New Mexico Medicaid Managed Behavioral Health Care Called so Deficient It Should Not Be Renewed

Update: Richardson Calls for Mental Health Changes in NM On Sept. 12, 2003, Governor Bill Richardson (D) directed several of New Mexico's state agencies to consolidate mental health care and behavioral health care services. Richardson's plan combines all behavioral health funding (including funds from Medicaid, and other state agencies) into a single carve-out that will be bid out through a competitive Request-for-Proposal (or RFP) process. Read Governor Richardson's remarks

Washington D.C., March 30, 2000—A leading national advocacy organization is "strenuously" urging the federal Health Care Financing Administration not to renew New Mexico's Medicaid managed behavioral health care program, Salud!, in light of reports documenting "extremely serious deficiencies" in services, especially services for children and adults with mental disorders.

The Bazelon Center for Mental Health Law cited several reports it has obtained as showing major violations of federal and state rules for behavioral health care by the three managed care programs contracting with Salud! to serve Medicaid-eligible consumers: Lovelace Health Plan, Cimarron Health Maintenance Organization and Presbyterian Health Plan. The reports were commissioned by the state's Human Services Department. In a summary of the reports and other information it has uncovered , the Bazelon Center said that:

• Administrative expenditures by Salud! are excessive. For every dollar spent on Medicaid, 51 cents goes toward administrative services and only 49 cents is used to provide services.
• Managed care plans deny care in ways that violate consumers' rights and often ignore procedures established to protect consumers' right to appeal a denial.
• Mental health services are so scarce that half of Salud! members were not easily able to get counseling. One quarter of primary care providers could not arrange for outpatient mental health or addiction treatment.
• The managed care plans violate the federal mandate to screen at least 80% of Medicaid-eligible children. One plan saw 5.5% of children enrolled in Salud! and conducted only 0.2% of the mandatory screens.
• The intensive services needed by children with serious emotional disorders, also required by Medicaid, "are not being provided."
• Salud! members' inability to see a doctor when necessary greatly increased their use of emergency rooms. The proportion who said they went "three or four times" doubled in 1999.
• Salud! members face long waiting periods for services, in excess of the 14-day limit.
• Case management, a service required by Medicaid law for people with mental health needs, "has virtually ceased to exist" in New Mexico's program.
• The plans lack data systems for monitoring consumers' access to care.

In a memo urging the federal agency not to approve continuation of behavioral health care services through Salud!, Bazelon Center policy director Chris Koyanagi said she also had reports that mental health therapy sessions had been "cut to 20 minutes because the providers spend the rest of the 'hour' on administrative work."

Advocates in New Mexico have initiated litigation aimed at reforming the state's Medicaid managed care program.

For more information: Rafael Semansky, 202-467-5730, rafaels@bazelon.org