Boys Town's research hospital provides little charity care ― less than 1% of annual expenses

Boys Town's National Research Hospital and clinics, a spinoff from the iconic residential nonprofit for youth in need, now accounts for about 45% of the organization's annual expenses.

The hospital provides specialty care and research focusing on childhood deafness, visual impairment and communication disorders.

Under U.S. Internal Revenue Service code, nonprofit hospitals are required to provide charity care to receive tax-exempt status. According to the KFF health policy research organization, the IRS defines charity care as “free or discounted health services provided to persons who meet the organization’s eligibility criteria for financial assistance and are unable to pay for all or a portion of the services.”

The hospital spent $203,000 on charity care in 2022 ― amounting to 0.06% of its annual expenses, according to its most recent publicly available tax return.

“Their (estimated) tax exemption value is around $11 million, but they don't spend anywhere close to that in charity care or other community benefits,” said Bernata Haynes, a senior attorney with the National Consumer Law Center.

A review of 2021 figures for 14 children's hospitals across the country shows 11 provided more financial assistance than Boys Town's research hospital, according to Judith Garber, a senior policy analyst for the Lown Institute, a nonpartisan health care think tank in Massachusetts.

On the high end, Shriners Children's Hospital in Tampa, Florida, put 25% of revenues toward financial assistance, while Blythedale Children's Hospital in Valhalla, New York, provided just $12,464 in financial assistance in 2021, about 0.01% of its expenses.

"Boys Town’s level of spending as a percent of their expenses is pretty low," Garber said. "There’s a huge variety on this level. The average is between 2% to 3% of expenses. They do less than 1%."

Garber, who researches hospital community benefits policy, said Boys Town's hospital also serves fewer patients on Medicaid, the government insurance program for low-income people, than other children's hospitals.

"They're serving more affluent clientele," she said.

Boys Town says that it educates patients through its website and at the hospital on how to obtain financial assistance and that it uses federal poverty guidelines in determining free or discounted care. However, patients have to document they applied for other existing financial assistance and disclose their personal assets and liabilities before being considered for charity care.

Across the country, the level of economic benefit that nonprofit hospitals provide to low-income families has become a greater issue as research has shown how much Americans are burdened by medical or dental bill debt ― 41% of adults, according to a 2022 KFF health care debt survey.

Some states, such as Connecticut, Illinois and Nevada, require nonprofit hospitals to provide a minimum amount of charity care. Nebraska has no minimum.

“You would have the expectation that there’s a floor on how much they would have to spend and who would qualify,” Haynes said. “Yes, they have to establish a written (charity care) policy, and they have to have it on their website and on their statements. But notably, they aren’t required to screen patients for eligibility or tell them they may be eligible. … It feels unfair. It feels like a really glaring oversight, and it is."

Lee Rood's Reader's Watchdog column helps Iowans get answers and accountability from public officials, the justice system, businesses and nonprofits. Reach her at lrood@registermedia.com, at 515-284-8549, on Twitter at @leerood or on Facebook at Facebook.com/readerswatchdog.

Part of a series supported by the Pulitzer Center.

This article originally appeared on Des Moines Register: Boys Town's National Research Hospital provides little charity care