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Obamacare Creates 'Upheaval' At Free Clinics

WebMD News from Kaiser Health News

By Phil Galewitz

Mon, Aug 04 2014

WHEELING, W.Va. - Without insurance, Pam Milliken relied for years on the free health clinic here to help manage her arthritis, high blood pressure and diabetes. When she needed to have her gallbladder removed, the clinic, located in a former State Farm Insurance building, found her a specialist and hospital willing to do the surgery at no cost.

This year, Milliken was among the 70 percent of patients at Wheeling Health Right Center who enrolled in Medicaid after the state expanded the program under the Affordable Care Act.

Worried that patients like Milliken would leave their care and struggle to find doctors accepting new Medicaid patients, the clinic took a rather radical step: It became a Medicaid provider and started billing the state-federal health insurance program for the poor.

On a recent weekday, Milliken, 55, who makes salads at a local truck stop restaurant, was getting a checkup and X-rays at the clinic, which now requires a $2 Medicaid co-pay. "I've been with these people for years and they know me better than anyone," Milliken said, explaining why she chose to keep coming to the clinic.

In fact, eight of the nine non-profit free clinics in West Virginia this year began participating in Medicaid. The shift - which also occurred to a lesser degree in Ohio and Illinois, among other states - is being closely watched nationwide and reflects how facilities are adapting in the 26 states that expanded Medicaid.

"We used to say ... 'wouldn't it be great if we no longer had uninsured and we could close our doors and go out of business,'" said Michelle Goldman, CEO at the Eastern Panhandle Care Clinic in Ranson, W.Va., which is one of the free clinics now also taking Medicaid. "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."

'REAL DISRUPTION'

While a few free health clinics have shut their doors in Arkansas and Washington, most expansion-state non-profit free clinics are reassessing their business strategies. Medicaid offers the potential to give their patients better access to specialists, diagnostic testing and hospital care, and that's created a sense of unease for operators of the clinics that for decades have played a key role in the nation's health-care safety net.

"These changes have caused some real disruption in the free clinic sector trying to anticipate what it means for patients who continue to need our services, and how we can sustain ourselves," said Marty Hiller, senior consultant with Echo, a consulting firm that works with free clinics. "It's been a tremendous upheaval."

The nation's loosely organized network of free clinics have come a long way since the 1970s when most were made up of volunteer doctors and nurses working a day or two a week in church basements. Today, about 1,200 free clinics serve about 6 million patients, according to the National Association of Free and Charitable Clinics. Their increasingly modern facilities look much like private medical offices that serve patients with insurance. They often use electronic medical records, pay administrative staffs and nurse practitioners, and run their own pharmacies.

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