ST. LOUIS -- Charity care has long been a core mission of BJC HealthCare, but the St. Louis area's largest employer is cutting back amid increasing financial pressures.

The St. Louis Post-Dispatch reported that BJC has changed the "upper level of eligibility" for the charity care it provides. Beginning Jan. 1, BJC reduced the pool of patients eligible for financial assistance to those earning up to 300 percent of the federal poverty level. The previous cap was 400 percent.

Spokeswoman June Fowler said 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 Health Care 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 because of 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 health care providers," Fruend said.

"The good news is that folks over 100 percent of poverty have options in the [insurance] marketplace," he said. "They need to use it."

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Information from: St. Louis Post-Dispatch, http://www.stltoday.com