Post ACA: The evolving business models of free clinics

Purpose: The Affordable Care Act (ACA) aims to reduce the uninsured population through Medicaid expansion and health insurance exchanges.  Changes in the demography of the uninsured bring into the question the current business models and need for free clinics in the healthcare safety net.

Methods: Key informant telephone interviews were conducted with executives from 15 state/regional free clinic associations, of the 25 such associations nationally. Topics addressed included the impact of state policies on free clinic operations and business strategies or model adaptations used to meet the changing needs of the uninsured due to the ACA. We specifically explored the adoption of hybrid models, whereby clinics provide care to Medicaid beneficiaries as well as the uninsured, and charitable or reduced cost care, whereby patients pay a fee based on what they can afford.

Results: Overall, free clinic executives reported minimal changes in the demand for free clinic services in their states/regions. Large numbers of uninsured persons remain and locating new sources of care for newly Medicaid-eligible persons is challenging. A large majority of free clinics are waiting for more components of the ACA to be implemented prior to adopting alternate business models. Very few executives identified free clinic closures; only 2 were attributed to a reduction in need associated with the ACA.

Conclusion: As additional components of the ACA are implemented, changes in business models for safety net providers may be required. Monitoring these changes to determine their impact on vulnerable patient populations is essential.