Virginia's Free Clinics are Facing 'Unprecedented' Growth in Patient Demand
Fredericksburg's Lloyd Moss Free Clinic has a three-month wait list.
By Adele Uphaus
MANAGING EDITOR AND CORRESPONDENT
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The Lloyd Moss Free Clinic is not closed and does not intend to close, said Thomas Brashears, the clinic’s new executive director.
That’s a good thing, because free clinics around the state are experiencing “unprecedented” growth in patient demand, according to a recent analysis of member data by the Virginia Association of Free and Charitable Clinics (VAFCC).
Fredericksburg’s Moss Clinic is one of 71 member clinics in the association. Brashears said the demand for appointments combined with a limited staff has created a wait list that is three months long.
In order for free clinics around the state to meet patient needs, the VAFCC is supporting a budget amendment submitted by Delegate Rodney Willett and Senator Schuyler VanValkenburg (both Democrats representing Henrico County) requesting $4 million in additional state funding for free clinic operations.
“State funding on average is about 20% [of a free clinic’s operating budget],” said Rufus Phillips, CEO of the VAFCC, in an interview with the Advance. “That’s down from 30% in 2016, which was the last time there was a multimillion increase from the state in funding to help support the clinics. We’re trying to close that gap with the request we’re making this year.”
The Moss Clinic receives around $55,000 each quarter—$220,000 per year—in state funding through the VAFCC, Brashears said.
VAFCC’s data shows that the total number of patients served by Virginia’s free clinics increased by 19% between 2021 and 2022, and then another 32% between 2022 and 2023.
“We went from 75,000 total patents in 2021 to slightly over 108,000 in 2023,” Phillips said.
At the same time, there has been an 11% increase in the average cost of care, going from $900 per person per year to $1,003.
“For comparison, in 2016, it was $353 per patient per year,” Phillips said. “So, it’s a modest request, given that if you think about that cost of care per patient per year at $1,003, with the $4 million request you’re covering the cost of care annually for 4,000 patents.”
Increase due to “a variety of factors”
Phillips attributes the increase in patient demand to “a variety of factors,” including inflation and a high cost of living.
“So, when you look at that economic picture, it’s often the case that unfortunately health care is something that goes by the board,” Phillips said. “Families might prioritize and typically do prioritize children’s health care but sacrifice the adults because of the costs.”
Virginia’s free clinics, including the Moss Clinic, see primarily uninsured patients, but also those who are “underinsured.”
“We define that as families who might be carrying medical coverage but maybe don’t have dental or vice versa,” Phillips said. “Or they have a deductible that is more than 10% of their income and thus are cautious about using their insurance. We are seeing growth in both these vulnerable populations [the uninsured and the underinsured].”
Another reason for the increase in demand at free clinics is “the unwinding of Medicaid,” Phillips said.
When the pandemic freeze on determining Medicaid eligibility was lifted, many states redetermined eligibility for the program and many people came off, Phillips said.
“Presumably, that’s because their income situation was much better, or they had aged into Medicare, but in a lot of cases, people may have gotten a job that provided better income but maybe that employer doesn’t offer insurance, or they’ve become underinsured,” he said.
Meeting ALICE’s needs
Virginia’s free clinics traditionally served individuals with incomes at 200% of the federal poverty guidelines, but in recent years, many—including the Moss Free Clinic—have increased eligibility to 300%, due to the cost of living and to meet the needs of the population that meets the definition of ALICE (Asset Limited, Income Constrained, Employed).
According to a planning guide published by the American Council on Aging, 300% of poverty level for a household of four people is an annual income of $96,450.
“[Clinics] have recognized that the ALICE population is under a real squeeze and often might need safety net care,” Phillips said. “That’s also led to greater demand.”
Virginia’s free clinics are 501c3 nonprofit organizations that get the bulk of their funding from the local community. It’s “not as common these days” for local hospitals to provide direct financial support to local free clinics, Phillips said.
“It’s getting more challenging for hospitals because they’re under a real squeeze with operating margins being at a historic low right now,” he said.
A “symbiotic” relationship between hospitals and free clinics
The Moss Clinic for a number of years received funds from a capital campaign conducted for it by the Mary Washington Hospital Foundation. That funding is gone and Brashears said the clinic now has a goal of raising $1 million per year for its operating expenses.
The relationship between the clinic and the hospital was contentious for a time last year, but Brashears said, “Everything that happened with [Mary Washington Healthcare] is behind us.”
“One of the first things I did [when he started in December] was repair that relationship,” he said, adding that the hospital foundation recently awarded “a small grant” to the clinic.
Phillips said the relationship between free clinics and hospitals is important and “symbiotic,” and that the hospital association has traditionally been “a big champion” of the free clinics, “which we appreciate.”
“A free clinic can help keep people from unnecessarily going to the emergency room, which drives up the cost of care unnecessarily and creates a crowded ER,” he said. “They can also prevent unnecessary readmission to the hospital.”
Brashears echoed that belief in the value of a free clinic.
“We provide a wonderful service to the community,” he said.
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