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ROCHESTER — At his with area DFL lawmakers on Saturday, Minnesota Attorney General Keith Ellison took time to talk about his office's investigation into Mayo Clinic, the results of which had become public just the day before.

"We came to the conclusion that they could be doing better," Ellison said.

The investigation into Mayo Clinic's charity care and debt collection practices began in December 2022, after the Post Bulletin reported that some patients despite being eligible for charity care, had they known about the program.

Financial assistance, often called charity care, is a program all U.S. nonprofit hospitals are required to provide. Patients meeting certain financial benchmarks may qualify for free or reduced-cost care if they apply.

The found that "several of Mayo's policies were acting as a barrier to care for Minnesotans unable to pay for services," including steering patients toward fundraising or taking out a loan before discussing charity care.

During the investigation, Mayo Clinic made changes, such as screening patients with outstanding bills for their charity care eligibility and, if they qualified, reducing their debt owed. As a result, the health system's charity care contributions grew to $130 million in 2024.

"With this settlement, we move closer to patients being able to focus on what matters most: their recovery," said state Sen. Liz Boldon, DFL-Rochester.

In the years between the Post Bulletin's reporting and the end of Ellison's investigation, Boldon and state Rep. Liz Reyer, DFL-Eagan, saw their and reform bills become law in 2023 and 2024, respectively.

Now, Minnesota hospitals must screen patients for their eligibility for charity care before taking certain actions to collect payment. Medical debt no longer impacts credit scores, and hospitals cannot withhold care to patients with outstanding bills.

"Everyone deserves the medical care they need," Boldon said. "It’s concerning that when it came to patients with lower incomes, Mayo Clinic neglected to put the needs of the patient first."

In response to the report, state Rep. Kim Hicks, DFL-Rochester, said "charity care applications and access should not be a secret."

State Rep. Tina Liebling, DFL-Rochester, said she is "very pleased" with Ellison's work.

"People don't take on medical debt because they want to," Liebling said. "Too often, folks get sick and need care but can't afford to pay for it. This is not the patient's fault, but the result of our broken health care financing system."

The report also makes three policy recommendations:

• Have all hospitals implement a "presumptive eligibility" process to see if patients qualify for charity care, similar to Mayo Clinic's new process;
• Create a simplified charity care application that would be uniform across hospitals;
• Provide a basic income-based eligibility floor for charity care programs.

State Rep. Andy Smith, DFL-Rochester, said they are "good suggestions."

"I think most Minnesotans want hospitals to have some form of charity care, to do it well, to do it responsibly so people can get it," Smith said.

"I believe that health care is a human right," Hicks added. "Policy changes that ensure Minnesotans have access to the health care they need are a top priority for myself and my DFL colleagues. The suggestions in the attorney general’s report are ones we should lean into as we work to improve the system."

With roughly two months left in the Minnesota Legislature's 2025 session, an evenly split House and the state's next two-year budget to square away, Boldon said it's unlikely that lawmakers will take up Ellison's suggestions this year.

"I'm very interested in digging into those (recommendations) and bringing those forward next session," said Boldon, who has this session.

While Liebling said the streamlined application form "seems like pretty easy, low-hanging fruit that could be done," she had reservations about the other two recommendations.

"The problem that we have, I think, is that hospitals across the state have very different financial stability pictures," Liebling said. "I don't want to jump on board ... without understanding more of what it would do."

Future policy aside, Ellison's report states that Mayo Clinic's cooperation and changes "demonstrates its interest in serving as a leader in the field for other health systems to follow."

"Mayo's a leader," Ellison said on Saturday, "not just in Minnesota, but in the world. And if they're willing to step up and take serious action on this, so should everybody else."

During a press conference in Rochester on Monday morning related to medical research, U.S. Sen. Amy Klobuchar said she was "really glad" the issue was settled.

“I appreciate that the attorney general looked into this and that this resolved in a settlement and that we will have a changed process going forward. That’s how the legal system is supposed to work," she said.

In a statement to the Post Bulletin on Friday afternoon, Mayo Clinic said it does contest some of the findings in the report.

"Mayo will not comment further other than to refer to the 'Allegations' section of the settlement agreement, the language of which was negotiated by the Attorney General‘s office over several months and notably does not include most of the information reflected in the report, which ... the Attorney General admits does not reflect their formal determination," Mayo Clinic said.

The Post Bulletin reached out to U.S. Sen. Tina Smith, U.S. Rep. Brad Finstad, Rochester Mayor Kim Norton, Minnesota Gov. Tim Walz and Lt. Gov. Peggy Flanagan, the Minnesota Hospital Association and state Rep. Duane Quam, R-Byron, for comment on the report but did not receive responses. A spokesperson for state Sen. Carla Nelson, R-Rochester, said the senator was not able to provide a response before the deadline.