Strained Safety Net: Free Clinics Face Funding Uncertainty Amid Growing Need

Sharon Brown wakes up before sunrise to help feed over a thousand students at Powhatan High School. By the time the last lunch tray is cleared at 1:45 p.m., her workday is done — just short of full-time hours and, more critically, full-time benefits.

(Photo courtesy of Virginia Association of Free and Charitable Clinics)

Despite earning $17 an hour, Brown is stuck in a frustrating gap: she earns too much to qualify for Medicaid but not enough to receive employer-sponsored health insurance.

“I make too much and my job said I don’t have enough hours,” Brown said.

With a heart condition and diabetes, she depends on the Free Clinic of Powhatan to access life-saving medication. Brown, 57, is one of many Virginians who turn to the state’s network of free clinics, which provide care to uninsured residents earning up to 200% of the federal poverty level.

It’s a reality that Richmond resident Florence Roanne-Bell knows all too well. As jobs and employer-provided insurance come and go, her local clinic has been a constant.

Health Brigade, formerly known as the Fan Free Clinic, helped diagnose her fibromyalgia, manage pre-diabetes and high blood pressure, and, more recently, address her mental health.

“I didn’t realize how damaged I was,” she said, her voice cracking as she recalled the toll of losing loved ones during the COVID-19 pandemic.

Now in her 60s, Roanne-Bell wishes she had prioritized her mental health sooner. But in her generation and in Black communities, she said, it simply wasn’t talked about.

“Black and brown folks — we don’t want to accept or we don’t think we need mental health care,” Roanne-Bell said.

Testimonies like her’s and Brown’s illustrate why lawmakers are pushing for more funding for the state’s free clinics. Del. Rodney Willett, D-Henrico, and Sen. Schuyler VanValkenburg, D-Henrico, aimed to secure $4 million through a recent budget amendment, but Willett said that a more modest $500,000 is the likely outcome.

“We have $500,000 on the table based on what funding is available and will take that for now,” he said. “It’s better than nothing, but we’ll need to go right back to the budget process next year to try to get more.”

A greater need and a funding question mark

The demand isn’t slowing. More Virginians are turning to free clinics after losing Medicaid coverage, facing long appointment wait times, or struggling between jobs. Medicaid eligibility, typically reviewed annually, was temporarily paused during the COVID-19 pandemic. But as the state undergoes an “unwinding” process, thousands have been disenrolled — some without alternative healthcare options.

Health Brigade is one of about 70 free or charitable clinics in Virginia. (Photo by Charlotte Rene Woods/Virginia Mercury)

Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics, said many of these patients fall into a category called ALICE — “asset-limited, income-constrained, employed.”

“They’re often a medical bill or two away from a crisis,” Phillips said. “I think after the pandemic, things got even more challenging for obvious reasons — with inflation in the cost of housing, transportation, food.”

As ALICE patients turn to free clinics, the strain on resources grows. Phillips calls them “the safety net to the safety net.”

Still, even a $500,000 boost will help, and VAFCC plans to make the most of it.

Virginia’s network of free and charitable clinics is seeing a surge in demand. In 2023, VAFCC reported serving 108,270 patients — a 32% jump from the nearly 82,000 patients seen in the previous year.

While full data for 2024 isn’t in yet, some clinics are already reporting waitlists for care, alongside growing concerns about potential federal Medicaid funding cuts that could drive even more patients through their doors.

If Medicaid expansions are rolled back, more than 630,000 Virginians could lose coverage, adding immense pressure on the state’s healthcare safety net. In response, Virginia lawmakers are preparing for possible federal cutbacks: The House of Delegates has formed a special committee to assess the impact, while state senators have included provisions in budget proposals to study the effects of funding reductions.

On the federal level, U.S. Sen. Tim Kaine, D-Va, pledged to push back against any efforts to strip away coverage. Meeting with nonprofit healthcare providers at Richmond’s Health Brigade earlier this week, he vowed to “strongly oppose” congressional actions that could take healthcare away from vulnerable Virginians.

The uncertainty has left free clinics bracing for what could be another year of record-breaking demand.

by Charlotte Rene Woods, Virginia Mercury

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