Free health clinics around the Kansas City area, like many across the country, are shedding their free designation and preparing to accept payment from most patients as they adapt to the federal health care law.

The shift will be a big one, especially for the bustling Kansas City Free Health Clinic in midtown. Its one of the largest free clinics in the country, treating upward of 15,000 patients a year with more than 100 staff members and 1,000 volunteers.

In its 42 years, KC Free, as its commonly called, hasnt charged fees or billed patients for care. And it has seen only the uninsured.

Soon, all that will change.

Like several other free clinics across the country, KC Free will soon accept Medicaid and add a sliding fee scale. The dramatic shift in the non-profits business model is necessary under the new law, its leaders say, and will allow the clinic to continue caring for many of Kansas Citys most vulnerable residents.

The face of health care is changing, and we are changing with it. We must, Sheri Wood, the clinics executive director, wrote in a letter to volunteers and supporters in December.

Similarly, the Health Partnership Clinic of Johnson County has shifted its structure; and the Duquesne Clinic in Kansas City, Kan., has changed the definition of whom it serves and may start accepting Medicaid. Other health care providers are moving away from an urgent care approach in an effort to become a primary medical home for patients. Community mental health centers have started offering medical services to some patients, too.

With federal law aiming to expand health coverage, the entire safety net is realigning in preparation for an influx of patients accessing care for the ry first time, or for the first time in a very long time. And yet, parts of the law itself are still unclear, and much of how everything unfolds locally depends on how Missouri and Kansas implement the law.

We are entering a new era, and I think that free clinics are very consciously trying to decide what the best path is, said Julie Darnell, professor of Health Policy at the University of Illinois-Chicago.

A clinic for hippies

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Health care law means free clinics have to accept payments