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Health center advocacy group launches legal action over ‘inadequate’ Medicaid reimbursement
Mar 13, 2025
An exam room at Community Health and Wellness Center in North Canaan.
Photo by Riley Klein
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.”
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Employment Opportunities
Mar 13, 2025
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.
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Dan Howe’s time machine
Mar 12, 2025
Dan Howe at the Kearcher-Monsell Gallery at Housatonic Valley Regional High School.
Natalia Zukerman
“Every picture begins with just a collection of good shapes,” said painter and illustrator Dan Howe, standing amid his paintings and drawings at the Kearcher-Monsell Gallery at Housatonic Valley Regional High School. The exhibit, which opened on Friday, March 7, and runs through April 10, spans decades and influences, from magazine illustration to portrait commissions to imagined worlds pulled from childhood nostalgia. The works — some luminous and grand, others intimate and quiet — show an artist whose technique is steeped in history, but whose sensibility is wholly his own.
Born in Madison, Wisconsin, and trained at the American Academy of Art in Chicago, Howe’s artistic foundation was built on rigorous, old-school principles. “Back then, art school was like boot camp,” he recalled. “You took figure drawing five days a week, three hours a day. They tried to weed people out, but it was good training.” That discipline led him to study under Tom Lovell, a renowned illustrator from the golden age of magazine art. “Lovell always said, ‘No amount of detail can save a picture that’s commonplace in design.’”
Training led to work. Early on, while still a graduate assistant at Syracuse University, Howe began painting portraits — chancellors, deans, and, later, an endless roster of chairmen and medical executives. It paid well, but Howe found that the job of a portraitist, even a highly skilled one, is ultimately limited. “They’re just the same thing, you know, just a guy in a suit. Later, maybe it was a girl in a suit,” said Howe.
Between commissions, he painted for himself. This show is a gathering of those moments — studies of his wife and daughters, mythic scenes painted for libraries, and Star Wars covers from his time living near Dark Horse Comics in Oregon.A large painting, originally commissioned for a library, shows a girl in an attic opening a trunk, imagination spilling into the room. The library remodeled and sent the painting back. Now it anchors a wall in the show.
Dan Howe’s work reflects the Brandywine School’s devotion to craftsmanship, narrative depth, and a luminous, almost nostalgic realism. Like Howard Pyle and N.C. Wyeth before him, Howe builds scenes using light and composition to evoke mood and meaning. His meticulous brushwork and layering techniques nod to the tradition of classical illustration, yet his work diverges in its contemporary stillness. Of Norman Rockwell, Howe said, “He’s of my era, and our styles are similar. Of course Rockwell is Rockwell. I’ve got a little more painterly, Sargent-esque stuff running through mine.” The influence is there, not as mimicry, but as a quiet echo, refined through his own aesthetic language. “I’m an anachronism,” he said, without regret. His influences form a lineage of illustrators whose work once filled the pages of The Saturday Evening Post and Collier’s. They understood, as Howe does, that a painting must be more than accurate.“Mood is everything,” said Howe, drawing a comparison between two paintings in the show — a couple by a fire — to an old Star Wars concept painting. “Same color scheme. Different world. Mood is everything.”
Teaching remains a passion for Howe. When he and his family moved to the east coast from Chicago, Howe taught a series at the Norman Rockwell Museum called “Painting Like Rockwell,” something he hopes to revive. “I like beginners,” he said. “They don’t have bad habits yet.”
Howe also runs a summer figure drawing workshop at HVRHS with an old-school approach. “You’ve just walked into a time machine — this is art school, 1965. Three hours of drawing in the morning, three in the afternoon. No cell phones.” His methods may be antiquated but the results are living proof that some things are worth preserving. “Maybe this stuff is so old it’s new again,” he mused.
As he hung his pieces for this show, Howe said teachers stopped by, connecting his images to their own memories. “That’s a success,” he said. “If a picture makes someone feel something, then it’s done its job.”
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Jon Kopita reading between the lines at the David M. Hunt Library.
Natalia Zukerman
Jon Kopita’s work, with its repetitive, meticulous hand-lettering, is an exercise in obsession. Through repetition, words become something else entirely — more texture than text. Meaning at once fades and expands as lines, written over and over, become a meditation, a form of control that somehow liberates.
“I’m a rule follower, so I like rules, but I also like breaking them,” said Kopita, as we walked through his current exhibit, on view at the David M. Hunt Library in Falls Village until March 20.
In 2007, Kopita and his husband, Olaf, an architect, took a trip to The Vitra Design Museum outside of Basel, Switzerland. Kopita found himself infuriated by the pomp surrounding the collection of what were once utilitarian objects, now absurdly canonized. “The irony is that a lot of that furniture was designed to be mass produced, taking really good design and making it accessible to middle class people,” Kopita explained. “It wasn’t supposed to be something so special.” Upon returning home, Kopita began repeatedly writing, “I hate Vitra” on lined paper. Channeling his frustration, he wrote the simple statement 100 times and through the act, found a cathartic release. “It harkened back to when you’re in school and you have to write out, ‘I will not speak in class’ or something 100 times on the black board.” Except for Kopita, what was meant to be disciplinary was not only a contemplative practice, but a healing act.“For me, the experience of repetitive writing became meditative and cathartic, more of an exorcism of thoughts rather than something either punitive or tedious.”
His current show at the library includes work spanning a decade, with many of the pieces created during the COVID-19 pandemic. An educator for over 30 years, Kopita found he had time and space during the pandemic to really investigate his process and to create work in volume.“I did 40 works during the first 150 days,” he said. The early pieces were instructional in nature with words like “wash hands,” “social distancing,” and “zoom” but soon began morphing into existential inquiry —with questions like “is this all there is?” repeating like a dark mantra. Some are reminders of the stark political divisions that emerged during those days. There is a tribute to the Black Lives Matter movement with names repeated in grief: George Floyd and Breonna Taylor. The whole display, Kopita delights, demands something that feels almost radical in today’s digital age: slowness. “This is a difficult show because you really have to stop and process. It asks people to read.”
In many ways, Kopita has spent a lifetime questioning the boundaries imposed on him, both literal and figurative. “90% of going to school is a hazing system where you’re just learning how to write between the lines — these are the rules.” He felt the pressure of conformity from an early age. His own father had expectations for him: a stable corporate job, health insurance, a 401k. Kopita tried it for a year and a half.“It was like my boss was saying, ‘if you work really hard, you can have what I have.’” Kopita took one look at “what he had”— a suburban house, a company car —and thought, “Yeah, I don’t want this at all.” He moved to New York, got a job in a Soho gallery, and never looked back. “I know really well firsthand what it means to step across the line and try to do things differently and do things on your own terms.”
In his piece, “Transition,” Kopita grapples with the fluidity of identity, a structured yet random exercise where “he” gradually transforms into “she.”
“There’s so much going on right now with ideas of gender and what gender means, a kind of war on how people identify,” he said. “There are days where I’m 100% he, and then maybe there are days where I’m more she.” The work, much like his larger practice, is about change, about pushing against the expected, about honoring the beauty in what falls outside the lines.
Kopita is fascinated by the tension between order and deviation, by the way small shifts — whether in handwriting, identity, or thought — can carve out new landscapes. But for all its rigor, Kopita’s work is not about control. It’s about surrender. The act of writing, for him, is like a river cutting through rock, shaping itself as it moves. “I think of it as how the words carve up the paper. So, it actually becomes a three-dimensional exercise in my head at times.” It is discipline as liberation, structure as rebellion, a practice that turns the most mundane act — writing the same word over and over — into something sacred.
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