CANAAN — Mascoma Community Health Center’s medical provider will be ending services Oct. 31, the eve of its second anniversary in the Upper Valley.
The governing board of HealthFirst Family Care Center, which has provided primary care and behavioral health services in Canaan since November 2023, made the decision at a special meeting July 16 and announced it to the staff and the public on Tuesday.
The organization cited Medicaid reimbursement issues, federal funding changes, high operating costs and low patient volumes as reasons to end the services in a Tuesday news release.
“It’s a sad day for the community here in Canaan and the Mascoma Valley,” HealthFirst CEO Ted Bolognani said in an interview on Tuesday. “It’s been a struggle and who knows what the next chapter of this beautiful health center is going to be.”
HealthFirst is a federally qualified health center, or FQHC, with locations in Laconia and Franklin, N.H. The Canaan location at the corner of Roberts Road and Route 4 shares space with an independent dental clinic operated by the nonprofit Mascoma Community Healthcare. The Mascoma nonprofit also owns the 14,000-square-foot building.
In the lead up to the Oct. 31 date, HealthFirst is working to assist patients to find other options for their care. The five full-time and two part-time providers have all agreed to transfer to other HealthFirst locations.
HealthFirst leases the property and subleases the dental clinic back to the nonprofit. Before HealthFirst came into the picture, the nonprofit offered medical and dental care, starting in 2017.
When HealthFirst took over medical services at the clinic that has been operating since 2017, Bolognani said they were also told that the previous patient volume in Canaan was about 6,000 patients.
“We needed that number, but we never even got close to it,” Bolognani said.
Before HealthFirst took over, the clinic served 5,500 patients, indicated a report on the partnership issued by the New Hampshire Attorney General’s Office in July 2023.
Since starting in Canaan, HealthFirst has seen about 1,900 unique patients, which is about how many one provider would typically see, Bolognani said. This compares to about 6,000 each in Franklin and Laconia.
To try to reach higher volumes, HealthFirst spent $150,000 on patient marketing in the first year, Bolognani said.
Financial struggles for the Mascoma nonprofit hurt HealthFirst’s ability to continue operating in Canaan, Bolognani said, including unpaid reimbursements for subletting the dental unit.
Mike Samson, finance director and member of the Mascoma Community Healthcare’s board of directors, declined to comment on the patient volume and unpaid debts. “The reason that we worked with HealthFirst to get them to operate the facility was because they had access to both federal and state funding that we don’t get,” said Samson, Canaan’s former town administrator.
The board has been planning for the possibility of losing HealthFirst since April, he said.
“It’s not just HealthFirst, all community health centers are experiencing these types of issues and one of the biggest concerns is the cutback of Medicaid patients’ eligibility and that affects all of us,” Samson said.
HealthFirst is not the first FQHC in the area to recently announce the closure of a location. In June, Ammonoosuc Community Health Services, which has a clinic in the Upper Valley community of Woodsville, announced the closure of its Franconia, N.H., location, citing “inadequate financial support from both state and federal sources,” including cuts to Medicaid.
Going forward, the Mascoma health care center will continue to offer dental services uninterrupted and the governing board is “committed to maintaining a health practice and a dental practice in the Mascoma Valley,” Samson said Wednesday. “We are taking every step we can to ensure that that continues.”
He declined to comment further on how the board will move forward, adding that the planning is ongoing.
To keep its Canaan operation running, HealthFirst would need an additional $500,000 per year in outside funding to break even, Bolognani estimated.
The clinic cost just over $2 million to operate from October through June and had revenues of about $1.5 million.
The health center was awarded a $300,000 loan over two years from the state of New Hampshire, “but it wasn’t sufficient as it turned out,” Bolognani said. Though the clinic earns federal reimbursements for each insured patient who comes in, the network was not awarded additional funding via the Health Resources & Services Administration, its main federal funder, when the clinic opened, he added.
In 2023, several state agencies helped to facilitate and approve the partnership between Mascoma Community Healthcare and HealthFirst. But now there is little the budget-strapped state government can do, he said.
“I don’t know anyone at the state you could go visit right now and they would say, ‘Oh yeah there’s a possibility,’” Bolognani said. “I don’t think there’s any possibility at the state for any significant funding.”
As part of budget negotiations concluded in June, New Hampshire introduced changes to the state Medicaid program that providers worry will decrease enrollment and increase the size of the uninsured population, including premiums, a work requirement and more expensive co-payments.
At the federal level, the One Big Beautiful Bill Act that President Trump signed into law July 4 cut federal health spending by more than $1 trillion over a decade. The law reversed policies that increased access to health care and introduced enrollment requirements that are expected to result in almost 10 million people losing coverage by 2034, the Congressional Budget Office reported earlier this week.
After the Canaan clinic closes, options for patients include traveling to other HealthFirst locations for their care, but the nearest site is about an hour from Canaan, Bolognani said.
HealthFirst also is working with other partners to help transfer patients, including Mid-State Health, another FQHC which has locations about 30 minutes away in Bristol and Plymouth, N.H.
Patients also can choose to use telehealth to continue their behavioral health care and primary care with their current providers.
HealthFirst has an agreement to provide behavioral health services to the Mascoma Valley Regional School District and the program will continue, Bolognani said.
“That we hope to continue as our regular work in the community forever, for as long as the school will say they would like us to be there,” he said.
HealthFirst Canaan patients can contact 603-523-4343 or visit HealthFirstFamily.org to talk about transferring care.
Clare Shanahan can be reached at cshanahan@vnews.com or 603-727-3216.
