Virginia’s free and charitable health clinics are seeing demand climb, and leaders warn that the situation could worsen without state support as federal health insurance changes take effect.
Between 2022 and 2024, clinics reported a 43% increase in uninsured, underinsured and Medicaid patients, according to a review of data by the Virginia Association of Free and Charitable Clinics, a nonprofit organization that represents 70 free clinics statewide.
The state currently contributes about $8.8 million annually to these services. For Bradley Free Clinic in Roanoke, that funding covers just 8% of its costs, according to Janine Underwood, its director.
“For years, we have been increasing the number of patients we’re seeing, yet that money hasn’t increased incrementally as we see more patients,” Underwood said. When she became director 12 years ago, the state funding was enough to cover 20% of costs.
Now, clinic leaders are preparing for an even larger influx of patients. Federal changes to Medicaid eligibility and renewal and the Affordable Care Act could leave more than 300,000 Virginians without health insurance over the next two years, according to a federal analysis.
If that happens, officials in Southwest Virginia say waitlists will likely grow, services may shrink and more patients will seek care in emergency departments.
Del. Rodney Willett, D-Henrico County, is carrying a budget amendment to direct $15 million in 2027 and 2028 from the state’s general fund to free clinics that are members of the Virginia Association of Free and Charitable Clinics. Sen. Mamie Locke, D-Hampton, introduced a separate amendment that would direct $10 million to free clinics.
Sunday is the deadline for House Appropriations and Senate Finance and Appropriations committees to report their respective budget proposals.
Funding would be used to meet the increasingly high demand for medical, dental, vision, speech, hearing and behavioral health care services, as well as prescription medication and substance use disorder services for uninsured and underinsured patients.
Intensifying challenges
The Affordable Care Act expanded insurance coverage in 2010 by creating a national Marketplace. Individuals can purchase private plans, often with income-based subsidies to offset monthly premiums.
The American Rescue Plan Act of 2021 increased those subsidies in the midst of the pandemic, and the Inflation Reduction Act extended them in 2022. But the enhanced subsidies expired at the end of last year after congressional efforts to preserve them stalled. Without those subsidies, Marketplace premiums might be unaffordable for thousands of Virginians.
Additionally, Medicaid recipients must renew coverage every six months starting in 2027. These requirements, outlined in the federal spending bill, could cause eligible individuals to lose coverage because of paperwork or administrative hurdles.
For people without insurance, preventative care options are limited. Free clinics remain one of the few places where patients can access medical visits, lab work, behavioral health care and some dental services without insurance.
“In the coming months, I don’t know what we’ll see,” Underwood said. “I do know that our patients are already experiencing this.”
Rural communities feel the strain
In Marion, economic pressures are pushing more residents to seek care at the Mel Leaman Free Clinic.
Several downtown businesses have closed, said Executive Director Susan Ferrero. As employees search for new jobs in a region with limited opportunities, many lose access to employer-sponsored insurance. For preventive care, their primary option becomes the free clinic.
The clinic serves about 400 uninsured patients annually across four counties. It employs four full-time staff members and relies heavily on volunteers.
Its budget this year is about $350,000. As volunteer participation and charitable giving decline, Ferrero worries that the clinic could face operating losses without additional state support.
“[Without free clinics] our patients wouldn’t have anywhere else to go,” Ferrero said. “The people that we see are the ones that work in the grocery stores, fast-food restaurants, Walmart. They provide services to us that we utilize. We want them all to be responsible community members and they want that too. So they have to be healthy.”
Dental care remains the clinic’s greatest unmet need. An oral surgeon volunteers to perform extractions, but the clinic lost its restorative dentist two years ago when he retired. Few dentists in the area accept Medicaid because of low reimbursement rates.
Decline in charitable giving
The Free Clinic of Central Virginia faces its own challenges.
The clinic’s Lynchburg facility burned down in 2024. Since then, patients have accessed care at temporary sites. Despite the disruption, 4,000 patients received care last year, said Dr. Derrick Brown, the clinic’s executive director. He expects the number of patients seeking the clinic’s services will increase once it moves into a permanent facility.
The patients who receive medical services are completely uninsured. For dental services, about 40% of patients are covered by Medicaid.
The organization still needs to raise roughly $500,000 to complete its transition to a permanent facility. It must also secure additional funding for ongoing operations.
One local donor recently withdrew its support due to financial strain linked to tariffs, Brown said. Meanwhile, more nonprofits are competing for the same grants and charitable dollars, intensifying the fight for limited funding.
Without funding for free clinics, more patients will seek care in emergency departments, Brown said. Inability to pay for those services means health care costs will increase for everyone.
