Spokeswoman June Fowler says the change also requires uninsured patients to provide, as a minimum, co-pays for medical services.
Fowler acknowledged increased financial pressure on all health care providers. But she said the changed policy "was in response to the Affordable Care Act and the requirement that most Americans should go to the marketplace and buy insurance, knowing that there are subsidies available to low-income people."
Representatives of the region's other big hospital operators — Mercy Health, SSM HealthCare, and St. Louis University Hospital — said they have no plans to reduce their level of charity care.
The change at BJC was the latest potential setback for the region's health safety net for the poor. In the fall, St. Louis ConnectCare closed due to financial troubles. The organization helped uninsured patients obtain appointments with doctors who provide specialty services.
Robert Fruend Jr., executive director of St. Louis Regional Health Commission, said the reluctance of Missouri lawmakers to accept billions of federal dollars to expand the state Medicaid program was responsible for BJC's new charity care policy.
"Without Medicaid expansion, there are incredible pressures on our healthcare providers," Fruend said.
"The good news is that folks over 100% of poverty have options in the (insurance) marketplace," he said. "They need to use it."