Before Virginia expanded Medicaid in 2019 to low income adults, the Chesapeake Care Clinic saw close to 2,000 patients a year. By 2021, that was down to 750, but demand surged over the past few years. Now, the clinic sees about 900 patients a year.
Congressional Republicans are exploring potential changes to Medicaid that could include substantial cuts, though it’s not certain whether that will happen.
“If we were to see Medicaid (patients) — oh my gosh, I can’t even imagine the number of staff we would need,” said Dourina Petersen, executive director of Chesapeake Care Clinic .
The free clinic has a full-time physician and dentist. The rest of the staff is comprised of more than 400 volunteers who offer medical, dental and specialty care for uninsured, low-income adults.
“We are kind of at capacity,” Petersen said. “Without hiring additional staff, we don’t really have the availability to enroll but so many more patients.”
Clinics such as Chesapeake Care serve as the “front door” into the medical system for people who otherwise couldn’t afford health care. The aim is to keep people out of emergency rooms and, for the majority of patients, to manage long-term health issues.
Amid increasing demand and uncertainty at the federal level, advocates are asking the state for more funding.
In 2023, 71 clinics in the Virginia Association of Free and Charitable Clinics saw 108,000 patients, a 44% increase from 2021. The rise in demand comes in part to a growth of underinsured populations, said Rufus Phillips , CEO of VAFCC. Underinsured people might have medical health coverage, but not dental, or they might have an insurance deductible that amounts to more than 10% of their income.
“When you get to that level, you’ll see that a lot of people don’t use their insurance because they can’t afford to because of the deductible,” said Phillips. “They sort of use it more like a ‘major medical policy,’ which you would use if you were hospitalized.”
Free clinics in Virginia are funded mostly through charitable donations, grants and some money from localities. About 20% of their budget comes from state funding. Last year, the General Assembly voted to increase the annual budget for free and charitable clinics by $1.8 million to $6.8 million annually. Phillips said the hope is for the state to fund closer to 30 percent of the budget, a benchmark it last met in 2016.
To that end, VAFCC asked the legislature for an additional $4 million a year. Budget plans passed by the House and Senatedo not allocate that much — they would increase funding for free and charitable clinics by a half-million.
Phillips said while that is a positive step, he hopes the General Assembly will consider an additional increase.
The demand at free clinics has also increased in part due to Medicaid unwinding. At the start of the pandemic, Congress passed a law that would require Medicaid to keep people continuously enrolled through public health emergency. Continuous enrollment ended in March 2023 ; that’s what’s known as unwinding.
In Virginia , nearly 500,000 people lost coverage, some because their income increased or because they became eligible for Medicare. Others no longer lived in Virginia , or had died during the period of continuous enrollment. It’s not clear whether everyone who was disenrolled has found another form of care, according to a report from The Commonwealth Institute.
Currently, about 2 million Virginians are insured through Medicaid. About 630,000 receive Medicaid through the 2019 expansion, which advocates are worried could be rolled back as part of sweeping federal budget cuts.
“Even if just you know a quarter of those patients, or a third, couldn’t find coverage somehow some way, that could easily double or triple or quadruple the need at the clinics,” Phillips said. “And clinics could not meet that unless they had a heck of a lot more funding.”
In addition to demand, the cost and complexity of services free clinics offer has increased. Historically, free clinics might have offered a couple of services, such as medical and dental care. Now, they might include behavioral health, specialty care, speech and hearing, and substance abuse. Most also host food pantries, and some will provide transportation.
In 2016, it cost on average $350 a year to treat one uninsured patient. These days, that number is upwards of $1,000.
Free clinics aren’t the entire safety net for the uninsured and underinsured. Federally qualified health care centers, which are facing ongoing funding issues after last week’s now-rescinded federal funding freeze order, take some uninsured patients.
“But even between them and the clinics, you wouldn’t get anywhere close to meeting that need unless the safety net clinics were able to expand their capacity,” Phillips said.
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