Free and Charitable Clinics and Pharmacies (FCCPs) play a vital role in delivering healthcare to underserved communities. However, they are facing mounting challenges, including Medicaid unwinding, financial uncertainty, and workforce constraints. As demand rises, clinics are exploring ways to adapt quickly while grappling with limited resources. In a recent conversation with Rufus Phillips, Executive Director of the Virginia Association of Free and Charitable Clinics (VAFCC), we delved into the pressing issues influencing FCCPs and the strategies the Association is using to support its members.
The Impact of Medicaid Unwinding
One of the most significant challenges facing clinics today is Medicaid unwinding, which contributes to more uninsured patients seeking care at FCCPs. As individuals lose their Medicaid coverage, they often experience coverage gaps and administrative hurdles while navigating other insurance options. Phillips shared that Virginia’s Free and Charitable Clinics saw nearly a 50 percent increase in patient numbers --from 75,000 in 2022 to 108,000 in 2023. To better understand the full impact, VAFCC is actively gathering data from clinics across the state. This information will help tailor resources and support to meet the growing needs of FCCPs and their patients.
Financial Challenges and FQHC Closures
Financial instability of the safety net is another major concern, particularly for Federally Qualified Health Centers (FQHCs), which rely on federal grants and Medicaid reimbursements. Freezes or cuts to Medicaid and federal grants can leave these centers vulnerable, forcing them to scale back services or even close their doors.
Recently, a Virginia-based FQHC was forced to close multiple sites due to funding challenges. Closures of FQHCs and other safety net clinics can place additional strain on Free and Charitable Clinics, as they often serve overlapping patient populations. FCCPs already absorb patients that cannot be seen at FQHCs due to wait lists or sliding scale fees charged by FQHCs for patients with incomes above 100% Federal Poverty Level. They cannot take on all patients potentially affected by Medicaid unwinding and federal grant cuts.
Unlike FQHCs, which receive direct federal funding, FCCPs rely primarily on local communities for volunteers, grants, and donations. As patient volume increases, clinics must expand funding sources and add more providers—a challenge that is even more difficult in areas already facing healthcare provider shortages. Many FCCPs rely on volunteers, but more are seeking paid providers— a challenge due to below-market salaries.
To address these issues, VAFCC is working with partners to secure new funding and recruit volunteer providers, ensuring that FCCPs can continue meeting the needs of their communities.
How Virginia’s Clinics Are Coping with Increased Demand
While increased demand presents significant challenges, Free and Charitable Clinics and Pharmacies are known for their adaptability. Their local focus and funding allow them to pivot more easily than larger healthcare organizations. However, even with this flexibility, additional resources, funding, and volunteers are essential to keep up with growing patient numbers.
Here’s how some Virginia clinics describe their situation:
Capacity Constraints: A medical and dental clinic, Chesapeake Care Clinic is already at full capacity and unable to enroll additional patients, according to Executive Director Dourina Peterson.
Scaling Up Without Resources: Leigh Sicina of Shenandoah Community Health Clinic highlighted that clinics face pressure to expand services, but without additional funding or staff, this is becoming increasingly difficult. Shenandoah serves nearly 2,000 adults and children with medical, dental, and behavioral health services yearly.
Adjusting Financial Models: In addition to providing dental services to adults, the Augusta Regional Dental Clinic has run a school-based oral health program since 2004. ARDC currently sees patients with Medicaid as well as those without dental insurance. As the clinic has seen more patients in need of services, Executive Director Sophie Parson shared that they are considering raising patient copays and reducing new patient intake to balance capacity. See WHSV interview with Ms. Parson here.
Advocacy Efforts: Health Brigade is taking a proactive approach by meeting with policymakers. In early February, they hosted a roundtable with Senator Tim Kaine, Richmond Mayor Danny Avula, and other local officials to discuss the urgent need for supporting underserved populations in need of healthcare.
Advocacy and Relationship-Building
To address these challenges, VAFCC is intensifying its advocacy efforts at both the state and federal levels. Phillips emphasized that FCCPs must be "at the table" when key healthcare decisions are being made.
State and Federal Policy Advocacy
Virginia Legislature: Lawmakers are considering an additional $500,000 appropriation for Free and Charitable Clinics this year. While helpful, this amount falls short of the growing need. VAFCC continues to advocate for increased investment in community-based healthcare.
Federal Policy Engagement: VAFCC is actively working with Virginia’s federal delegation to monitor potential cuts to Medicaid and public health funding, as well as restrictions on diversity, equity, and inclusion (DEI) initiatives, which could further impact healthcare access.
Communication with the National Association of Free and Charitable Clinics (NAFC): Phillips described the importance of actively sharing information and insights with the NAFC about what is happening on the ground. “We’re the lifeblood for the NAFC,” adding that the NAFC can advocate better at the federal level with real-time information from state free clinic associations and their members.
Innovative Approaches and Collaboration
Beyond advocacy, VAFCC is exploring new ways to support member clinics through innovative programs and partnerships:
Pilot Programs & Cohort Initiatives: The association is testing new service models and expanding best practices across clinics.
Strengthening Partnerships with FQHCs: Recognizing that FCCPs and FQHCs serve complementary roles, VAFCC is encouraging more collaboration and shared resources among these organizations.
Looking Ahead: What’s Next for Free and Charitable Clinics and Pharmacies in Virginia
As Free and Charitable Clinics navigate these uncertain times, VAFCC is taking a proactive and strategic approach to ensure its members are prepared for what lies ahead.
By focusing on advocacy, relationship-building, and innovation, VAFCC is working to position clinics for long-term sustainability. Phillips and his team remain committed to understanding the evolving needs of clinics and adapting their support accordingly—a testament to the critical role Free and Charitable Clinics and Pharmacies play in Virginia’s healthcare landscape.
Learn more about VAFCC’s efforts to advocate for their membership in this video.
What Can Clinics Do Now?
To prepare for and respond to these challenges, clinics should:
✅ Develop clear messaging for board members and key stakeholders.
✅ Build financial reserves to cushion against potential funding cuts.
✅ Engage with policymakers to advocate for sustainable funding solutions.
✅ Strengthen collaboration with state associations, peer clinics, and local FQHCs.
✅ Adapt operational models to meet patient demand sustainably.
Need Support Navigating These Challenges?
At MaryCatherine Jones Consulting, we specialize in helping Free and Charitable Clinics and their associations secure funding, navigate policy changes, and expand their impact.
Times are challenging. You’re not in this situation alone. Let’s connect!
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