BJC HealthCare, the St. Louis area’s largest employer, has been operating under increasing financial pressure.

In 2013, its employees were hit with layoffs and reductions in certain benefits.

Now, the nonprofit organization is reducing its charity care, a core mission for BJC.

According to BJC spokeswoman June Fowler, the health care system has changed the “upper level of eligibility” for the charity care it provides. It also has required uninsured patients to provide, as a minimum, co-pays for medical services.

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. It previously provided aid to those who earned up to 400 percent of the federal poverty level.

For a family of four, the federal poverty level is annual income of $23,850; for a single person, it is $11,670. (Three times the federal poverty level is about $35,000 for an individual and $71,550 for a family of four.)

Fowler 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.”