Free clinic marketing: no-cost claims, volunteers and donor appeals

A free or charitable clinic markets to three audiences at once. Patients need to know the care costs nothing or very little and how to get it. Volunteer clinicians want to know what is expected of them and what liability protection applies. Donors want to know where their money goes and what they can deduct. Each audience has its own federal rules, and the words that work for one can mislead another. This guide covers what the federal free clinic definition says, how to describe malpractice coverage for volunteers without overstating it, how to make no-cost claims accurate, what the IRS expects from donation requests, and where HIPAA draws the line when a clinic asks its own patients for support.

Two related topics have their own guides and are not repeated here. Federally funded health centers, sliding fee discounts and the no one is turned away wording are covered in our guide to community health center marketing. Outreach to people enrolled in Medicaid, including gifts and managed care plan rules, is in our guide to marketing to Medicaid patients. For asking patients about food, housing and transport needs, see social needs screening outreach.

What federal law means by a free clinic

The term has a specific meaning in the Public Health Service Act. Under 42 U.S.C. 233(o)(3)(A), a free clinic is a health care facility operated by a nonprofit private entity that meets three requirements. It does not accept reimbursement from any third-party payor for the health services it provides there, including insurance, health plans and federal or state health benefits programs. It either does not impose charges on the individuals it serves or imposes a charge according to the individual’s ability to pay. And it is licensed or certified under applicable law for the health services it provides. Under 233(o)(3)(B), the entity may accept voluntary donations for its services.

That definition shapes the copy. A clinic that bills insurance or Medicaid for its services does not fit the definition, and a clinic that charges by ability to pay is not free to every patient. Use the word free only for what is free in practice, and describe any charge for what it is. If your clinic relies on the federal free clinic program described below, check with counsel before any page invites patients to use their insurance, since the program conditions turn on not accepting third-party payment.

Make no-cost claims accurate

Section 5 of the FTC Act, 15 U.S.C. 45, prohibits deceptive acts or practices, and 15 U.S.C. 52 prohibits false advertisements likely to induce the purchase of devices or services. A no-cost claim is a claim about price, and it has to be true for the people the ad reaches.

The FTC guide on the use of the word free, 16 CFR 251.1, is written for offers tied to a purchase, but its disclosure rule is a useful test for any free offer. Under 251.1(c), all the terms, conditions and obligations on which receipt of the free item depends should be set out clearly and conspicuously at the outset of the offer, and a footnote reached through an asterisk is not regarded as disclosure at the outset. For a clinic, the conditions that matter are eligibility rules such as income, residence or lack of insurance, services that are not offered, outside costs such as lab work, imaging or prescriptions that the clinic does not cover, and any charge by ability to pay. Put them next to the word free, not on a separate page.

Donations need the same care. The statute lets a free clinic accept voluntary donations. Keep that word true in practice: a donation request at the front desk that reads like a fee, or a suggested amount printed on the intake form without saying it is optional, can leave a patient believing they must pay. Say plainly that care does not depend on a donation.

Federal liability coverage for volunteer clinicians

Volunteer recruitment pages need to answer a clinician’s first question: what happens if a patient is harmed. Under 42 U.S.C. 233(o)(1), a free clinic health professional providing a qualifying health service, and an officer, governing board member, employee or contractor of a free clinic providing services for the clinic, is deemed to be an employee of the Public Health Service for purposes of that section, subject to the conditions in the subsection. Under 233(a), for a person deemed a Public Health Service employee, a claim for personal injury from medical, surgical, dental or related functions is brought against the United States under the Federal Tort Claims Act provisions of title 28, and that remedy excludes other civil actions against the individual for the same matter. The conditions for free clinic volunteers are specific.

• Sponsorship and a determination. Under 233(o)(5)(C), a health care practitioner is a free clinic health professional only if the clinic sponsors them, which means the clinic submits an application to the Secretary and the Secretary determines the practitioner is deemed a Public Health Service employee. Under 233(o)(5)(D), coverage applies to acts or omissions on or after the date of that determination.
• Where the service happens. Under 233(o)(2)(A), the service is provided at the free clinic or through offsite programs or events carried out by the free clinic.
• No payment. Under 233(o)(2)(D), neither the practitioner nor the clinic receives compensation for the service from the patient or from any third-party payor. The practitioner may be repaid by the clinic for reasonable expenses, and the clinic may accept voluntary donations.
• Written notice to the patient. Under 233(o)(2)(E), before the service is provided, the practitioner or the clinic gives the patient written notice of the extent to which the practitioner’s legal liability is limited under the subsection, or as soon as practicable after an emergency. For a minor or a legally incompetent patient, the notice goes to a legal guardian or other person with legal responsibility.
• A current license. Under 233(o)(2)(F), the practitioner is licensed or certified under applicable law for the service at the time it is provided.
• The clinic itself. Under 233(o)(5)(B), the subsection may not be construed as deeming any free clinic to be an employee of the Public Health Service.

So a recruitment page that says all our volunteers are federally covered, or volunteer with no liability risk, says more than the statute does. Accurate wording reads like this: we apply to HHS to have sponsored volunteer clinicians deemed Public Health Service employees for malpractice purposes; coverage starts on the date HHS makes that determination and applies only when the program conditions are met. Ask your clinic’s counsel to review the wording, and keep the patient notice in the intake packet, not only on the website.

Patient-facing pages should also avoid suggesting that deemed status is a federal endorsement of the clinic or its clinicians. It is a liability arrangement. Under 15 U.S.C. 45, a claim that the government approves or stands behind a clinic’s care would need to be true.

Volunteers without deemed status

Volunteers who are not deemed, and volunteers in roles outside the federal program, may fall under the federal Volunteer Protection Act. Under 42 U.S.C. 14503(a), a volunteer of a nonprofit organization is not liable for harm caused by an act or omission on behalf of the organization if four conditions are met: the volunteer acted within the scope of their responsibilities; they were properly licensed, certified or authorized where that is appropriate or required; the harm was not caused by willful or criminal misconduct, gross negligence, reckless misconduct or conscious, flagrant indifference to the safety of the person harmed; and the harm was not caused by operating a vehicle for which the state requires a license or insurance.

Three limits belong in any recruitment copy that mentions the Act. Under 14503(d), it does not affect the liability of the organization itself. Under 14503(e), states may attach conditions such as risk management procedures, mandatory volunteer training or a financially secure source of recovery. Under 42 U.S.C. 14502, the Act does not preempt state laws that give volunteers additional protection, and a state may elect that the Act does not apply to certain state court actions where all parties are citizens of the state. The definition of volunteer in 14505(6) also excludes a person who receives compensation, other than reasonable reimbursement or an allowance for expenses actually incurred, or anything of value in lieu of compensation above the limit set in that section. A stipend can change a volunteer’s status, so check before advertising one.

Asking for donations: what the IRS expects

IRS Publication 1771 explains the federal substantiation and disclosure rules for charities that receive tax-deductible contributions. Three of them affect how a clinic writes its appeals.

• Acknowledgments. A donor cannot claim a deduction for a single contribution at or above the threshold set in the publication without a contemporaneous written acknowledgment from the charity, and the charity must assist the donor by providing one. The acknowledgment states the amount or describes noncash property, and states whether the clinic provided goods or services in return. If it did, the acknowledgment includes a description and a good faith estimate of their fair market value.
• Quid pro quo disclosure. When a donor pays above the threshold in the publication partly as a contribution and partly for goods or services, such as a gala dinner ticket, the clinic must provide a written disclosure statement. It tells the donor that the deductible amount is limited to the excess over the value of what they received and gives a good faith estimate of that value. It is made with either the solicitation or the receipt of the contribution, and it must be made in a way likely to come to the donor’s attention. The publication notes that small print within a larger document might not meet this requirement. A penalty applies to charities that do not meet the disclosure requirement unless the failure was due to reasonable cause.
• Volunteer time. Publication 1771 says donors generally cannot deduct the value of services they give to a charity, though in narrow circumstances they may deduct unreimbursed expenses. Do not tell volunteer clinicians that their donated hours are tax deductible.

Event invitations, gala pages and donation buttons are where these rules surface. If an event ticket includes a meal or entertainment, state the estimated value on the invitation and the ticket page, not only in a later receipt. Charitable solicitation registration and disclosure rules for donation appeals are set state by state, so check with your state charity regulator before an online campaign reaches donors in other states.

Contacting patients: outreach, fundraising and stories

A free clinic that is a covered entity under HIPAA follows the same rules as any other provider when it uses patient information in outreach. Three situations come up.

Telling patients about your own services. Under the definition of marketing in 45 CFR 164.501, a communication that describes a health-related product or service provided by the covered entity making the communication is not marketing, unless the covered entity receives financial remuneration for making it. A message to existing patients about a new dental day, an eye clinic or extended hours fits that exception. A message promoting an outside company’s product, paid for by that company, is marketing and needs written authorization.

Asking patients for donations. Under 45 CFR 164.514(f)(1), a covered entity may use limited protected health information to raise funds for its own benefit without authorization: demographic information such as name, address, other contact information, age, gender and date of birth, dates of health care, department of service, treating physician, outcome information and health insurance status. Four conditions come with it under 164.514(f)(2). The notice of privacy practices must include the fundraising statement required by 164.520(b)(1)(iii)(A). Every fundraising communication must give a clear and conspicuous way to opt out of further fundraising communications, without undue burden or more than nominal cost. Treatment cannot be conditioned on the patient’s choice. And the clinic may not send fundraising communications to a patient who has opted out.

Telling a patient’s story. A story that names or identifies a patient in a donor appeal, a gala video or a grant report shared publicly goes beyond the information listed in 164.514(f)(1). Get the patient’s written authorization under 45 CFR 164.508 first, and let the patient see the final version. The same applies to photos taken at clinic events.

Illustration: two ways to write a free clinic page

Illustration: [Clinic name] runs a page that says Totally free health care for everyone, no questions asked, with volunteer doctors who are fully federally covered. A footnote mentions income limits and lab fees. The donation box at check-in carries a sign with a suggested amount, and the year-end appeal tells a patient’s story by first name with a photo, sent to every patient on file with no opt-out. The page hides eligibility conditions, overstates the volunteers’ coverage, makes a donation look required and uses patient information beyond what the fundraising rule allows.

Illustration: [Clinic name] runs a page that says Free primary care for adults in [county] without health insurance. The same paragraph explains how to check eligibility, which services are offered, and that outside lab and imaging costs are not covered. A separate volunteer page says the clinic applies to HHS for sponsored clinicians to be deemed for malpractice purposes and explains when coverage starts. The donation page says care never depends on a gift, the gala page states the estimated value of the dinner, and patient fundraising letters carry a simple opt-out. Patient stories appear only with signed authorization.

Checklist

• Compare your clinic’s operations with the free clinic definition in 42 U.S.C. 233(o)(3) before using the term in federal program materials.
• Put eligibility rules, services not offered and outside costs next to every no-cost claim.
• Describe any charge by ability to pay as a charge, and keep donations voluntary in wording and practice.
• Describe volunteer malpractice coverage as conditional on an HHS determination and the program conditions.
• Keep the written liability notice for patients in the intake packet.
• Check state conditions before mentioning the Volunteer Protection Act, and do not promise volunteers zero liability.
• Send written acknowledgments to donors and state the estimated value of event benefits on the invitation.
• Do not describe volunteer hours as tax deductible.
• Add the fundraising statement to your notice of privacy practices before asking patients for donations, and include an opt-out in each appeal.
• Get signed authorization before any patient story or photo appears in a donor appeal.

Free clinics that offer HIV testing can build their testing pages, self-test kit offers and reminder texts on our guide to HIV testing and care outreach, which covers window periods, follow-up tests and the federal undetectable wording.

How we help

We build websites, local search, Google Ads and AI front desk tools for independent practices and health businesses. For a free or charitable clinic, that means a website with eligibility and cost information next to every no-cost claim, separate pages for patients, volunteers and donors, search content that helps people find the clinic, and intake flows that ask eligibility questions before booking. We do not decide whether your clinic or a volunteer qualifies for federal coverage, what a donor may deduct or what your state requires; HHS, the IRS, your state and your counsel do. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal, tax or medical advice. We do not sell lead lists and we do not pay for referrals. For the wider rules, see our healthcare marketing rules hub.

Sources

• 42 U.S.C. 233: Civil actions or proceedings against commissioned officers or employees (subsection (o), free clinics)
• 42 U.S.C. 14502: Preemption and election of State nonapplicability
• 42 U.S.C. 14503: Limitation on liability for volunteers
• 42 U.S.C. 14505: Definitions
• IRS Publication 1771: Charitable Contributions, Substantiation and Disclosure Requirements (Rev. 11-2023)
• 45 CFR 164.501: Definitions (marketing)
• 45 CFR 164.508: Uses and disclosures for which an authorization is required
• 45 CFR 164.514: Other requirements relating to uses and disclosures (fundraising, paragraph (f))
• 45 CFR 164.520: Notice of privacy practices for protected health information
• 16 CFR 251.1: Guide concerning use of the word Free and similar representations
• 15 U.S.C. 45: Unfair methods of competition and unfair or deceptive acts or practices
• 15 U.S.C. 52: Dissemination of false advertisements

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