Tennessee’s Free and Charitable Clinics Steady Healthcare Access in Preparation for Rising Uninsured Rates

As upcoming Medicaid and SNAP cuts raise alarm bells, Tennessee’s Free and Charitable Clinics (FCCs) stand firm, delivering compassionate, community-based health care. Supported by the Tennessee Charitable Care Network (TCCN), these clinics not only enjoy strong support from their local communities, they promote trust and transparency in expanding essential services for the state’s most vulnerable populations.

“All politics is local," said Christi Granstaff, Executive Director of TCCN, "Legislators know that Free and Charitable Clinics are a place where they can send a constituent who says, ‘I’m uninsured and I need health care.’ These clinics are grounded in their communities—connected to churches, nonprofit networks, and local leaders. That credibility, that personal connection, is why they’re trusted to meet the needs of people across Tennessee.”

The Stakes: Growing Uninsurance and Shrinking Federal Support

Across the U.S., Free and Charitable Clinics (FCCs) are preparing for a surge in demand as federal safety net programs are scaled back. Under the “Big Beautiful Bill,” various restrictions to Medicaid participation, including work requirements and red tape, will leave more Americans unable to afford healthcare.

In Tennessee, one of only ten states that have not expanded Medicaid, the burden falls heavily on FCCs and Federally Qualified Health Centers (FQHCs) to serve the uninsured. In 2023, about 654,000 Tennesseans (9.3% of the population) lacked health insurance, well above the national average of 8.6%. Among working-age adults, the rate climbs to 14.6%. Distressingly, 4 in every 5 Tennessee counties have higher uninsured rates compared to the US overall, with Sevier County reaching 21.4%.

Health access disparities are most pronounced among rural communities, low-income residents, and Hispanic Tennesseans. While some progress has been made, significant access gaps remain, making the role of FCCs even more critical.

Tennessee’s Response: Invest in Free and Charitable Clinics

Against this national backdrop, Tennessee increased its 2025 investment in the Health Care Safety Net Fund by $3 million: an endorsement of the role that Free and Charitable Clinics play in providing high-quality, trusted care to uninsured residents.

Christi Granstaff points out that while large-scale programs like Medicaid may seem costly and politically vulnerable, FCCs offer something different: transparency, community credibility, and demonstrable results. Clinics receiving state grants must report data and participate in quality improvement activities, ensuring accountability and measurable impact.

Given Tennessee’s legendary volunteer spirit, investing in community-based clinics run by passionate volunteer providers and staff seems natural. The TCCN team coordinates opportunities for members to share stories of their impact with legislators and other key collaborators. By investing in charitable healthcare organizations, Tennessee is signaling a support for practical, effective, and human-centered care that meets people where they are.

The Tennessee Charitable Care Network: A Voice and a Bridge

Celebrating its 10th anniversary in 2024, TCCN was founded by clinics with a simple yet powerful vision: to strengthen the collective voice and capacity of Tennessee’s Free and Charitable Clinics. Since then, TCCN has grown into a dynamic statewide association, acting as a convener, connector, and advocate.

Whether coordinating learning collaboratives, sharing data and training, or representing clinics in conversations with the Tennessee Department of Health, mental health and substance use authorities, rural health associations, and federally qualified health centers (FQHCs), TCCN ensures that FCCs are not only at the table, but influencing policy and partnership strategies.

A shining example of its advocacy success was its role in securing the $3 million increase in safety net funding in 2025. Through partnerships, including with the Tennessee Primary Care Association, TCCN helped legislators recognize the value of investing in trusted, locally rooted healthcare providers.

Building Capacity Through Innovation and Partnership

TCCN’s leadership extends far beyond advocacy. It has been a pioneer in equipping member clinics to meet emerging needs from behavioral health and opioid response to health equity and community outreach.

One area of growing focus is the integration of behavioral health screening and referrals into primary care. TCCN is helping clinics build the capacity to assess mental health, substance use, and trauma as part of routine patient care. But screening is only the first step. Connecting patients to treatment, especially in rural or under-resourced areas, requires navigation, follow-up, and trust.

That’s where Community Health Workers (CHWs) come in. CHWs have played a vital role in FCCs by helping patients access housing, food, transportation, behavioral health care, and substance use treatment, often in hard-to-reach or high-barrier communities. Their shared experiences and cultural fluency make them trusted guides through otherwise disconnected systems. “CHWs help us understand the full context of a patient’s life,” said Granstaff. “They don’t just point people to services, they create warm handoffs that build trust along the way.”

Unfortunately, many clinics are now facing the loss of funding that supported CHW positions. TCCN is working to explore alternative models, including cost-sharing, shared staffing, and advocacy for reimbursement, to sustain these essential roles.

These efforts are part of a broader vision to offer shared services to TCCN members that build clinic resilience and strengthen sustainability. For example, in 2024, TCCN partnered with MaryCatherine Jones Consulting to provide customized, short-term capacity-building assistance to four member clinics. Projects included operations optimization, sustainability planning, community needs assessment, and development of a community health unit. These engagements allowed clinics to make critical strategic progress without burdening overstretched staff, and demonstrated opportunities for similar scalable support going forward.

TCCN also continues to help clinics pursue grants for high-impact, low-cost services that facilitate care, such as patient transportation and translation.

A Future Anchored in Resilience

As the national healthcare landscape grows more uncertain, Tennessee’s Free and Charitable Clinics remain committed to expanding access and improving outcomes for those most at risk. Their strength is in their relationships: with patients, with community partners, and with each other.

At the heart of this ecosystem is TCCN, amplifying voices, opening doors, and driving innovation. As Christi Granstaff shared, the most common sentiment she hears when clinics gather is simple but powerful, “I don’t feel so alone.”

In a time of political division and policy flux, that sense of connection, and the care it enables, not only nurtures the patients but the volunteer providers, staff, and full community.

Need Support Navigating These Challenges?

At MaryCatherine Jones Consulting, we help Free and Charitable Clinics and their associations secure funding, respond to policy changes, and grow their impact. These are challenging times, but you’re not alone.

Ready to take the next step? Schedule a free consultation and let’s talk about how we can support your mission.