providing free care, arguing that while hospitals are providing a fair amount of charity care, they have an obligation to do something more than they are doing. Elkins noted reports by the Lown Institute and state Legislative Auditor's Office indicating that some hospitals are gaining more in nonprofit tax benefits than they are spending on community benefits, including charity care. Erin Hartung, director of legal services at Cancer Legal Care, stated 'The system is not working' and 'the burden is falling hardest on the people who are least able to bear it.' Left-leaning coverage emphasizes the obligation hospitals incur by receiving tax-exempt status and calls for standardized, more accessible eligibility criteria. Left-leaning coverage centers on the inequity of nonprofit hospitals receiving substantial tax benefits while providing minimal charity care. The sources emphasize that this is a matter of fairness and accountability—nonprofit status comes with an implicit obligation to serve the public good. Coverage is notably absent of counterarguments that hospitals face genuine financial distress or that local boards are better positioned to determine community needs.

Right-Leaning Perspective

The Minnesota Hospital Association opposed standardizing financial assistance, saying hospital boards are in the best position to assess the need for charity care in their communities, arguing that adding mandates for providers across the state will not close the gap and will only increase bureaucratic and procedural barriers to patient care. Hospital officials argued it's unfair to expect them to solve the affordability problem when many of their facilities are financially strained, with Minnesota Hospital Association spokesperson Tim Nelson stating 'No amount of charity care from hospitals will ever fully meet the needs of uninsured or underinsured Minnesotans. The need is simply too great.' Travis Olsen, chief executive of Hendricks Community Hospital, defended stringent eligibility requirements, saying 'We don't feel it's fair for someone with lower annual income but yet owns numerous acres of land, debt-free, to be able to qualify for charity care.' Rep. Steve Elkins acknowledged that simply demanding more from hospitals isn't necessarily the answer, given that newly released financial data shows 31 Minnesota hospitals meet the state's definition of financial distress because they lost money on operations in four of the past eight years. Right-leaning hospital perspectives emphasize operational constraints, local decision-making authority, and the limits of charity care as a solution to broader affordability crises. Right-leaning or hospital-industry coverage frames the issue as one of limited resources and financial realities rather than insufficient obligation. The Minnesota Hospital Association argues that imposing standardized requirements will worsen bureaucratic burden rather than improve access, and hospital officials contend that local boards—not state mandates—should determine appropriate charity care levels given their communities' actual conditions.

Deep Dive

The May 11, 2026 Minnesota Star Tribune-KFF Health News investigation examined every hospital charity care program in the state through a detailed review, analysis of five years of hospital financial data, and dozens of interviews with patients, hospital executives and state officials. The investigation found that 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, while Minnesota hospitals spend about a third of that, on average. Of Minnesota's 123 general hospitals, 61 devoted less than 0.5% of their operating budgets to charity care from 2020 through 2024. The policy debate reflects genuine tension between competing values. Progressives like Attorney General Ellison argue that tax-exempt status carries an implicit obligation to serve the public good and that standardization ensures equity across regions. Their evidence includes the stark disparity in eligibility thresholds—from $15,000 to $47,000 annually—which creates arbitrary advantage based on geography. However, hospital officials argue they face real financial constraints: 31 Minnesota hospitals meet the state's definition of financial distress, and some hospital executives say they cannot afford screening software to assess eligibility. The Minnesota Hospital Association's position that mandates will increase bureaucratic barriers reflects genuine operational concerns, though critics counter that hospitals have optimized billing systems far more effectively than assistance systems. Following state investigation, Mayo's charity care spending nearly doubled, topping 1.5% of operating expenses in 2024, suggesting that accountability mechanisms can drive change. The story intersects broader healthcare affordability crises and state revenue challenges. Rep. Elkins proposed redirecting money from an existing health care tax to hospitals to cover charity care costs, arguing this makes sense as more Minnesotans are losing health insurance. This approach attempts to address both hospital financial strain and patient access—a middle-ground position—but raises questions about whether hospitals or the state should bear responsibility for covering uninsured care. The outcome of Elkins' bill and whether Attorney General Ellison's recommendations gain legislative traction remain unresolved in current reporting.

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Charity care programs at Minnesota hospitals provide minimal aid to low-income patients

A Minnesota Star Tribune-KFF Health News investigation of hospital data and charity care programs shows most Minnesota hospitals provide little financial aid to patients and often make assistance difficult to get.

May 11, 2026· Updated May 28, 2026
What's Going On

A Minnesota Star Tribune-KFF Health News investigation of hospital data and charity care programs shows most Minnesota hospitals provide little financial aid to patients and often make assistance difficult to get. Minnesota's hospitals and health systems are among the least charitable in the country, 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. Minnesota hospitals spend about a third of that on average, of the national average of 2.4%. Patients must submit detailed personal information, including bank statements, retirement accounts, mortgage documents and estimates of other assets such as cars, homes or livestock. Rep. Steve Elkins, DFL-Bloomington, introduced legislation to help hospitals with their own tax contributions, saying hospitals have an obligation to do something more than they are doing.

Left says: Minnesota Attorney General Keith Ellison said hospitals have a duty to increase charitable help for all needy patients in exchange for the tax breaks they receive. Rep. Steve Elkins introduced legislation redirecting hospital tax revenue to charity care, arguing hospitals have an obligation to do something more than they are currently doing.
Right says: The Minnesota Hospital Association opposed standardizing financial assistance, arguing hospital boards are in the best position to assess community need and that mandates will increase bureaucratic barriers to patient care. Hospital officials contend that no amount of charity care can fully meet the needs of uninsured or underinsured Minnesotans, as the need is simply too great.
✓ Common Ground
Some voices across the political spectrum recognize that Minnesota's charity care system lacks standardization. Both the investigation and hospital officials acknowledge that because Minnesota has not standardized the criteria for charity care, patients might receive aid at one hospital but not another, with some hospitals giving free care to patients with an annual household income of $47,000, while others cap it at about $15,000.
Both progressive policymakers and hospital officials acknowledge financial strain on the system. Rep. Elkins acknowledged that simply demanding more from hospitals isn't necessarily the answer given that 31 Minnesota hospitals meet the state's definition of financial distress. Hospital Association spokesman Tim Nelson acknowledged that 'No amount of charity care from hospitals will ever fully meet the needs of uninsured or underinsured Minnesotans.'
There appears to be agreement that the status quo requires some form of change. Minnesota Attorney General Keith Ellison stated the investigation 'makes it clear there is more work in front of us.' Rep. Elkins stated that hospitals 'kind of have an obligation to do something more than they are doing.'
Several perspectives recognize the role of broader policy factors beyond hospitals' control. The investigation notes that job-based insurance and an expanded Medicaid program offer broad coverage, and hospitals in states with less government assistance and more uninsured people typically spend more on charity care. This contextual framing appears in coverage across perspectives.
Objective Deep Dive

The May 11, 2026 Minnesota Star Tribune-KFF Health News investigation examined every hospital charity care program in the state through a detailed review, analysis of five years of hospital financial data, and dozens of interviews with patients, hospital executives and state officials. The investigation found that 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, while Minnesota hospitals spend about a third of that, on average. Of Minnesota's 123 general hospitals, 61 devoted less than 0.5% of their operating budgets to charity care from 2020 through 2024.

The policy debate reflects genuine tension between competing values. Progressives like Attorney General Ellison argue that tax-exempt status carries an implicit obligation to serve the public good and that standardization ensures equity across regions. Their evidence includes the stark disparity in eligibility thresholds—from $15,000 to $47,000 annually—which creates arbitrary advantage based on geography. However, hospital officials argue they face real financial constraints: 31 Minnesota hospitals meet the state's definition of financial distress, and some hospital executives say they cannot afford screening software to assess eligibility. The Minnesota Hospital Association's position that mandates will increase bureaucratic barriers reflects genuine operational concerns, though critics counter that hospitals have optimized billing systems far more effectively than assistance systems. Following state investigation, Mayo's charity care spending nearly doubled, topping 1.5% of operating expenses in 2024, suggesting that accountability mechanisms can drive change.

The story intersects broader healthcare affordability crises and state revenue challenges. Rep. Elkins proposed redirecting money from an existing health care tax to hospitals to cover charity care costs, arguing this makes sense as more Minnesotans are losing health insurance. This approach attempts to address both hospital financial strain and patient access—a middle-ground position—but raises questions about whether hospitals or the state should bear responsibility for covering uninsured care. The outcome of Elkins' bill and whether Attorney General Ellison's recommendations gain legislative traction remain unresolved in current reporting.

◈ Tone Comparison

Left-leaning coverage uses questioning and moral framing to highlight what it characterizes as hospitals' unfulfilled obligations. Ellison's question—'There is a benefit you get from being a nonprofit hospital in the state of Minnesota. But do the people get the benefit?'—positions the issue as a fairness problem. Right-leaning or hospital-industry coverage emphasizes constraints and competing priorities, using absolutes to establish limits. The hospital association's statement that 'No amount of charity care from hospitals will ever fully meet the needs' frames the issue as one of impossible expectations rather than insufficient effort.