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Health center advocacy group launches legal action over ‘inadequate’ Medicaid reimbursement
NORTH CANAAN — The new federally qualified health center in North Canaan has treated more than 1,000 patients since opening its doors last summer to strong demand in the Northwest Corner. However, operators of that facility, and others like it in Connecticut, said they are facing a “serious financial crisis” because Medicaid reimbursements have failed for decades to cover the actual costs of providing essential services.
In response to the longstanding problem, the not-for-profit Community Health Center Association of Connecticut has filed a Declaratory Ruling Request with the state Department of Social Services regarding that agency’s legal obligations for setting and revising Medicaid reimbursement rates for the state’s federally qualified health centers, also referred to as FQHC’s.
The legal action follows more than 18 months of administrative rate requests and unsuccessful negotiations with DSS, according to a statement issued by the association on March 11, which noted:
“After great effort made by the FQHC’s to work with DSS and reach resolution, the offer made by DSS offers inadequate rate adjustments, failing to address the FQHCs’ financial concerns, and requires them to surrender their due process rights under the law.”
Joanne Borduas, who chairs the association’s board of directors, said DSS’s offer was for “less than reasonable costs and came with unacceptable policy stipulations that we would be made to agree to in order to get the grossly inadequate proposed rate rebasing, which would be paid over a four-year schedule.”
“Our request to DSS was clear,” said Borduas, who also serves as CEO of Community Health and Wellness Center of Greater Torrington which also has centers in North Canaan and Winsted.
“We want DSS to follow the Federal law and compensate us accordingly so we can continue to care for our most vulnerable populations, and we need that to happen now because our 440,000 patients, 264,000 of whom are enrolled in Medicaid across our FQHC network, need us.”
Borduas noted that the decision to move forward comes after years of CHC/ACT and health centers making “good faith efforts” to get this important process changed to comply with federal law.
She said the financial strain on the state’s health centers has reached a point where vital services are at severe risk, including those under the umbrella of Community Health and Wellness Center.
“As of now we continue to operate without additional cuts or layoffs, however, it is difficult to fill vacant positions. It is difficult to recruit in this environment. We need to stay competitive with workforce wages in order to recruit providers, and that is difficult to do.”
She added that “We cannot provide raises for our staff who are extremely valuable, care about our mission and the people we serve and who work hard every day, and we cannot think of expanding services to meet community needs because there is an associated cost.”
In response to Declaratory Ruling Request filed with the state Department of Social services, that agency’s spokesperson, Christine Stuart reported on March 13 that the department acknowledges receipt of the request and “shall be analyzing and responding in due course and in compliance with statutes pertaining to petitions of state agencies for a declaratory ruling.”
DSS 2024 report: state’s method cost effective
In 2024, the Department of Social Services issued a “final report” into the state’s Medicaid program which found the state’s operating methods to be “cost-effective and high-performing, while identifying some areas where further improvements can be made.”
The analysis, which was conducted by Accenture and Manatt at the request of the state, evaluated the current program’s cost efficiency, quality and access, “while also exploring whether other models of operations could be an improvement over the current system, which operates through an administrative services organization model.”
The report found that Connecticut’s program “stands out as a model of cost-efficiency, with per capita spending 14% lower than the average of most northeastern states, and administrative costs significantly lower than managed care states (3.8% vs. 9.4%).”
The DSS “final report” further noted: “It also shows that the state is meeting national benchmarks to provide reliable service delivery while maintaining fiscal responsibility and is performing above the median on approximately 70% of national adult and child quality measures,” and suggests other states “could benefit from reviewing Connecticut’s program as a blueprint to achieve similar results.”
The Community Health Center Association of Connecticut is not convinced.
It maintains that as the state’s health centers begin to “suspend vital services, freeze hiring and deplete their cash reserves,” they have been left with no choice other than to pursue legal remedies. “They are not seeking special treatment, but simply asking DSS to follow the law as written.”
CHWC’s dental services ‘not sustainable’
Speaking to her experience as CEO of Community Health and Wellness Center of Greater Torrington, Borduas explained that adjusted rates for medical and mental health were received by the state Department of Social Services for adding the North Canaan Health Center.
“Medical rates per our 2024 cost per Medicaid patient leaves a $122.48 gap between reimbursement and cost per patient. This difference,” she noted, “is what we lose for every patient enrolled in Medicaid that we care for.”
Behavior health is better compensated, said Borduas, but dental, which was offered at Community Health and Wellness Center’s Torrington and Winsted locations, is compensated $137.15 below 2024 costs and as a result, “CHWC has had to unfortunately suspend our dental services having incurred $350,000 in losses for restorative care in 2024.”
That included services like dentures, bridges, crowns and root canals, and an analysis of full services is in process and will likely yield greater losses, said Borduas. “The low Medicaid reimbursement that applies to 60% of our patients, the large gaps in payments are simply not sustainable.”
440,000 patients served by FQHC’s
Connecticut’s federally qualified health centers provide critical medical, dental and behavioral healthcare to more than 440,000 of the state’s neediest and most marginalized residents.
On average, 60% of patients at the statewide centers have Medicaid coverage, where their care cannot be denied, according to the association.
“The FQHC’s need a rate-setting process that makes sense and follows the law, to ensure that all Connecticut residents, regardless of their income or background, can continue to access the care they need,” added Borduas.
Shawn K. Frick, CEO of the Community Health Care Association of Connecticut, noted that “The Connecticut legislature has been consistently supportive of our work, but our attempts to address this issue through the legislative process have been consistently opposed by the administration.”
Employment Opportunities
LJMN Media, publisher of The Lakeville Journal (first published in 1897) and The Millerton News (first published in 1932), is a 501(c)(3) nonprofit news organization.
We seek to help readers make more informed decisions through comprehensive news coverage of communities in Northwest Connecticut and Eastern Dutchess County in New York.
We currently have the following positions open.
Audience Development Editor
The Lakeville Journal and The Millerton News seek an Audience Development Editor to expand and engage our readership across digital platforms. In this role, you will select stories for wider distribution, craft and write engaging promotions, and leverage social media and other digital channels to help inform and educate our communities and broaden our reach.
Working closely with editorial and business teams, you will analyze audience data to refine strategy, identify and execute new growth opportunities, and continually enhance best practices for attracting and retaining readers. If you thrive in a collaborative, fast-paced environment and have a strong interest in connecting communities through local journalism, please email your resume and cover letter to James Clark, publisher@lakevillejournal.com.
Full-time Reporter
The Millerton News is seeking a news reporter to cover Harlem Valley towns, including Millerton/North East, Amenia, Millbrook/Washington and Pine Plains and school districts.
Are you interested in your local news scene? Here is a chance to report on community news, business news, the environment, government, police and all the issues that affect the lives of Millerton News readers.
Writing skills and basic knowledge of how New York government functions are a must.
Email Resume and Writing Samples to James Clark, publisher@lakevillejournal.com.
LJMN Media is an equal opportunity employer.
North Canaan Town Hall
NORTH CANAAN — “If you’re not coming to work, why would you get paid?”
Selectman Craig Whiting asked his fellow selectmen this pointed question during a special meeting of the Board on March 12 discussing Town Clerk Jean Jacquier, who has been absent from work for more than a month. She was not present at the meeting.
“There’s been no reasoning, no explanation, no anything as to why you’re not here,” said Whiting.
Jacquier has worked in Town Hall since 1993 and was first elected town clerk in 2017. Conflict arose in 2023 when several complaints of misconduct were lodged against Jacquier.
First Selectman Brian Ohler filed the complaints to the Attorney General’s office, which included, among others, improper security of the vault, posting candidate campaign material in Town Hall and untimely stamping documents. The subsequent investigation found misconduct on the part of Jacquier in each of these three areas but took no punitive action.
Jacquier filed suit against the Town of North Canaan to recoup $15,000 in legal fees accrued during the investigation. The town motioned to strike the case, which was granted by Hon. Walter Menjivar at Torrington Superior Court on Jan. 28, 2025.
Ohler said Jacquier stopped coming to work after that ruling and has not been in contact since Feb. 4. During her absence, she continued to receive pay checks.
Assistant Town Clerk Marilisa Camardi had been filling in part time but was away the first week of March. To keep the office open, Executive Assistant Paul Mattingly was appointed assistant town clerk by the Board of Selectmen at its March 3 meeting. The two will work together until the next election or until Jacquier returns.
“It’s an essential function of the town to have that office open,” said Whiting.
Last week, Jacquier told The Lakeville Journal her recent absence is due to harassment and antagonism in Town Hall, which is taking a toll on her health.
Jacquier’s attorney, Jeffrey Mirman, communicated with the selectmen to request the meeting regarding her salary be open to the public as opposed to executive session. The selectmen complied.
Selectman Jesse Bunce said he has been in contact with Jacquier and he presented a letter from her to his fellow selectmen during the March 12 meeting. Ohler stated he could not verify the source of the letter, but he would forward it to the town attorney. The letter was not read into the record.
Ohler made a motion to suspend Jacquier’s salary until she returns to work. Whiting seconded. The motion passed 2-0 with Bunce abstaining.
Patton Oswalt
Comedian and actor Patton Oswalt is well known for his standup routine as well as his roles in film and television. Oswalt made his acting debut in the Seinfeld episode, “The Couch” and has appeared in “Parks and Rec,” “Reno 911,” “Modern Family,” and “A.P. Bio.” He has done voice-over work for movies including “Ratatouille,” and had his own Netflix special. “Patton Oswalt: Talking for Clapping.”
Oswalt will present his unique brand of humor in a show titled “Effervescent” at the Mahaiwe Theater in Great Barrington, Massachusetts, on Saturday, March 22. With sardonic style, he makes keen observations about American culture and gives biting critiques of the current administration.
In a recent interview with the Lakeville Journal, Oswalt said,
“Things are so dark. It feels like they’re depending on craziness to bulldoze their stuff in. So, I’m using absurdity and almost surrealism to battle it. I also realize that when you’re coming into a show like this, you want some escape. It’s certainly not the whole set.”
“Politics used to be about getting stuff off of your plate so that you can live. Now it wants to dominate the news cycle and everyone’s emotions. So, in a weird way, comedy is an act of defiance,” he added.
Comedians like Richard Pryor and, more recently, Dave Chappelle pushed boundaries of taste and limits. George Carlin was quoted as saying, “I think it’s the duty of the comedian to find out where the line is drawn and cross it deliberately.” So, how far is too far and who decides?
“When you became a comedian, you signed up for having the ground continually cut from underneath you. That’s the deal you made. Comedy is an ephemeral art that doesn’t age very well, and you have to embrace that,” Oswalt said.
In recent years, political correctness has restrained the growth of comedy and free speech. Today, the pendulum seems to have swung in the opposite direction to the far right.
So, are there funny right-wing comedians?
“There have been comedians who are more conservative in their outlook, but they don’t make it their identity. I know some comedians who are right wing but are still good at doing comedy. It’s not that right wing comedians aren’t funny, it’s that there’s a lot of right wing people who think that they deserve to be funny. The failed comedian to right wing grifter pipeline is pretty short,” Oswalt said.
And how about politicians who think they’re funny and use their pulpit to bully?
“You have to know how to be funny. Fast forward to people who just want to break boundaries and are just cruel. They don’t understand what comedy is. The nightmare that Elon is putting us through is all because he wants to be cool, and he’s not. So, he’s gonna blow up the world. That’s an oversimplification, but it’s also accurate. He’s like the kid whose dad owns the rec-center and thinks that all the kids should like him, but he’s obnoxious and mean so no one wants to hang out with him,” Oswalt said.
Like many comedians, Oswalt tests out new material in small clubs and open mics. When asked if he receives any pushback on his politically pointed jokes, Oswalt said, “When you go out in the world, people are just kind of the same. I’m never saying anything that’s unreasonable, even when I’m making fun of stuff like religion, conservatism and especially, fascism. It’s not in a way that people can say, ‘No, wait a minute, fascism’s good!’ unless they’re just trolling.”
At this point in his career, Oswalt has developed his own fans who come to see him. He wins crowds over by staying welcoming of everyone.
“I’m a big believer that if you treat audiences with respect, they’ll come and meet you. I’m always excited to be in front of people,” he added.
With surprise as a key element to any new show, Oswalt won’t divulge the nature of his new act, but he guarantees it will feature new material.
“Look at how accelerated the news has gotten. Who knows what I’ll be talking about by the time I get to Great Barrington!” he said.
For tickets to Patton Oswalt’s show, go to: mahaiwe.org
