Free and charitable clinics across the state said they are preparing for an influx of patients as fewer Virginians sign up for health insurance through the Affordable Care Act marketplace. They’re pushing the state for more funding to handle the mounting need.
Early federal estimates suggest more than 300,000 Virginians could lose coverage over the next two years if enhanced ACA premium tax credits are not extended and if Medicaid work requirements and more frequent eligibility checks take effect.
Many of those patients will turn to free and charitable clinics for care.
“We expect and hope many of these newly uninsured patients will turn to free clinics,” said Rufus Phillips, chief executive officer of the Virginia Association of Free and Charitable Clinics, which represents 70 nonprofit clinics across the state.
During the 2026 General Assembly session, the association is backing a budget amendment that would add $15 million a year from the state’s general fund to support operating costs at free and charitable clinics. Virginia currently contributes roughly $8.8 million annually to free clinics.
Phillips said the average cost for an uninsured patient at a free clinic is roughly $1,000 a year, meaning every extra million in funding could cover 1,000 patients.
He said clinics are seeing record numbers of uninsured patients. Between 2022 and 2024, Virginia’s charitable clinics reported a 47% increase in patients, most of them uninsured.
At the same time, costs have risen sharply.
Eight charitable clinics serve the Hampton Roads area, where providers said they are seeing patients with more complex health needs.
Matthew Stern runs HELP, a charitable dental clinic serving uninsured and low income patients in Newport News. He said insurance gaps often show up first in dental care.
“When your medical insurance costs go up, generally, one of the first things that disappears is dental insurance,” Stern said. “It's really unfortunate, far more like a luxury item in our current economy than kind of one of those necessities.”
He said untreated dental problems can quickly affect the body’s overall health.
The clinic serves about 600 active patients, many of them working adults and families earning up to 300% of the federal poverty level, roughly $47,880 for an individual or $99,000 for a family of four.
The clinic suggests patients make a small donation, but the vast majority of care is paid for through donations and state support.
Stern said the biggest challenge faced by free clinics is the uncertainty.
“We serve as the safety net for people who lose coverage. So our ability to accommodate is very dependent upon our ability to raise funds outside of the insurance world,” Stern said.
The clinic operates with a small paid team and without a hygienist, meaning sometimes dentists need to handle routine hygiene services. Still, Stern said the clinic has the capacity to add on additional patients under its current model and generally see between 15 and 30 new applications each month.
“We’re still welcoming people in the door when we get their applications in,” Stern said.
In Suffolk, the Western Tidewater Free Clinic serves both uninsured and Medicaid patients across a large rural section of southeastern Virginia.
Executive Director Ashley Greene said they provide medical, dental, vision, mental health and women’s health services, along with an on-site pharmacy for Medicaid and uninsured patients.
In 2025, the clinic saw nearly 1,700 patients at more than 14,000 visits. Roughly 46% of those patients were covered by Medicaid, while the rest were uninsured.
Greene said the clinic also works closely with local hospitals, including Sentara Obici Hospital and the new Riverside Smithfield Hospital. Patients discharged without a regular provider are referred to the clinic and, if they meet income and residency requirements, are seen within seven days for follow-up care.
She notes that patients who lose Medicaid coverage - something that happens a lot - are not turned away. But that shift carries financial consequences. When patients move from Medicaid to uninsured status, clinics lose partial Medicaid reimbursement from the state that helps offset operating costs.
“It’s good for patients that they don’t have to leave our care and seek care elsewhere, but it does make it difficult for us financially,” Greene said.
Dental care is among the most strained services at the Western Tidewater clinic, even after a recent expansion. Greene said urgent cases are seen first, while patients with less immediate needs often wait longer.
