For 89 years, Shriners Hospitals have provided free medical care to children in Minneapolis and around the country. But no more. By month's end, all 20 U.S. hospitals will be billing insurance companies and charging some families copayments, marking a major shift in the charity's mission. Shriners leaders say the change is necessary to save the iconic name amid rising health care costs, flat donations and declines in a multibillion-dollar endowment that has been ripped apart by the whims of the stock market. "We're not a poor organization," said Doug Maxwell, president/CEO of Shriners Hospitals for Children, based in Tampa. "But if we don't make wise decisions now, we won't last." Those without insurance will still be covered at no cost, but some families with copays may have to pony up. The federal government will allow Shriners to waive copays and deductibles for Medicare and Medicaid, which make up about 40% of patients.