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August 11, 2014

After Medicaid expansion, what happens to the free clinics?

Daily Briefing

Clinics that once specialized in no-cost care for uninsured patients have begun to accept Medicaid beneficiaries as a result of the Affordable Care Act's (ACA) Medicaid expansion.

There are about 1,200 no-cost clinics in the United States that provide care for about six million residents, according to the National Association of Free and Charitable Clinics. Such clinics traditionally have treated low-income patients at no cost and relied on private donations, as well as state and local funding.

Some no-cost clinics have closed as more low-income U.S. residents gain coverage through the Medicaid expansion.

However, most clinics in states that expanded Medicaid under the ACA are re-evaluating their business strategies and many have chosen to become Medicaid providers. Clinic leaders say they made the switch partly out of concern for patients who had long sought care at the free clinics and would now struggle to find doctors who accept Medicaid.

Michelle Goldman, CEO of the Eastern Panhandle Care Clinic in Ranson, West Virginia, says, "We used to say ... '[W]ouldn't it be great if we no longer had uninsured and we could close our doors and go out of business[?]" adding, "But the truth is we like the work we do and enjoy helping this population and believe we still have a lot to offer them."

Eight of West Virginia's nine not-for-profit, no-cost clinics now participate in the state's Medicaid program.As a result of participating in Medicaid, the clinics must:

  • Charge patients a small copayment, typically about $2, for an office visit;
  • Switch some patients' medications to align with those that Medicaid will reimburse; and
  • Receive state approval for certain patient referrals, including for surgery or costly diagnostic tests such as CT scans or MRIs.

According to KHN, becoming a Medicaid provider also has risks involved. For example, such clinics could lose donations, upset volunteer physicians, or cause clinic physicians to lose liability protection, according to Marty Hiller, a consultant at Echo, a consulting firm that works with no-cost clinics (Galewitz, Kaiser Health News, 8/7).

How to understand the Medicaid expansion debate

Looking for background on the Affordable Care Act's Medicaid expansion, the state of the debate, and why it matters? Daily Briefing editor Dan Diamond offers a simple, fast-paced primer in just three minutes:

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