‘Care is resistance.' Va. free health clinics strategize survival after state, federal funding cuts

Yahoo

02-06-2025

Health Brigade executive director Karen Legato speaks at a town hall on May 29, 2025 to discuss state and federal funding cuts to Virginia's network of free clinics. Photo by Charlotte Rene Woods / Virginia Mercury
Amid federal and state funding cuts, freezes and delayed payments, the outlook is grim for free clinics in Virginia that have had to trim or halt some services, but there is hope, Health Brigade executive director Karen Legato said Thursday evening.
'Care is resistance,' she reiterated during a speech outside of the clinic's Thompson Street location in Richmond.
Having first opened in 1970 as the Fan Free Clinic, what is now known as Health Brigade was the first free clinic established in Virginia. It is one of about 70 free clinics currently in the state that provide care to uninsured or underinsured people.
The Thursday gathering brought workers, volunteers, supporters and patients of several Richmond-area free clinics together for a town hall to express concerns and frustrations and to brainstorm ways to keep doors open and patients served.
Before her calls to action, Legato shared that Health Brigade alone has lost $1.8 million in state and federal funding over the past year. Programs that have taken a hit include ones that offer HIV/AIDS treatment and testing for diseases like Hepatitis C and Tuberculosis, as well as a clean syringe program that also provides naloxone kits — the medication that reverses opioid overdoses.
'We are witnessing the largest cut in the health care safety net that's ever been made,' Legato said.
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In March, President Donald Trump's administration announced it was planning to pull back $11.4 billion in COVID-19-related funds for state and local public health departments. Virginia's Department of Health had to prematurely end three such grants, resulting in a loss of $219 million and about 500 employees, according to a Freedom of Information Act request filed by The Mercury.
Among the crowd was Del. Rodney Willett, D-Henrico, and a staff member representing Sen. Ghazala Hashmi, D-Chesterfield. Hashmi serves as the chair of the Senate's Education and Health committee while Willett had carried a budget amendment hoping to boost funding for Virgnia's free clinics that did not survive legislators' negotiations.
Both lawmakers have noted that they're monitoring how federal actions are affecting Virginia. Willett said last week the state legislature could reconvene for a special session later this year — particularly if Congress and Trump achieve the steep cuts in federal Medicaid funding GOP lawmakers are pursuing as part of a 'big, beautiful bill' designed to shave trillions from the country's budget. The measure has already passed the U.S. House of Representatives and will be debated in the U.S. Senate this summer.
As federal funding and systems dwindle, states are left to decide how and whether to make up the difference.
At Thursday's town hall, some speakers recalled that Gov. Glenn Youngkin held back $900 million of Virginia's budget surplus pending federal government actions, and posited that some of that funding could bolster Virginia's free clinics or help support any federal Medicaid losses. Meanwhile about $1 billion is earmarked in the state budget for tax relief to Virginians — resulting in $200 for individuals or $400 for joint filers. While that cash could be beneficial to families in the short term, Legato said that money could be better spent investing in public health.
'While we're gutting this safety net, we're worried about getting some chump change back to people in Virginia. I think it's disgusting,' Legato said.
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Her organization reached out to the Youngkin administration in recent weeks, she said, to nudge the state government about $300,000 in reimbursement payments it owes the clinic. She added that Health Brigade almost couldn't make payroll earlier in May.
'Some of the struggle we have had in the past year … is when you're having grants from the state … the safety net has to finance the state services until you get paid from the state.'
A Youngkin spokesman didn't respond to request for comment by press time.
As Health Brigade handles several public health services, it fronts the cost for testing and treatment and then seeks repayment from the state.
'When we run out of cash because we're waiting for the state to pay, we have to go to a line of credit to float us until those payments come in,' she said 'What that means for us is that our line of credit bottoms out. So we're at $500,000 on our line of credit right now. We can't get any more.'
Other speakers included representatives from neighboring clinics, like CrossOver, which has lost $935,000, and Daily Planet, which is facing $1.3 million in cuts from federal grants and state-administered payments.
In recent days, Daily Planet learned that federal funding for its 'Every Woman's Life' cancer screening program has been frozen, Dr. Patricia Cook, a chief medical officer, said. The program is meant to help uninsured and underinsured people catch breast or reproductive organ cancers early on.
Detecting and treating illnesses early is something that Dr. Jeffry Reihl, an emergency medicine doctor, said is paramount to avoiding costly ER overflows and poorer health outcomes.
'I feel that this is going to flood our emergency departments with more and more patients who are sicker because they haven't gotten care as an outpatient they should have gotten,' he said. 'It's just going to make an overburdened system even more overburdened.'
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His argument echoes that of U.S. Rep. Jennifer McClellan, D-Richmond, who has recently cautioned her congressional colleagues against cutting Medicaid. Without preventative care within reach, people will likely flood emergency rooms when they need care, McClellan said at a press conference last month. As hospitals are federally-required to provide care, uninsured patients who cannot pay can become a shared financial burden on taxpayers.
'These cuts are impacting multiple nonprofit health clinics, public health departments, hospitals and medical providers across the state,' Legato said Thursday as she connected the dots between how state and federal funding helps local health care providers serve the public. 'We are now on the verge of the feds taking a chainsaw to Medicaid, which will exacerbate the crisis of access to primary care for low-income residents and vulnerable community members.'
To counter the current losses, Health Brigade plans to put the building it owns up for sale. It will lease space to operate from the future owner while it secures a new location down the line, she said.
The organization also plans to host future town halls with other local health partners to discuss intersectional health issues like housing and homelessness, and to make calls to action for fundraising.
'Now is the time for courage, creativity and turning caring into action,' Legato said.
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