This story was reported and written by VPM News.
Providers say significant new funding is required to keep up with need.
Sharon Brown has been serving breakfast and lunch at Powhatan High School for more than 20 years.
During that time, she told VPM News, she’s lost health insurance because she wasn’t working enough hours to qualify. As a cafeteria worker, Brown makes $17.27 an hour; that means it can be a struggle to pay for food during the summer when school is out.
For the past four years, Brown has relied on support from the Free Clinic of Powhatan.
“They will help me out with bags of food,” Brown said. “I tried for unemployment. They denied me, so I came here.”
The free clinic also treats Brown for myriad health issues. She was born with a heart defect and has a mechanical mitral valve that ensures the vital muscle functions properly. Brown’s also been diagnosed with diabetes and high blood pressure, which the clinic monitors at her regular visits.
Brown falls into a frustrating gap for patients who make too much money to qualify for Medicaid or Medicare, but not enough to cover medical bills. This happens so often the United Way has coined a term for people in situations like this: ALICE, for asset-limited, income-constrained and employed.
Elizabeth Ream, the clinic’s executive director, said many of her patients fit that description.
“A lot of people have health coverage they can’t even afford to use because of high deductibles and how much it would impact their very thin budget.” she said.
Medical centers like the Free Clinic of Powhatan provide health care for the uninsured and underinsured. They operate with only a few paid staff members and rely primarily on medical professionals who volunteer their time and expertise. The majority of their funding comes from charitable donations, grants and state funding.
Medicaid has historically covered patients with incomes up to 138% of the federal poverty line in states with expanded coverage like Virginia. Some free clinics in the state do accept people receiving Medicaid but that is not the primary source of funding.
The Free Clinic of Powhatan serves county residents as well as people from Cumberland, Amelia and Chesterfield counties. Its patients, who make up to 300% of the federal poverty line, get access to medical, dental and mental health care, as well as nutrition services.
“We are a medically underserved area for primary care and for mental health care,” Ream said. “It means that even for people who do have Medicaid, there aren’t enough providers to see those people, and so there is a lot of need.”
Ream said she’s seen demand for care in this population skyrocket: “In 2023, we went from having around two people looking into becoming a patient here a week, to 20.”
Health care advocates have said demand is growing across the commonwealth. From 2022 to 2023, Virginia’s free clinics saw a 44% increase in the number of patients — from 75,000 to 108,000 people.
Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics, called the spike “pretty significant.”
“I think a lot of that has to do with the pandemic, there was a lot of pent-up demand for care coming out of the pandemic,” Phillips said. “People’s chronic conditions got worse. Also, economic conditions became more challenging.”
He said the state’s nearly 70 free clinics don’t have the resources to absorb that type of growth year after year when funding sources have not seen similar trajectories.
Del. Rodney Willett (D–Henrico) and state Sen. Schuyler VanValkenburg (D–Henrico) tried to secure $4 million in funding through a budget amendment during this General Assembly session, but both the House and Senate budgets cut that down to $500,000.
Phillips described the state funding as a “positive step forward,” but he warned that clinics are going to need “much more funding to remain sustainable.”
He said he’s concerned about possible federal cuts to Medicaid, and what that could mean for the already-strapped free clinic system.
Janine Underwood, executive director of the Bradley Free Clinic in Roanoke, said her clinic has become an integral part of the community since opening in 1974. The state’s second-oldest free clinic provides medical and dental services, a full-service pharmacy and a recently-opened behavioral health center.
“We’ve been providing those services for so long and have been that safety net in the community,” Underwood said. “Almost the safety nets of safety nets.”
Underwood added the Bradley Free Clinic has expanded its services to meet need over the years, but staff have started cutting back some services as more patients come through the doors.
The General Assembly’s funding attempt “disappointed” her.
“Our operating expenses have more than doubled, almost tripled in the last five years,” Underwood said. “So, as we continue to see more growth, how are we going to afford to continue to provide the services for our patients?”
Bradley Free Clinic’s board of directors has developed a strategic task force to address rising patient numbers and costs. According to Underwood, the clinic has a three-month waitlist that might have to be extended to six months; it’s already stopped taking new dental patients.
As funding from state coffers falls short, Underwood said she’s been forced to rely more heavily on grant funding and donations. The clinic has seen an increase in charitable contributions and has been awarded roughly 45 grants.
Bradley’s staff applies nonstop for grants, Underwood said, but “it’s just not enough.”
She is still holding out hope for an increase in this year’s budget, which amends state spending through June 30, 2026. (Virginia’s fiscal year runs from July 1 through June 30.)
“That would be wonderful. That would be amazing,” she said. “Because we can only do so much with our donors and our grantors. We’re doing all we can.”
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