The Cleveland Ibn Sina Clinic in Parma seems plain in comparison with its host building, the Islamic Center of Cleveland, with its towering white minarets.
The only outward sign the free clinic exists is some plain lettering on a side door.
Inside, though, the scene is bustling. The waiting room is full of patients seeking medical care for everything from pediatrics to podiatry to renal care.
Crystal Turner of Cleveland says she lost her job a few months ago 鈥� and with it, her health insurance. Under her former plan, she had coverage for medications related to her Type 1 diabetes, asthma and high blood pressure.
"If I don't have my insulin within a day or two, I'm in the hospital," said Turner. "You know, and I鈥檝e had that happen. I've been in ICU. I don't want to do that again."
She says government programs such as Medicaid have been hard to access. She's been denied previously and has an appeal pending, she says. Until then, the free clinic helps her avoid hospitalization or worse.
"It's been a lifesaver," Turner says.
Charity care needs rising
Parma and other nearby suburbs are near the epicenter of a rising need for charity care in southwest Cuyahoga County. Although they have long known as a bastion for middle-class families with steady jobs and steady insurance coverage, the reality on the ground is changing, says Ramona Brazile, executive director of government and community relations at the MetroHealth System, Cuyahoga County鈥檚 safety net hospital.
"What we saw in our own patient population is that some of the zip codes in the cities that have higher charity care costs are in the southwest suburbs of Cuyahoga County," Brazile says.
She says the hospital system is seeing charity care costs rise to more than $15 million a year in suburbs such as Parma, Parma Heights and Middleburg Heights 鈥� some of the largest numbers in all of Cuyahoga County. The steepest rise was in the middle-class southwest Cleveland neighborhood of Old Brooklyn.
The high numbers in those areas may be due in part to MetroHealth's historically strong association with the southwest part of the county. Its main campus is southwest of Downtown Cleveland, and some of its longest-established care centers are in southwest Cleveland and adjacent suburbs, though the health system has expanded its East Side presence in recent years.
Still, Brazile believes additional factors may be at play.
"It caught me by surprise," says Brazile. "We often think about the city center or the cities touching the city center where we might see lower incomes, but those might be areas where more people are qualified to be on something like Medicaid. And in another community, folks (who) make a higher income, they may not be Medicaid eligible.鈥�
At the same time, she says, those workers may not be making enough to afford to buy into their employers' plans or buy their own coverage if they鈥檙e self-employed. Or they could be a gig employee working for a company such as Uber, where health insurance may not be offered to all workers or is unaffordable.
"So in some ways there might be folks who are kind of falling through a crack," says Brazile.
She says the system is doing targeted outreach on the county's southwest side to spread the word about its charity care services.
Falling through the cracks
The situation Brazile describes 鈥� of middle-income people falling through the cracks 鈥� is similar to what the Cleveland Ibn Sina Clinic is seeing, says Brenda Qolek, the clinic鈥檚 executive director.
"What we mostly see is people coming in and they don't have insurance, they can't get it," says Qolek. "And this is kind of the last place for them to go."
The clinic offers medical supplies provided via grants from the Charitable Health Networks and MedWish organizations. Physicians offer their services for free. Qolek says she has seen a steep increase in usage since the clinic opened in 2019, especially recently.
"In the past two years we've had almost a 100% increase in patient volume," said Qolek. "And right now we are on the verge of definitely surpassing those numbers for 2026."
Recent data from a shows nationwide, the amount hospitals spent on unpaid and free care rose 32% in 2025 compared with 2022. MetroHealth鈥檚 own charity care expenditure nearly doubled from $44.5 million in 2023 to $84.1 million for the same quarter of 2025.
Those increases raise questions for charity care providers about how long the current situation is sustainable 鈥� especially as further restrictions on Medicaid coverage and a stagnant job market are expected to leave .
