A woman walked into the Montgomery County Free Clinic for a free mammogram, not expecting much—until the test revealed something life-threatening. A follow-up biopsy confirmed breast cancer. Because of that early detection, she was treated quickly and is now living well. Another patient, once terrified of needles and struggling to manage her diabetes after decades without seeing a doctor, began working with the clinic’s nurse practitioner. With gentle nutrition coaching and simple movement routines, her blood sugar levels fell so dramatically that she no longer needs medication.
Stories like these, Executive Director Ashley Menard says, are what the Montgomery County Free Clinic is built for—quiet victories that change and sometimes save lives. But those victories could soon become harder to sustain. With cuts to Medicaid and the expiration of Affordable Care Act subsidies looming, Menard believes the need for care in Montgomery County is about to surge. For her and the clinic’s small team, the question isn’t if they’ll feel the impact, but how soon—and how severely.
Due to state and federal cuts and procedural restrictions, the Kaiser Family Foundation estimates that 15-16 million Americans will soon be without health insurances: 7.8 million Americans will be left uninsured due to unprecedented cuts to Medicaid and HIP 2.0. Another 3.1 million will be uninsured from provisional changes to the ACA marketplace due to the One Big Beautiful Bill Act (OBBBA. And 4.2 million Americans will likely not be able to afford insurance without the tax rebates.
This means that for Menard and the Free Clinic team, the question is not if the clinic will feel the impact.
The Montgomery County Free Clinic serves roughly 200 to 280 individual patients per year, with about 800 visits recorded annually. Their eligibility rules are clear: patients must reside in the county, they must earn under 300% of the federal poverty guideline, and they must not have private or public insurance.
Menard knows the Free Clinic is not reaching even 10% of the county’s 5000 eligible residents. But they are making a difference for a narrow slice of residents, many of whom come from the Latino community—families who are often disqualified from state insurance programs and may carry deep fears about going to public hospitals. Because the Free Clinic takes no money from the federal government, it can provide a degree of trust that other healthcare providers cannot.
Yet the new wave of cuts threatens to completely redefine that patient base. As Menard explains, when ACA subsidies vanish in 2027, many families—her own included—will find health insurance premiums unaffordable. The same is true for those currently on Medicaid losing coverage under government rollbacks. Those patients, newly uninsured, will have nowhere else to go but the local free and charitable clinics.
“If you look at the median household income in Montgomery County, which is about $70,000,” Menard notes, “90% of folks here could qualify for our services. I just don’t think they know they could.”
That paradox—vast potential need but limited reach and resources—defines the challenge ahead.
Unlike some nonprofits, the Montgomery County Free Clinic is not supported by state or federal funding. Around 90% of its annual $350,000 budget comes from local donors—individuals who, year after year, quietly sustain a vital safety net. The rest is stitched together from Community Foundation grants, the local United Way, and the Montgomery County Medical Care Trust.
That self-sufficiency has been a blessing, shielding the clinic from immediate state or federal clawbacks. But it is also a vulnerability. As Menard puts it, “High eligibility is both a blessing and a curse.” If demand were to double—or triple—because hundreds lose ACA coverage or Medicaid slots, the clinic’s financial groundwork would need to be rebuilt almost overnight.
Plans are already forming: by 2027, the organization hopes to operate as a full-time primary care center, open five days a week instead of part-time. To do that, however, the budget must swell to $700,000. Put simply, the clinic will need either more community donations or brand-new funding streams, all while more patients crowd through the doors. And that’s only part of the equation.
If money is one side of the challenge, people are the other. The Montgomery County Free Clinic has long leaned on volunteers for frontline services, from nurses and physicians to front desk staff. But as Menard recognizes, volunteerism is a challenge for busy families.
“Our generations can’t take off time during the week to volunteer at a clinic,” she says. “That used to be easier for a stay-at-home mom or a retired nurse or teacher. We’re just not seeing that anymore.”
As a result, Menard herself is often balancing five jobs at once: grant writer, bill payer, referral coordinator, and even front desk assistant, on top of overseeing the whole organization. More hands, she insists, would lighten the load and make it easier to sustain programs long-term.
Asked where the clinic might compromise if resources tighten, Menard doesn’t hesitate: the medical program and Meals on Wheels will be preserved at all costs. Already, in 2025, the clinic made the painful decision to cut its dental program to protect core healthcare.
Menard’s message to our community is twofold. First, that if you need help, resources like the clinic exist—and walking through the door should not be a source of shame. Second, if you can give more—whether time, money or skills—now is the moment to rise to the challenge.
For small counties like ours, the test will be whether we dig deeper and become a community that cares for and protects each other, knowing one day, we might be the person in need.