As of July 2025, newly passed legislation is expected to trigger the removal of an estimated 12 million people from Medicaid rolls across the country. While the full impact of this change will vary by state, what’s clear is that millions of families—many of them children—will suddenly find themselves uninsured, or caught in the gray zone of being technically ineligible for Medicaid but unable to afford the steep costs of private insurance.
For families who already live on the margins—those who were just barely qualifying before, or who are now navigating confusing redetermination paperwork—this policy change is likely to result in delayed care, untreated illnesses, and increased stress around finances and health decisions.
As pediatricians, our mission has always been to advocate for the well-being of children. And as DPC pediatricians, we now find ourselves in a unique position. We are not bound by insurance billing systems. We don’t rely on bloated overhead and bureaucratic red tape to care for our patients. We can move more nimbly to meet the needs of families falling through the cracks—if we choose to. The DPC model isn’t just a way to restore our joy in medicine—it’s a way to reimagine how care can be delivered, especially during times of systemic upheaval.
So what can we do to help this growing group of uninsured families?
1. Flat-Fee Visits for Nonmembers
💡 Transparent, predictable pricing when they need it most
Not every family can—or wants to—commit to a monthly membership, especially when finances are tight. Some only need occasional care: the once-a-year school physical, the sudden ear infection, or the mystery rash that pops up the night before a big trip. For these families, offering clearly priced flat-fee visits can be a game-changer.
These visits allow families to access expert pediatric care without the psychological hurdle of paying for a subscription they might not “use” every month. This can be especially important for parents who’ve just lost Medicaid and are still emotionally adjusting to being uninsured for the first time. They may be fearful of hidden costs or skeptical of anything that sounds too good to be true. Transparent pricing helps build trust.
And importantly, this approach doesn’t undercut our membership model. In fact, we can and should price nonmember visits higher than the monthly cost of membership, preserving the incentive for families to enroll if they foresee more frequent needs. This pricing structure also allows us to cover our time, expertise, and access to ancillary services.
Flat-fee visits also give us the chance to do what we do best as DPC doctors: act as guides through the often-inaccessible healthcare system. We can refer families to low-cost imaging centers, independent labs, or community health clinics for services we don’t offer in-house. And because we’re not walled off by insurance contracts, we tend to know the most affordable and reliable cash-pay options in our areas.
This kind of visit may be the only pediatric care some families receive in a year—and we can make it count.
2. Offering Discounted Memberships to a Limited Panel
💡 Sustainable generosity with clear boundaries
Another option is to offer a discounted membership rate to a limited number of families who wouldn’t otherwise be able to access DPC care. Because we control our overhead and make our own rules, we can build in margin for compassion without threatening the viability of our practice.
This doesn’t have to be a sweeping policy—it can be a thoughtful, limited offering. For example, you might reserve 5–10% of your total panel for sliding-scale or sponsored memberships. Or you might allocate a fixed number of scholarship spots that renew every 6–12 months.
Offering this kind of tiered membership gives families the benefit of continuity, relationship-based care, and same-day access, which can be transformative—especially for those managing chronic conditions or behavioral health concerns.
What matters most here is clarity. Be transparent about the availability of these discounted spots and set clear expectations around re-evaluation. It can also be helpful to partner with a local community organization or school nurse who can help discreetly identify families in need of such support.
Even a handful of spots can make a difference—and can serve as a meaningful expression of our values.
3. Creating a Community Sponsorship Fund
💡 Let patients with means support those without
Some of our member families are in a place where they want to help. They know they’ve found something special in your practice, and they’re grateful. Many would jump at the chance to pay it forward—if given a clear, trustworthy mechanism for doing so.
One option is to create an informal care fund—essentially a pool of money contributed by existing members to help cover the membership or visit fees of another child in the community. These donations can be one-time, monthly, or tied to specific campaigns (e.g., “Back-to-School Sponsorship Drive”).
Unfortunately, due to the complexity of U.S. tax law, these contributions are unlikely to qualify as charitable donations without creating a formal nonprofit. But if you’re transparent about this from the outset, many families may still be happy to participate.
You could keep it simple: add a checkbox to your intake form or portal saying, “Would you like to contribute $10/month to help sponsor care for another child?” Or you could create a gift card system where families can prepay for a visit that will be used anonymously for someone in need.
Some practices have even partnered with local civic or religious groups to administer these funds on behalf of the practice, offering a bit more infrastructure while maintaining flexibility.
Even small acts of generosity—when multiplied—can create access for children who would otherwise go unseen.
4. Engaging in Local Advocacy and Policy
💡 Be part of the broader conversation
Finally, don’t underestimate the power of your voice outside your clinic walls. As Medicaid disenrollment ripples through the country, each state will face the challenge of figuring out how to meet the needs of its newly uninsured citizens. This moment presents an opportunity for innovation—and DPC pediatricians should be at the table.
We can advocate for flexible healthcare solutions that incorporate the DPC model as part of a broader safety net. For example, in some states, there may be legislative interest in creating health access vouchers, or in recognizing DPC practices as qualified providers for certain public programs. Others may explore public-private partnerships that bring together community clinics, nonprofits, and cash-pay practices in new ways.
Attending town halls, joining local physician associations, or simply meeting with your state representative can help put DPC on the radar. We bring something few others can offer: real data, real experience, and real relationships with the families who are directly impacted by these policy changes.
If DPC is going to be part of the future of equitable, child-centered care, we need to be willing to show up, speak up, and share what’s working.
Moving Forward with Compassion and Creativity
The loss of Medicaid for 12 million Americans is not a small shift. It’s a seismic disruption with real consequences for the most vulnerable among us. And while we cannot solve this crisis alone, we can be a meaningful part of the safety net—if we’re willing to flex, adapt, and lead with compassion.
We don’t need to abandon the membership model to serve these families. We just need to offer a few well-designed alternatives—flat-fee visits, limited discounted memberships, community sponsorships—and be ready to collaborate with others doing the same.
This is one of those moments where DPC can shine not only as a physician-centered model, but as a child-centered one. Let’s keep building solutions that honor our values, sustain our practices, and ensure that no child is left without care just because their insurance status changed.
