The Hill-Burton Act and its Impact on Kentucky

In 1946, the United States Congress passed a new law that afforded hospitals and other healthcare facilities to apply for grants and funding to construct new facilities and/or modernize existing ones. The hospitals would, in return, provide service to the local citizens of which the facility served at little or no cost. Essentially, those who were unable to pay for medical or hospital services could get them for free. The Hospital Survey and Construction Act of 1946 (P.L. 79-725), also known as the Hill-Burton Act, provided nearly $30,000,000 in grants to Kentucky to construct and modernize its hospitals. Kentucky received the funds on a yearly basis and the state’s Commissioner of Health in Kentucky applied a flat ratio of 66 2/3 percent to all approved applications for public and non-profit institutions in the state. Underwood agreed to building health centers with emergency and obstetrical beds, state legislation permitted counties to combine for join construction and management of health facilities, and an educational campaign. Applications were rejected for hospitals in which community would not keep up.

The original legislation stipulated that, in return for assistance, facilities were required to provide free care for 20 years to eligible persons unable to pay for health care services. Although there has not been any Title VI funding authority for the program since Fiscal Year 1974, many facilities that received Hill-Burton funds continue to have an obligation to provide a certain level of uncompensated care. Facilities funded under Title XVI must provide uncompensated care in perpetuity. In 1954 the original Hill-Burton Act was amended to allow other kinds of medical facilities such as nursing homes, diagnostic and treatment centers, and rehabilitation centers eligible for funds under the act. By the 1960s, Kentucky had built 57 public-health centers, 32 general hospitals, a mental hospital, a tuberculosis hospital, two chronic disease hospitals, four schools of nursing, three nursing homes, and a diagnostic and treatment center. Additions and modernization were completed at 34 general hospitals, four mental hospitals, a tuberculosis hospital, and two schools of nursing. Other projects included a State Health Department building, steam plant at University of Kentucky Medical Center, and equipment for five tuberculosis hospitals. In 1962, five new general hospitals, seven general hospital additions, one tuberculosis addition, 13 new health centers, and one new diagnostic and treatment center and rehabilitation center at the University of Kentucky Medical Center were all actively under construction.

Federal law prohibited racial discrimination (including mental and tuberculosis hospitals) under the Hill-Burton Act.


Statement from Governor Edward T. Breathitt

(From the Public Papers of Governor Edward T. Breathitt, 1963-1967)


The Hospital Survey and Construction Act of 1946



Report of the Commission on Financing Health Care for the Medically Indigent, Legislative Research Commission, Frankfort, Kentucky



Contributed by Shawn Logan | contact@kyhi.org


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