The nonprofit ProPublica has published an investigative report detailing how St. Jude Children's Research Hospital is a mammoth fundraiser, provides free medical treatment for children, and yet does not pay for every single financial burden incurred by families struggling to care for their sick children.

St. Jude, based in Mepmhis, Tennessee, is the largest health care charity in the United States. The hospital costs an estimated $3.3 million per day to operate, but patients are not charged for the care they receive. Instead, the majority of the nonprofit's funding comes from generous donors, including celebrities and well-known public figures who feature in the hospitals advertisements.

ProPublica reports that St. Jude was recognized as the 10th-best children's cancer hospital by U.S. News & World Report and raised a record $2 billion last year — nearly as much as the other nine hospitals ahead of it raised combined. The report notes the hospital currently has another $5.2 billion in reserves, "a sum large enough to run the institution at current levels for the next four and a half years without a single additional donation."

Because of the overwhelming generosity of its donors, St. Jude promises that "families never receive a bill from St. Jude for treatment, travel, housing or food — because all a family should worry about is helping their child live."

But the report focuses on the expenses St. Jude does not cover, including "housing, travel and food costs that fall outside the hospital's strict limits."

While families may not receive a bill from St. Jude, the hospital doesn't cover what's usually the biggest source of financial stress associated with childhood cancer: the loss of income as parents quit or take leave from jobs to be with their child during treatment. For many families, the consequence is missed payments for cars, utilities and cellphones. Others face eviction or foreclosure because they can't keep up with rent and mortgage payments.

Parents at St. Jude have exhausted savings and retirement accounts, borrowed from family and friends or asked other charities for aid. ProPublica identified more than 100 St. Jude families seeking financial help through the online fundraiser GoFundMe, with half of the campaigns started in the past two years. We counted scores of other events like concerts and yard sales organized to help St. Jude families in need.

ProPublica reported that in the last five fiscal years, roughly half of the $7.3 billion St. Jude raised funded research and care for patients. About 30% of that figure covered operating expenses and the remaining 20%, $1 out of every $5 gifted, was put into the reserve fund.

"Further, ProPublica found, a substantial portion of the cost for treatment is paid not by St. Jude but by families' private insurance or by Medicaid, the government insurance program for low-income families," the outlet reported.

"About 90% of patients are insured, bringing in more than $100 million in reimbursements for treatment a year. If a family shows up at St. Jude without insurance, a company hired by the charity helps them find it. St. Jude does cover copays and deductibles, an unusual benefit."

In a written response to ProPublica, lawyers for St. Jude and its fundraising arm, the American Lebanese Syrian Associated Charities, highlighted how the research team at St. Jude is committed to finding cures for deadly childhood diseases and pointed out thousands of sick children have been treated for free over the years.

"This often comes as a huge relief to families who often expect to sell all their belongings just so their children can get the medical care and treatment they need to save their lives," the lawyers wrote. "St. Jude and ALSAC understand that this arrangement cannot cover all financial obligations of all families, nor can St. Jude or ALSAC shield families from all the financial and emotional effects" of a child's illness.

"ProPublica should be celebrating St. Jude and ALSAC for their commitment to finding cures, saving children's lives, and optimizing patient outcomes," the lawyers wrote.

The report received a fair amount of backlash on social media from readers who thought ProPublica was criticizing the charity unfairly.

Here\u2019s an investigation into the dark side of a free hospital that treats children at no charge, and the dark side is that it doesn\u2019t also pay their parents salaries or mortgage repayments https://www.propublica.org/article/st-jude-hoards-billions-while-many-of-its-families-drain-their-savings\u00a0\u2026pic.twitter.com/2Ioo08Z0mM

— Tom Gara (@tomgara) 1636725607

So ProPublica wrote this terrible hit piece on St. Jude's because while the hospital provides life-saving medical care for children, it does not provide a safety net for families. Why don't ProPublica's wealthy donors step in to cover those costs? https://www.propublica.org/article/st-jude-hoards-billions-while-many-of-its-families-drain-their-savings\u00a0\u2026pic.twitter.com/nP1VEcza7N

— Chuck Ross (@ChuckRossDC) 1636732492

There\u2019s a Pro Publica hit piece on St. Jude today that seems completely crazy to me. I won\u2019t dignify with link. Says \u2014 among other things \u2014 that, sure, St Jude won\u2019t bill you a single cent ever but \u2026 won\u2019t make up for loss of work if you have to quit your job to care for kid.

— Geoff Calkins (@geoff_calkins) 1636726915

St. Jude's is one of the only children's hospitals that covers housing/travel/food. I have some issues w/their fundraising practices, but I don't think it's fair to hang this on them when it's a huge problem that probably can only be addressed w/legislation like paid leave...pic.twitter.com/BSk3PGJZ1y

— andrew kaczynski (@KFILE) 1636731458

But following ProPublica's reporting, St. Jude announced a "dramatic expansion" of the financial assistance it will provide to parents and other relatives during their child's stay at the hospital.

"Among the most significant changes are increasing travel benefits to two parents instead of one and covering regular trips to Memphis for siblings and other loved ones. St. Jude's letter to parents said the changes take effect Nov. 15," ProPublica reports.