For Immediate Release: 9 am, Tuesday, September 5, 2000

As Federal Teams Review New Mexico's Medicaid Mental Health Care, New Data Show "Snapshot of Failure"

Washington D.C., September 5--For the third time in the renewal process of Medicaid managed care in New Mexico, the federal Health Care Financing Administration (HCFA) is gathering first-hand information about reported deficiencies in mental health services provided by Salud!, the state's Medicaid managed care plan. On September 5-7, HCFA teams are meeting in Santa Fe, Albuquerque and Las Cruces with state legislators and mental health providers and consumers who have complained about lack of access to needed services.

Today in Washington, the Bazelon Center for Mental Health Law issued its fourth analysis of data showing that few Salud! enrollees with mental illnesses are receiving any mental health services at all. In particular, the legal center found, adults and children with the most serious disorders are not receiving the types of intensive community services they need.

The Bazelon Center reviewed data on the use of services by all Salud! enrollees in October-December 1999, collected by the New Mexico Medical Assistance Division. HCFA requires a state to collect such "encounter data" for all Medicaid managed care consumers when it waives Medicaid rules for the state to provide services through managed care. The division is operating Salud! under such a waiver, contracting with three managed care health plans, Cimarron, Lovelace and Presbyterian.

According to the Bazelon Center's analysis:

--At least 6,445 of the 44,072 adults served by Salud! have a serious mental illness, such as schizophrenia, based on the number of adults in New Mexico who receive federal disability benefits due to a severe mental illness. Yet Salud!'s encounter data show that at most 2.5% of adults, or only about 1,100 individuals, received any of the intensive mental health services needed by people with such disorders.

--National data on the prevalence of serious mental or emotional disorders among children suggest that at least 9% of the 191,838 children enrolled in Salud! need intensive services to address severe impairments. Yet the data show that only 1,621 children received any of these services.

"New Mexico's encounter data on behavioral services provide a snapshot of failure," asserts the Bazelon Center. "The number of adults and children receiving mental health services is woefully low and the services most needed by those with more serious conditions fall well below appropriate treatment standards."

For example, according to the Bazelon Center's analysis, 19% of adults (8,257 individuals) enrolled in Salud! received an antipsychotic medication, yet only 21 individuals were reported as receiving medication management visits to a physician. "Even if some physician visits included such services but were not billed as medication management, this is an irresponsibly low number," the center concludes.

The encounter data analyzed here are consistent with other data on utilization, provider closings and with the concerns that providers and consumers expressed to HCFA in two prior site visits and to state legislators in a hearing by the interim Legislative and Human Services Committee last July.

The Medical Assistance Division has asserted that Salud! members are satisfied with their access to mental health services and recently released the results of a new telephone and mail survey. However, Bazelon Center researcher Rafael Semansky questions the validity of the division's surveys:

"In the first place, with services so hard to access, consumers by now have very low expectations, so they'll probably say 'satisfactory' to almost anything but total rejection," Semansky noted. He also takes issue with the survey itself, for several reasons:

"The calls are made from the health plans and that's likely to intimidate consumers. Few Spanish-speaking consumers were reached. We aren't told the response rate or how the people who responded differ from those who were contacted but didn't respond. Furthermore, the survey was developed for adults, but the division used it for children as well; no other state using this survey instrument has done that."

The Bazelon Center issued three earlier analyses criticizing the deficiencies in Salud!'s mental health services and has asked HCFA not to renew New Mexico's waiver for behavioral health care. The state has claimed that the center's findings were based on old and invalid data. The new report is based on the state's own encounter data, which the state is on record in a letter to HCFA as considering accurate and appropriate to assess Salud!

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For more information or a copy of the analysis, Rafael Semansky, 202-467-5730 ext. 23, rafaels@bazelon.org or Lee Carty, 202-467-57340 ext. 21, leec@bazelon.org