Virginia free clinics hit by funding cuts, brace for more to come
Steep reductions in federal health care funding mean big cuts in emergency mental health, housing and food help for some of Richmond’s sickest people, the Health Brigade free clinic says.
And Richmonders who may be sick with HIV, sexually transmitted infections or tuberculosis may never know until it's too late because there’s no money for community testing programs.
“Preventive care doesn’t seem to be a priority” for Washington, said Karen Legato, Health Brigade’s executive director, after briefing Rep. Jennifer McClellan, D-4th, on how the free clinic has been struggling to provide medical and mental health services for Richmond’s uninsured and underinsured residents.
The clinic, which had been doing 2,500 HIV tests a year with large community outreach programs thanks to funding for HIV prevention and treatment, has reduced the number of tests it can do by 75% because the funding has been cut, Legato said.
“We've been in this space around the HIV AIDS work for many, many years. … But you know, numbers of what we used to do, you know, 2,500 tests a year kind of thing, when we were out in the community … nobody's got funding for that,” Legato said.
“And so now we have to worry about the rise in HIV,” she said.
Funding cuts around HIV health care forced reductions in the clinic’s case management services and meant the clinic had to drop its program helping people with HIV as they are leaving prison.
The clinic’s comprehensive harm reduction program, which, among other things, distributes overdose prevention medication and needle exchanges, “really stepped in to try to provide some wraparound services for these folks,” said program coordinator Dziko Singleton.
But “they just dissipated. We haven't seen a lot of these people, and so it becomes concerning. When they happen to show up at our outreach sites, we're overjoyed, because we know that they're alive. And that sounds really graphic and morbid, but we look for these people. We look for people whom we haven't seen here in the building,” she said.
“And so it just makes you wonder, you know, what's next?” she added.
Like other free clinics across the state, Health Brigade is bracing for a flood of new, needy patients, as President Donald Trump’s “One Big Beautiful Bill” tightens eligibility for Medicaid and failed to extend a tax credit that helps keep down the cost of Affordable Care Act insurance.
They’ll be coming at the same time the clinics’ costs are rising because of medication and the need to pay clinicians to fill in, as the volunteers who have long been the backbone of the system face pressures of their own.
There could be worse to come, McClellan said.
When she looked at Trump’s just-released proposed fiscal year 2027 budget, “What hit me was, OK, we're going to cut Medicaid. We've already cut the ACA stuff, so we're going to create all these uninsured people. Now we're going through health and human services in the proposed budget, and now we're going to start cutting a bunch of other stuff related to health,” she said.
That includes a $15.8 billion cut for the Department of Health and Human Services, a 13% reduction.
It eliminates the Prevention and Public Health Fund and means a $3.5 billion cut for health centers, a $985 million cut for chronic disease and prevention activities, a $923 million cut for HIV/AIDS programs and a $561 million cut for maternal and child health programs.
That's got free clinics worried.
“I’m hearing from some of our most established clinics, the ones that have been around the longest and are the largest, that they’re having the biggest operating deficits they’ve ever seen, as much as $500,000, which is unsustainable,” said Rufus Phillips, chief executive of the Virginia Association of Free and Charitable Clinics.
He has his fingers crossed that a $5 million increase in state support for free clinics, included in both the state Senate and House of Delegates budgets, doesn’t get lost in the shuffle as the two bodies try to resolve their budgetary differences.
“You know the average cost for a patient in a free clinic is $1,000 … so $5 million is 5,000 patients.”
And just in the final six months of 2025, more than 8,600 new patients reached out to the state’s free clinics seeking care.
Phillips said clinics are telling him they need to cut back on some services, particularly mental health and dental care.
Clinics that expanded dental care coverage after the state Department of Medical Assistance Services expanded the benefit have been whipsawed, he said. They're now dealing with a cap on dental benefits from then-Gov. Glenn Youngkin’s last budget.
Legato, meanwhile, worries that the need to ensure the sickest patients get the medications they need, as costs keep rising, limits what free clinics can provide as preventive care.
“It's a juggling act, just trying to make sure that something really serious doesn't fall through the cracks, like somebody's insulin or somebody's blood thinner,” said Dr. Rachel Waller, the clinic’s medical director.
The Medicaid and drug company paperwork involved in securing medication — and, in many cases, helping patients maintain any Medicaid coverage — eats up a lot of Waller’s time, she said.
“We find ourselves in the position of being able to actually give less tangible resources and kind of shifting to just being supportive and trying to give people hope in trying just to be there, be a listening ear,” said Jenee Johnson, the clinic's director of social work.
It can be wearing.
There are times, said Muriel Azria-Evans, the clinic’s director of mental health services, when she’s counseling someone these days “when I myself want to sit on the other side of that and say, 'Yeah, you're right, yeah, everything is really scary, and we, you know, are feeling under attack.'"