Federal Medicaid Agency Asked to Investigate Data on Salud! Mental Health Services

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 DC, June 28, 2000—The Bazelon Center for Mental Health Law today asked the federal Health Care Financing Administration (HCFA), which administers Medicaid, to seek explanations of apparent discrepancies in reports on mental health service delivery in the New Mexico managed care program for Medicaid recipients, called Salud!.

In a letter to HCFA, the national legal center reiterated its request that the federal agency not renew the state's waiver to provide mental health services through managed care. The letter includes responses to the New Mexico Medicaid agency's criticism of one of two earlier Bazelon Center reports documenting serious deficiencies in mental health service delivery under Salud!

"Many of New Mexico's responses to our findings are either irrelevant or misleading," said Bazelon Center researcher Rafael Semansky. "In some areas the state agency has simply ignored the surveys it commissioned when they showed that Salud! wasn't fulfilling its responsibility to children and adults with mental or behavioral disorders."

Semansky is scheduled to testify about his findings in a hearing before the Interim Legislative Health and Human Service Committee in Santa Fe on July 5.

The Bazelon Center's letter asks HCFA to take a closer look at data that the state agency appears to have obscured in several key areas:

• selective use of surveys of Salud! members' satisfaction with access to mental health services. Two surveys—one by phone, one by mail—found different rates of satisfaction among Salud! members. The state cited only one survey—the one that showed adequate satisfaction. HCFA is asked to investigate reasons for consumers' "markedly different perceptions of access to mental health" in the two surveys.

• use of irrelevant statistics to refute findings that rates of community mental health services were too low. The state listed $11 million paid to the Children, Youth and Families Department for case management (coordination of services for people with mental health needs), but this was for children who are not enrolled in Salud!

• public denial of problems with Salud!, despite evidence that the state agency itself is concerned about declining mental health authorizations. Internally, the division has asked providers to examine authorization trends. One of the Salud! plans identified a drop in authorizations of child and adolescent community treatment per 1,000 members from 1,000 to 300 units of service between August 1999 and February 2000.

• failure to pursue preliminary information on excessive administrative costs. Data showing that, under Salud!, administrative costs were 51% of every Medicaid dollar spent on behavioral health services appeared in a draft report prepared for the state. The Bazelon Center asks HCFA to request that the state complete this report and release it to the public.

• apparent overcounting of children receiving Medicaid screening. "Suspiciously large increases" in the reported rates of children screened under Medicaid's Early and Periodic Screening, Diagnosis and Treatment program suggest that the managed care contractors may be including children who were treated along with those who were screened. HCFA should request an independent audit of health plans' encounter data for children.

The Bazelon Center is urging HCFA not to approve New Mexico's Medicaid managed care waiver without major changes in the behavioral health part. The center's analysis finds provider surveys, member surveys, the external review and evaluations by other state agencies all indicating that behavioral health services are hard to find in New Mexico. "Even if one study or one indicator finds positive results for Salud!," Semansky said, "the evidence is consistent that an appallingly small percentage of Salud! members—many of them on Medicaid precisely because of their mental health problems—receive appropriate mental health services."

For more information:

Rafael Semansky, 202-467-5730 ext. 23; rafaels@bazelon.org
Lee Carty, 202-467-5730 ext. 21, leec@bazelon.org