Article
The latest findings
KFF Health News and the Minnesota Star Tribune reviewed every hospital charity care program in Minnesota along with five years of state financial data. Nationally, hospitals spend about 2.4% of operating budgets on charity care, based on federal data compiled by a Johns Hopkins researcher. Minnesota hospitals spend about a third of that on average, and 62 of the state’s 123 general hospitals spent under 0.5% from 2020 through 2024. Charity care statewide runs about $163 million a year, compared with roughly $200 million in annual bad debt and $2.4 billion in combined net income in 2024.
The review also found 11 different income thresholds for free care across the state, with the most generous set at 300% of the federal poverty level. Mayo Clinic’s charity care nearly doubled after a state investigation and a 2025 agreement with the attorney general.
The industry’s response
On May 13, AHA President and CEO Rick Pollack answered a May 4 Washington Post op-ed critical of nonprofit hospitals. He cited nearly $150 billion in community benefit in 2022, an EY estimate that tax-exempt hospitals deliver benefits more than 11 times the value of their forgone federal taxes, and hospital expense growth of 7.5% in 2025, more than double the growth in payment for patient care.
Both points can hold at once. Systemwide community benefit totals can be large while an individual hospital spends little on free care for low-income patients. Critics and policymakers increasingly focus on the second figure.
What boards should review
- Charity care as a share of operating expense, by hospital, against state and national benchmarks.
- Eligibility thresholds compared with peers. Texas and Nevada require minimum amounts of charity care, and New York and Maryland use common eligibility standards and a standard application.
- The ratio of charity care to bad debt. A high bad debt figure can point to patients who qualified for help but were never screened.
- Screening at registration, especially as uninsured rates climb. Minnesota’s uninsured rate in 2025 was its highest since 2017.
- Collection practices, and whether they match the mission statement.
Archive entry for May 16, 2026, added Nov. 11, 2026.