Minnesota Hospitals Offer Minimal Charity Care, Leaving Patients in Debt

A Star Tribune-KFF Health News investigation found Minnesota hospitals devote far less of their operating budgets to charity care than peers. Of 123 general hospitals, 62 spent under 0.5% (2020-2024); CentraCare’s St. Cloud Hospital contributed less than 0.25%. Nationally, hospitals spend about 2.4% of budgets on charity care, while Minnesota averages roughly 0.8%.

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Minnesota nonprofit hospitals receive millions in federal, state and local tax breaks in exchange for providing charity care. The expectation is that tax advantages translate into community assistance.

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Eligibility thresholds vary from $15,000 to $47,000 across hospitals, with no statewide standard. Applications often require bank statements, retirement accounts, mortgage documents and asset valuations; Hendricks Community Hospital asks 53 detailed financial questions, discouraging many patients.

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Attorney General Keith Ellison questioned whether patients receive the benefit of nonprofit status. Minnesota Hospital Association spokesperson Tim Nelson said no level of charity care can fully meet the needs of uninsured or underinsured residents. CentraCare spokesperson Karna Fronden cited privacy constraints and noted additional services such as insurance enrollment assistance.

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Erin Hartung of Cancer Legal Care called the system “not working,” noting the burden falls hardest on the vulnerable. Dollar For founder Jared Walker warned that extensive paperwork raises applicant drop-off rates. Rural hospital chief executive Robert Pastor stressed razor-thin margins and underpayment by public programs.

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Four years ago, 40-year-old Cori Roberts, a recently divorced mother earning $41,000, was diagnosed with early-stage cervical cancer while living in a rented basement. Despite insurance, she accrued over $8,000 in CentraCare bills, paid $6,000 over two years, and took a retirement-plan loan to settle the remaining balance after a lawsuit was filed and later dropped.

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• “They're supposed to be a nonprofit,” Roberts said. “It's like, ‘Come on!’” — Cori Roberts, former patient

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• “The system is not working,” — Erin Hartung, director of legal services, Cancer Legal Care

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• “There is a benefit you get from being a nonprofit hospital in the state of Minnesota,” — Keith Ellison, Minnesota Attorney General

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• “ "Rural 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.” — Robert Pastor, chief executive, Rainy Lake Medical Center

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Attorney General Ellison said hospitals have a duty to increase charitable help for all needy patients, and the investigation highlighted the need for a standardized charity-care eligibility standard.

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