ACA causes free clinics to reconsider their business model

Many not-for-profit clinics now reassess their business strategies as a result of the Affordable Care Act (ACA) and the expansion of Medicaid, Kaiser Health News reported.

As a result, these clinics, which unlike federally qualified health centers do not receive federal funding, usually treat and bill patients merely on their ability to pay (or not), and often rely on private donations. They may soon accept Medicaid, particularly those in the 26 states that have decided to expand Medicaid eligibility guidelines under the ACA.

Those patients newly enrolled in Medicaid have more choices--they can choose a primary care physician, for example. The clinics apparently feel the need to continue to woo those patients.

"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," Marty Hiller of Echo, a consulting firm that works with free clinics, told KHN. "It's been a tremendous upheaval."

Many clinics pursue Medicaid business as a result.

"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,'" Michelle Goldman, chief executive officer at the Eastern Panhandle Care Clinic in Ranson, West Virginia, which expanded its Medicaid eligibility. "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."

In other states that have decided not to expand Medicaid, the options are decidedly more constricted. North Carolina's lawmakers have decided to review and dramatically change the payment structure of its Medicaid program, and may privatize parts of the program, the Associated Press reported. That is leaving some other providers concerned about the future. The Carolinas HealthCare System, for example, faces a shortfall of up to $500 million over the next decade.

"It's very difficult for people to appreciate the sort of triple whammy of poverty, ill health, relatively low education,'' Dennis Stuart, M.D., who practices at a clinic connected to Southeastern Regional Medical Center in Lumberton, North Carolina, told the Associated Press. "How do our friends in Raleigh hope for us to change that?''

To learn more:
- read the Kaiser Health News article
- here's the Associated Press article

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