Doctor holding stethoscope to toddler's chest

In less than a month, Virginia will open wide the door to health care coverage for hundreds of thousands of residents. Medicaid expansion will reduce by half (and then some) the estimated 700,000 Virginians under age 65 who aren’t covered. On Jan. 1, 2019, Medicaid will enroll up to 400,000 of our fellow citizens, giving them — many for the first time in their lives — regular access to care, enhanced access to medications, and coverage that means not having to forgo medical treatment in deference to some other household expense. The New Year will truly mark a new day in Virginia.

While all eyes have been on the newly enrolled, there is another significance to Medicaid expansion that will further enhance access to health care for many of the remaining 300,000 of the uninsured, those whose incomes are too high to qualify for Medicaid yet too low to afford private insurance, given the demands on their household income for housing, food, transportation, and other essentials. These “working uninsured” — by and large working families with at least one parent holding down a full-time job — represent four of the five Virginians who are currently uninsured.

Who will provide for the health care needs of these hardworking families? The answer lies, at least partially, in the network of more than 60 free and charitable clinics across most of the state. These patient-focused and professional medical facilities, funded by donations and a critical annual appropriation from the commonwealth, have been providing vital health care services to people who would otherwise have no place to turn. Largely supported by volunteer, licensed health care professionals, the clinics are a model of efficiency, annually turning a collective operating budget of $40 million into $191 million worth of care.

Moving forward from January, the patient population among the free clinics will undergo a distinct change. Hundreds of thousands of Virginians who relied on the clinics in the past may have the opportunity to visit private providers who accept Medicaid. That shift will create opportunities for the clinics to begin focusing on the “working uninsured” who historically exceeded clinic income eligibility limits. Additionally, not only does Medicaid expansion give direct access to care by private providers, it also allows free clinics to continue to serve an uninsured patient population that struggles to afford or access health care.

Just who are these working uninsured? To qualify for Medicaid expansion, a family’s income cannot be higher than 138 percent of the federal poverty level. (The actual dollar amount depends largely on the size of the family.) But while a higher income disqualifies a family from participating, that income is often not enough for the family to be able to afford insurance on the open market. In fact, there are individuals and families in that predicament in every locality in Virginia. To put the situation in perspective, a suburban family of four with a household income of $63,000 would not qualify for Medicaid, and yet their income would not be sufficient to afford insurance on the ACA Marketplace. About 20 percent of the state’s uninsured population are facing this all-too-familiar dilemma.

We are at the crossroads of a historic opportunity for free clinics to significantly reduce the population of Virginians who are currently forgoing care because they lack either insurance or financial resources to afford a visit to a doctor or a medication. The clinics will become the medical home for this cohort, providing checkups, wellness visits, and a range of traditional treatments. Many of them also will provide specialty care, including preventive dentistry, which can stave off more serious medical conditions.

Where there is opportunity, there are also challenges. To start, Medicaid expansion may make it more difficult for people just outside the Medicaid eligibility limits to access free prescriptions. For the majority of vulnerable Virginians, broadening Medicaid will actually improve access to medications — but not so for the 300,000 working uninsured. To qualify for prescribed medications, they must undergo a lengthy process that requires wait times of more than a month. In order to get these folks the often life-saving prescriptions they need in the meantime, clinics will step in, even if it means spending more of their limited budgets to purchase these medicines.

The expansion of Medicaid in Virginia has been long awaited and will dramatically transform access to care. As a consequence, the role of Virginia’s network of free and charitable clinics has never been more critical. They are the safeguard protecting hardworking families that have no other health care options.

At the end of the day, Medicaid expansion will mean more health care for more people, and the impact on the health of our citizens will be profound. Virginia’s network of free and charitable clinics is proud to be a partner and advocate in this effort. Where Medicaid stops, clinics begin.

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Linda D. Wilkinson is the CEO of the Virginia Association of Free and Charitable Clinics. She can be reached at Linda@vafreeclinics.org.

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