Virginia's New Health Coverage for Adults
As of 2016, an estimated 700,000 Virginians under the age of 65 lacked health insurance – about 10 percent of the nonelderly population of the state. In 2018, Virginia’s legislature and governor agreed to take part in the federally-funded expansion of Medicaid, which broadened the eligibility of Medicaid to include adults ages 19-64 whose incomes fall within 138% of the federal poverty line (e.g. $16,754 for a single adult or $28,677 for a family of three). When the Virginia law takes effect in January 2019, the Commonwealth will become the 33rd state in the country to expand Medicaid.
If you think you might be eligible for new health coverage for adults, you can apply for health coverage in any of the following ways:
- Call the Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590) to apply on the phone Mon - Fri: 8:00 am to 7:00 pm and Sat: 9:00 am to 12:00 pm.
- Complete an online application at Common Help: www.commonhelp.virginia.gov
- Complete an online application at The Health Insurance Marketplace: www.healthcare.gov
- Mail or drop off a paper application (Spanish) to your local Department of Social Services (Mailing may take longer than other methods of applying). Find your nearest local department of social services by visiting: http://www.dss.virginia.gov/localagency/
- Call the Virginia Department of Social Services Enterprise Call Center at 1-855-635-4370 (If you also want to apply for other benefits)
Supporting Free & Charitable Clinics Through Expansion
Medicaid expansion means more healthcare for more people, and the impact on the overall health of Virginia’s citizens will be profound. Virginia’s network of free and charitable clinics are proud to be a partner and advocate for increased access to health care. With Virginia’s expansion of Medicaid, health coverage will broaden to include to an additional 400,000 people throughout all corners of the state. Even so, an estimated 300,000 Virginians, most of whom are working families, will remain uncovered, caught between incomes that are too high to qualify for expanded Medicaid coverage yet too low to afford health insurance, given the cost of other essential needs like housing, food and transportation. Currently, four out of five uninsured Virginians come from working families.
To take care of their ongoing, routine and preventative healthcare needs, these 300,000 Virginians must rely on the Commonwealth’s traditional healthcare safety net – including the private network of more than 60 free and charitable clinics across the state. Funded through a combination of charitable donations, earned income and state funding, these community-based facilities provide critical healthcare services mostly through the use of volunteer healthcare professionals to people who would otherwise have no place to turn. The collective operating budget of the clinics is an estimated $40 million annually, about one-sixth (16%) of which is provided through an annual state appropriation. Through partnerships and efficiencies, clinics turn the $40 million into $191 million in care each year.
Clinics are major players on the front line of Medicaid expansion in Virginia. As a result, Virginia’s free and charitable clinics are experiencing a time of rapid change and mounting challenges. Clinics are having to evaluate their business models and evolve their operations and infrastructure to best accommodate new realities in a post Medicaid expansion state. Through all this change and transition, the need for clinics, now and in the future, is indisputable. Where Medicaid stops, clinics begin.
VAFCC is committed to bringing our member clinics current information to help support them through the process of Medicaid expansion and to share information that will be helpful to patients. For those lacking health insurance and access to care, free and charitable clinics have always been there to provide comprehensive, quality care -- and they will continue to do so.
Frequently Asked Questions
What are free and charitable clinics?
Virginia’s free and charitable clinics look much like your primary care provider’s office. Our clinics provide primarily on-going, comprehensive care to thousands of low-income, uninsured or underinsured patients across the state in patient-focused medical centers staffed by 6200 volunteer licensed physicians, nurses, dentists, pharmacists and other healthcare practioners that provide high quality care without regard to patient’s ability to pay.
How will free and charitable clinics be impacted by Medicaid expansion?
Thanks to Medicaid expansion, along with the assistance of Virginia’s free and charitable clinics, more Virginians than ever will have access to preventative and life-saving care.
Medicaid expansion is a win-win for Virginians and the state’s free and charitable clinics. Approximately 400,000 Virginians will receive Medicaid benefits on January 1. Because Medicaid expansion will not cover everyone, free and charitable clinics will have the opportunity to step in and fill remaining gaps to those who continue to lack access to care.
Each of our clinics will evolve their operations to continue to best meet the needs of their patients within their community. Here are a few approaches:
- Hybrid: Certain clinics will accept Medicaid-enrolled patients, while also treating uninsured patients with certain income levels. Income eligibility will vary based on the cost-of-living in each locality served by the clinic.
- Supplemental Services: In locations where Medicaid-enrolled patients have access to providers, free clinics may choose to allocate resources to specialized services that Medicaid may not fully cover, if at all – services may include preventative dental care, optometry, and podiatry. These new clinic specialties can help supplement, not duplicate, services provided by Medicaid.
- Expanding Eligibility: In localities where Medicaid-enrolled patients have access to other providers, free clinics will expand their eligibility requirements to serve a broader population of uninsured and underinsured. In this scenario, patients who historically made too much to qualify for a free clinic’s services – but not enough to access traditional insurance – will now be able to access care at a clinic. It has been estimated that as many as 300,000 people will remain uninsured after Medicaid expansion thus further demonstrating the need for clinics.
How do free and charitable clinics use Federal Poverty Level data when helping patients?
Virginia’s free clinics provide low-income, uninsured people with free or low cost health care services without regard to payment. Each clinic sets its own income eligibility requirements. Depending on which clinic is in your area, income limits are typically between 0-250% of the Federal Poverty Level (FPL). Following Medicaid expansion, some clinics may expand their income limit ranges to assist more people lacking access to health care.
What does a free and charitable clinic patient look like?
Most of our clinic patients are chronically ill, living with multiple co-morbities such as diabetes, heart disease, hypertension, and COPD and need regular access to healthcare. Additionally, most clinic patients have jobs but cannot afford insurance. In fact, four out of five uninsured Virginians come from working families. These are our neighbors and friends who are fully employed or underemployed and do not earn enough to afford all of their basic necessities, such as healthcare. You most likely know someone who doesn’t have health insurance. These people include those with part-time and hourly jobs in food service, retail, construction, and hospitality industry as well as self-employed and contract employees.
The majority of uninsured Virginians are families living with incomes at or below 200% of the Federal Poverty Level. For example, a family of four making $49,200 is at 200% of the Federal Poverty Level. They would also not qualify for Medicaid in the expansion. The uninsured population also comes from a diverse racial and ethnic background across the state: Nearly half are white, a quarter are Hispanic and 20% are African American.
Are the working uninsured by choice?
Most people without insurance, want insurance, but can’t afford it. When working families struggle to make ends meet, co-pays and medical bills become out of reach along with access to preventative care. These same families may also avoid addressing chronic conditions, such as diabetes, that may ultimately result in costly ER visits or hospitalizations. Some families don’t have the means to cover expenses incurred from healthcare. That’s why Virginia’s free clinics are so important. Clinics serve as an important resource for working families who can’t afford healthcare or health insurance.
How has Medicaid expansion impacted clinics in other states?
It’s a good trend. From what we understand, when enrollment in Medicaid goes up, and utilization of free and charitable clinic increases. We know that when states expand Medicaid, more people access healthcare. That’s why it’s important to continue investing in healthcare, including the state’s free and charitable clinics.
Why is it important to continue funding clinics within Medicaid expansion?
Free and charitable clinics remain an important part of Virginia’s healthcare safety net, even after Medicaid’s expansion on January 1. For years, Virginia’s free clinics only had the capacity to serve people with very low incomes. With Medicaid expansion, this population will have new options for healthcare, which gives free clinics the opportunity to evolve to continue to serve these newly covered patients and/or expand to serve new, underserved patients such as Virginia’s working families. But even with enhanced Medicaid coverage, Medicaid does not cover all necessary health services; this is another place where clinics can have a great impact – continuing to fill a gap in services where none exist.
For Medicaid expansion to have the greatest impact, it’s imperative to continue funding Virginia’s free and charitable clinic network.
Will current patients still need free and charitable clinics?
Every clinic is approaching their service models differently, based on the needs of their community. Depending on geographic location, some patients may be able to access healthcare using their Medicaid coverage at other facilities. In those situations, free clinics will be able to expand their Federal Poverty Level limits to help more, underserved patients. In other cases, free clinics may accept Medicaid covered patients and continue to see the same patients they’ve seen for years. Regardless of the approach a clinic chooses, our facilities will continue to be busy serving patients who lack access to health care. We will need the help of our volunteer providers to continue this important work.
Will clinics still need support from medical volunteers?
We know that medical volunteers are committed to helping the uninsured and underinsured. Medicaid expansion means more people with access to health care coverage and free clinics are an integral part of this effort. To make Medicaid expansion successful, we need the help of medical volunteers more than ever because volunteers help to make our health care services affordable for patients, the community and an excellent return on investment for donors.
How will I know what model my clinic decides to change to?
Every clinic is approaching their service models differently, based on research and the needs of the community. Clinics will be communicating changes to their stakeholders in the coming months. Contact your local clinic directly for more information.
How will free and charitable clinic patients afford medications after Medicaid expansion?
Medication affordability is an issue everyone is grappling. Virginia’s free and charitable clinics help patients obtain necessary free and low cost medications. Many medications are provided through Patient Assistance Programs offered by pharmaceutical companies. Once Medicaid expands, clinics are concerned about their continued ability to continue to help uninsured patients obtain their life-saving medications.
Does Medicaid expansion mean everyone across the state can access healthcare?
Medicaid is health insurance not healthcare. Therefore, while many will find themselves insured for the first time, they might find it just as difficult to receive care. That’s because in Virginia, there are areas with little to no access to health care. These localities are “Health Professional Shortage Areas” and have too few primary care, dental and mental health providers and services. While free and charitable clinics continue to strive to meet the needs in these underserved areas, even within Medicaid expansion, it will be important for partners to work to increase healthcare access across the state.
Additionally, even within Medicaid expansion, a large percentage of the population will be underinsured. While these people may have some type of healthcare coverage, the cost of accessing care – such as extremely high co-pays and deductibles – makes actually seeing a healthcare professional out of reach for thousands of Virginians. Free clinics will continue to play an active role in providing healthcare for this population.