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Post-pandemic, many free medical clinics face financial pressures

Charlottesville's free clinic served about a thousand patients last year.
Charlottesville Free Clinic
Charlottesville's free clinic served about a thousand patients last year.

This Sunday, supporters of a free medical clinic in Fredericksburg will hold a rally to generate new support after a falling out with the local health system that had provided a number of free services.

The Moss Clinic is one of 68 in the state providing healthcare at no charge to those who have no insurance and cannot afford to pay out of pocket.

When Obamacare was approved by Congress, many people assumed it would cover those Americans who didn’t have insurance. In fact, 45 million people have coverage thanks to the Affordable Care Act, but here in Virginia several hundred thousand don’t qualify or can’t pay the premiums, deductibles and co-pays that insurance requires.

“They have to weigh that against the cost of housing, which has spiked tremendously since the pandemic, the cost of transportation and food," says Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics.

He notes many people were able to enroll in Medicaid under Obamacare.

“During the pandemic the federal government decided those who had Medicaid coverage should be able to maintain that coverage no matter whether there had been a change in their eligibility. Following the pandemic that public health emergency was lifted, and then states started re-determining eligibility for the first time in a while.”

As a result, more than 160,000 Virginians were told they no longer qualified. They joined undocumented immigrants and refugees in need of care. And then there are people like Tom – who asked that we not use his last name. He works part-time, earning too little to cover insurance but too much to be on Medicaid – and, frankly, he loves going to Charlottesville’s Free Clinic.

“There’s no bureaucracy. There’s no paperwork, and they actually really do care about each and every individual. Having that individual attention and care is fantastic, and I will say when I leave there and I’m walking to my car, there’s a skip in my step.”

That clinic relies on about 700 volunteers – doctors, nurses and support staff -- whose mission is not to make money but to serve patients. Willa Barnhardt is the clinic’s chief development officer.

“If a patient needs to come into the medical clinic four times in three weeks, fine – we can do that, because we’re not held back by any health insurance compliance,” she explains.

And the clinic welcomes new patients in English and Spanish, without demanding proof of need for that first visit.

“Somebody can come to our desk or make a call, say ‘Can I come in?’ We say yes. No questions asked. Don’t show us your salary. Don’t show us anything. Just come in, and they come in. We give them an appointment and a 30-day supply of medications, and then we help them find their appropriate medical home, and sometimes it is the free clinic. Sometimes they qualify for Medicaid or Medicare, and we can help them navigate that, because it’s such a complicated process.”

The clinic’s new home is clean, bright and comfortable, with large windows and colorful art work on the walls. Exam rooms and offices are spacious, and construction crews have created additional room for dental services.

“We have a walk-in clinic that opens at 7 a.m.," Barnhardt says. "Our patients arrive between 5 and 6 a.m. to get in line, to make sure they get that appointment.”

There’s a free pharmacy on the premises, counseling and psychiatric services are provided through telehealth, and laboratory costs are covered by the University of Virginia’s Medical Center and Martha Jefferson Hospital.

Barnhart points out that – in the long run – the free clinic’s approach saves society money – ensuring people attend to problems before they get worse and require more costly care.

She’s grateful to have generous donors who help raise the annual budget of $2.9 million. Statewide, Rufus Phillips says, many clinics are not so lucky. His group asked the state for $5 million enough to cover 30% of clinics’ operating costs. The budget contained just $1.5 million, and now that the pandemic is over, he adds, donations from foundations, non-profits and individuals are down.

Sandy Hausman is Radio IQ's Charlottesville Bureau Chief