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The National Association of Free & Charitable Clinics Celebrates 25 Years Supporting Healthcare Access
Free and charitable clinics across the U.S. are providing critical healthcare services for those who might otherwise go without. A recent symposium spearheaded by the National Association of Free and Charitable Clinics, brought together those on the front lines of the country's U.S. health safety net.
A pharmacist manages patient medications at Cape Fear Clinic, Wilmington, North Carolina, in this file photo. Direct Relief supports free and charitable clinics across the United States with medical and financial aid. (Photo by Donnie Hedden for Direct Relief)
“There was a handful of people sitting around a hotel saying there’s got to be a way that we can work together to fix this,” said the executive director of Greenville Free Medical Clinic in Greenville, South Carolina.
Participants in that first conversation became the 14 founding members of the NAFC. In 2006, the association hosted its first annual conference in Chicago, Illinois. Their goal was to bring clinicians of free and charitable clinics together to share ideas and work towards solutions. Last month, NAFC celebrated its 25th year of provider and organizer support with over 500 individuals at its annual symposium in Washington, D.C.
The NAFC staff said that this year’s symposium was meaningful as they celebrated the impact of free and charitable clinics nationwide. Ariana Gordillo De Vivero, senior director of strategic initiatives at the NAFC, said that bringing advocates, providers, volunteers, and partners together was energizing and inspiring.
Representatives from free and charitable clinics pictured at a recent symposium spearheaded by the National Association of Free and Charitable Clinics in Washington, D.C. (Photo by National Association of Free & Charitable Clinics)
“Our members are part of a much larger movement committed to expanding access to quality healthcare, and the opportunity to learn from one another and share ideas is what makes the Symposium so valuable year after year,” Gordillo De Vivero wrote in an email to Direct Relief.
Since its founding, the NAFC has grown to support over 1,400 free and charitable clinics with 847 as members, through advocacy, information-sharing, grants, and member engagement. With a predominantly volunteer-based workforce, the clinics provide care to individuals across the country who can’t afford or access care anywhere else.
Nearly 2 million uninsured and underinsured people across the United States sought care from free and charitable clinics in 2025. More than half of those patients are employed, but lack health insurance. Most of their patients are adult women ages 18 to 64.
According to the NAFC, 45% of free and charitable clinics have an operating budget of $250,000 or less. Just over 70% are free clinics, which do not require patients to pay for their care. The NAFC is anticipating an increase in patient demand in 2027 as healthcare subsidies and Medicaid rollbacks are implemented nationwide.
Free and charitable clinics often rely on prescription medication donations to support patient care. Since 2009, Direct Relief has provided more than $1.6 billion worth of medications to 827 free & charitable clinics and charitable pharmacies in 48 states, Washington, D.C., and Puerto Rico.
The organization has also provided more than $28 million in funding to 832 free & charitable clinics and pharmacies. Those funds have supported clinics through disaster preparedness and response, chronic disease management, mental health, women’s health, health equity, and resilient power and infrastructure.
The Greenville Free Medical Clinic was one of the 14 founding clinics of NAFC. Greenville serves just over 2,600 patients each year in medical, dental, vision, and mental health visits. Most of their patients are women.
According to Foley, ongoing changes to healthcare policy have highlighted the need for NAFC’s organized voice on the value of the clinics and the data they can provide on America’s healthcare needs. Foley said that changes like the Affordable Care Act and expansion of Medicaid increased access to care, but gaps still existed in areas where there were fewer providers.
“We were able to be a resource of information and acknowledge that patients weren’t uninsured and poor because they didn’t want to work,” Foley said. “There are a lot of other circumstances that cause (patients) to be in the position that they are in.”
A provider at Cape Fear Clinic in Wilmington, North Carolina, carries medical support from Direct Relief into the clinic in this file photo. Cape Fear Clinic, which has received $7.3 million in donated medications from Direct Relief, provides compassionate and affordable patient-centered healthcare to low-income individuals and families in the Cape Fear region regardless of ability to pay. (Photo by Donnie Hedden for Direct Relief)
Foley said that the NAFC has helped the clinics develop a “significant national voice” on healthcare, while creating a space for them to gather and share ideas.
“It’s just a huge value,” Foley said. “There are clinics that are very similar to what we do, and have the kind of organization that we have, and there are some that are very dissimilar. But there’s ideas going on (in) all of those clinics that can be replicated or adapted across communities.”
Operating a clinic can be difficult work.
Over 90% of the free and charitable workforce is volunteers. This includes 72,000 licensed or certified clinical volunteers. According to the NAFC, only 10,800 people are paid, full-time staff at free and charitable clinics across the United States.
Syril Pettit, a volunteer medical scribe at the Arlington Free Clinic in Arlington, Virginia, spoke about volunteer management at the conference.
Pettit began volunteering at the clinic through the Virginia Medical Reserve Corps during the height of Covid-19. She has since dedicated her Thursday afternoons each week to supporting the 1,639 patients who visit the clinic. She said it would be difficult for the clinic to provide comprehensive care without the support from the community and its volunteers.
“These services are needed by so many members of our community who don’t have access to core medical or social services to support them in getting through their daily lives,” Pettit said. “It’s important that we all have that opportunity to live healthily and to thrive.”
Pettit attended the NAFC conference for the first time this year. She works in public health and said it was affirming to see so many dedicated to improving access to healthcare.
“The chance to sit in a room with hundreds of other people who are so incredibly dedicated to the free and charitable clinic arena was really encouraging,” she said. “I saw how many people are willing to put their hearts and souls and time into making these successful, and we have a lot of challenges ahead.”
Dr. Angie Settle (left) and Gisela Bretones (right) on the main stage at the National Association of Free & Charitable Clinics 25th Annual Symposium. (Photo by National Association of Free & Charitable Clinics)
Gisela Bretones, chief operating officer at Miami Rescue Mission Clinic in Miami, said that the NAFC has given her a valuable lesson in perspective. Her clinic serves 11,000 patients who are homeless and/or underserved across three locations in Miami.
Most clinics are hyper-local and community-focused. But Bretones said she has learned through the NAFC that all the clinics are working against national barriers to improve care for patients.
Bretones has attended the annual conference over the last 10 years and said she makes meaningful connections with people every year who are doing ‘remarkable work with limited resources.’
“I love the conference because you come back with ideas that you can implement,” she said. “You come back with a stronger ability to advocate for your patients, better practices.”
This year, she was on the main stage to award professionals for their dedicated service. The COO said they have reminded her that Miami is not alone. She awarded Dr. Angie Settle from West Virginia Health Right for Patient Advocate of the Year; Cape Fear Clinic in Wilmington, North Carolina as Member Organization of the Year; and Volunteers in Medicine in Wilkes-Barre, Pennsylvania, the Dr. Jack McConnell Circle of Caring Award.
“When you work in this type of environment, it gets hard,” Bretones said. “We deal with very difficult patients, very small budgets, and we have to make difficult decisions every single day.”
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