New Data Bolster Request to Federal Medicaid Agency Not to Renew New Mexico's Managed Behavioral Care Program

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., April 24, 2000—The Bazelon Center for Mental Health Law, a leading national advocacy organization, today reiterated its request to the federal Health Care Financing Administration (HCFA) not to renew the managed behavioral health care component of New Mexico's Medicaid program, Salud!, citing information the center recently obtained documenting "even more serious deficiencies" in services for children and adults with mental disorders.

In a four-page report titled "Problems with Salud!, New Mexico's Managed Health Care Program: Information Sheet #2," the center cited reports commissioned by the state's Human Services Department (HSD) from the Health Employer Data Information System (HEDIS) and information from a member survey, showing that services through Salud! fall far below national standards. In particular, adults and children enrolled in Salud!:

• lack access to behavioral health services—mental health care and addiction treatment;
• are much less likely than under the prior health care system to receive services through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program—required for all Medicaid-eligible children; and
• are much less likely than families in other states to visit a primary care doctor for preventive or other non-emergency purposes (well-child visit).

The report compares data on access to behavioral health services from the three managed care programs contracting with Salud! to serve Medicaid-eligible consumers to national averages reported by the National Commission on Quality Assurance (NCQA) and to the fee-for-service program operated by the state Medicaid agency until 1997. For example:

• Nationally, 45% of individuals hospitalized for mental illness receive follow-up care within seven days of discharge, compared to fewer than 15% of Cimarron Health Maintenance Organization members, 16% of Presbyterian Health Plan members and 27% of Lovelace Health Plan members.
• From 1994-96, New Mexico completed almost 40% of screening under EPSDT, but Salud! currently conducts only 0.2% of the required screens.

Rafael Semansky of the Bazelon Center, who reviewed both sets of reports, acknowledged that New Mexico is a state with large rural areas that increase the difficulty of providing health services. However, he said, "the gap between the national averages and Salud!'s performance in providing access to mental health and addiction treatment services is wider than even the West's open spaces."

HCFA requires that all programs operating with Medicaid waivers provide all medically necessary services and that services not deteriorate under managed care. The Bazelon Center has asked HCFA not to allow the state to continue operating Salud!'s current behavioral health managed care arrangement and to disallow renewal of that part of the state's waiver of federal Medicaid rules.

The center accompanied its initial request to HCFA with a review, released March 30, summarizing reports that showed major violations by Salud! of federal and state rules for behavioral health care. Although, according to the reports, Salud! appears to have fewer problems for members requiring physical health care, serious deficiencies in the provision of medically necessary behavioral health services were consistently and thoroughly identified in HSD-commisioned surveys of providers and enrollees, in an external review conducted for the state by an outside agency, and in memos written for the state and by other state groups, outside consultants and HCFA.

The March 30 report cited examples documenting that Salud! members with mental health needs are unable to get necessary care when they need it and that, according to behavioral health specialists, members who need mental health and addiction treatment services are worse off under Salud!

HSD contested some of the center's findings in interviews with reporters. The Bazelon Center has not received any communications from HSD and has learned of the agency's challenge to aspects of its review only through the media. "To our knowledge," Semansky said, "HSD has not taken issue with many of our findings, including the lack of required monitoring data and the inadequacy of protections for the rights of behavioral health care consumers."

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

Salud! members who have sought behavioral health care can put a human face on the failings uncovered by the reports. The following groups can put reporters in touch with adult consumers and parents of children who have been unable to access services.

• Delfy Peña Roach, Parents for Behaviorally Different Children, (505) 265-0430
• Deborah Fickling, the National Mental Health Association in New Mexico, (505) 753-4131, email: mhanm@cybermesa.com
• The New Mexico Chapter of the National Alliance of the Mentally Ill, (505) 260-0154

For more information or a copy of either or both of the reviews, contact

Rafael Semansky, 202-467-5730, rafaels@bazelon.org
or
Lee Carty, 202-467-5730, leec@bazelon.org