State awards community health centers $80 million Medicaid funding boost

“The fact that we have reached an agreement with the state’s Department of Social Services is a step in the right direction.” — Joanne Borduas, CEO, Community Health and Wellness Center

NORTH CANAAN — A network of 17 Federally Qualified Health Centers (FQHC) in Connecticut, including three in the Northwest Corner towns of North Canaan, Winsted and Torrington, will receive a long-awaited funding boost in Medicaid reimbursement rates to the tune of $80 million over the next three years.

In making the July 16 announcement, Governor Ned Lamont (D) and Connecticut Department of Social Services Commissioner Andrea Barton Reeves unveiled a three-year plan to boost rates for the centers that service 440,000 people across the state each year.

The decision follows more than 18 months of unsuccessful negotiations between an advocacy group representing Federally Qualified Health Centers and the state Department of Social Services (DSS) to boost reimbursement rates.

As a result of the long-standing stalemate, the not-for-profit Community Health Center Association of Connecticut, on behalf of the state’s 17 federally qualified health centers, had filed a Declaratory Ruling Request with DSS in March over its failure to comply with federal law to compensate the health centers appropriately.

That filing has since been withdrawn, reported Joanne Borduas, CEO of Community Health and Wellness Center, which operates facilities in Torrington, Winsted and North Canaan.

“The fact that we have reached an agreement with the state’s Department of Social Services is a step in the right direction,” said Borduas, who also chairs the Connecticut Health Center Association of Connecticut’s board of directors.

The state had a timeline of 90 days to respond to the Declaratory Ruling Request. “The next step could have led to a lawsuit,” noted Borduas. However, since an agreement was reached, the request, she said, was pulled on July 10 and is no longer in effect.

Borduas said the FQHCs serve the largest number of Medicaid patients in the state and Connecticut has had some of the lowest Medicaid rates compared to other states. “The bottom third nationally,” she noted.

“It has been difficult to maintain services and access for our community. Many of us have faced scaling back or eliminating services and have dealt with workforce reductions in an effort to keep our doors open and maintain our commitment to our patients and the communities we serve.”

As a result of the low Medicaid reimbursement rates, CHWC had to make the difficult decision to suspend dental services, said its CEO.

“Now that we understand what the new rates will be, we are able to go back and re-evaluate getting dental services back up and running, though on a smaller scale.”

Dental services, Borduas explained, are one of the highest cost services to run and to recruit for. “We will continue to evaluate business models that will contribute to appropriately addressing patient needs while ensuring financial sustainability.”

The agreement, she said, increases Medicaid rates over the next three years and “gets us to 2023 costs. It begins to close our payment gaps, which will contribute to our long-term financial stability and help us keep our doors open serving nearly 60 percent of the state’s Medicaid patients.”

The deal clarifies the process for these centers to request rate adjustments based on the scope of services they offer and authorizes collaboration between the state and the centers to develop alternative payment models.

“While Republicans in Congress are defunding Medicaid and raising health care costs for all Americans, here in Connecticut we are making key investments in primary care, dental and behavioral health,” said Lamont in making the announcement.

DSS Commissioner Reeves referred to the state’s FQHCs as “essential partners” in delivering high quality, affordable health care to all residents.

The plan, said Borduas, envisions a more systemic approach to future rate hikes to prevent stagnation of reimbursements as has happened in the past.

“Medicaid rates have not been rebased since 2007 for all core services of medical, dental and behavioral health, with the exception of those FQHCs who have submitted rate requests to DSS over the years for adding services that meet the state’s requirements for a rate increase,” she noted.

The new agreement, she said, “will certainly help close our payment gaps and make providing care to our most vulnerable populations, those that are insured by Medicaid in particular, more affordable,” said Borduas.

“We are hopeful that we can continue to work with DSS to ensure our Connecticut FQHCs are able to carry out their missions to create healthier communities for a long time to come,” added Borduas.

The agreement also changes the appeals process for FQHCs to align with other Medicaid providers beginning Jan. 1, 2027.

Shawn K. Frick, CEO of the Community Health Center Association of Connecticut, noted that “patients across the state will benefit from this investment in primary care.”