BEND, Ore. -

Under the Affordable Care Act, millions of people who previously had no insurance now have access to health care.

In Oregon, over 154,000 people have signed up for Cover Oregon. The new influx of patients means strategic planning for providers such as Mosaic Medical.

"We've had 4,000 new Medicaid patients, or OHP (Oregon Health Plan) patients assigned to our clinics," Elaine Knobbs, Mosaic's director of programs and development, said Tuesday.

Mosaic Medical was prepared.

"We knew we were going to get that surge, and actually from the federal government even got extra grant funding to be able to have enrollment specialists to help our uninsured patients and community members to sign up for OHP," said Knobbs.

While Mosaic Medical is hiring new staff to handle the increased volume of patients, on the other side of town, Volunteers In Medicine is facing the opposite problem.

The clinic, created to help the uninsured get needed medical care, served around 2,000 patients last year. Since the Affordable Care Act began implementation, that number has dropped to just 500.

"We anticipate we'll probably go a little bit lower before it goes back up with our new programs," said Kat Mastrangelo, executive director of Volunteers In Medicine.

Volunteers in Medicine, or VIM, typically only serves the uninsured. Now they are looking into alternative ways of providing service, as more and more Oregonians have health insurance.

"And then we're looking at things that aren't covered -- things like dental care or vision care, things that we already do," said Mastrangelo.

But Volunteers In Medicine is here to stay. The clinic offers need-based care, and the pre-screening now includes helping those that qualify to apply to Cover Oregon.

"We have trained people, trained volunteers who can help you walk you through this process and help you find out where you need to be," said Mastrangelo.

Both Mosaic Medical and Volunteers In Medicine help members of the community with their Cover Oregon applications. For details, visit their websites: Mosaic Medical: http://mosaicmedical.org/ Volunteers In Medicine: http://www.vim-cascades.org/