HCFA Reinstates Mental Health in New Mexico Medicaid
Waiver
Reprieve Sets Conditions with Potential to Improve
Salud! Services
February 22, 2001-- The federal Health Care Financing Administration
(HCFA) has reversed its precedent-setting October
2000 decision to request that New Mexico remove mental health
from Salud!, the state's integrated physical and mental health managed
care arrangement, created under a waiver of federal Medicaid rules.
The state had agreed to do so in response to a letter
from HCFA noting "serious deficiencies in the New Mexico waiver"and
requiring the state to take major corrective actions.
The Bazelon Center had strongly criticized Salud!'s performance
in a series of reports documenting
major deficiencies in access to mental health services for Medicaid-
eligible children and adults and in protection of consumers' rights.
In a March 30, 2000 letter to HCFA
and another on April 24, 2000,
we had asked HCFA not to renew the behavioral health portion of
the state's managed care waiver. A
third letter factually refuted the state's "irrelevant or misleading"
responses to the Bazelon Center's findings, which came from reports
commissioned by the state's own Medicaid agency.
Although we disagree with the reinstatement of behavioral health
care in Salud!, we note that HCFA, in its February
16 letter to the state's Human Resources Department specifically
allows New Mexico to restructure its managed care plan, possibly
moving to a carve-out for behavioral health care. Further, the federal
agency is requiring the state to take significant actions to improve
the Salud! program's flawed delivery of mental health care.
New Mexico Congressional Delegation Expresses Concern
New Mexico's delegation to the United States Congress has expressed
concern in a letter
to the Health and Human Services Secretary over the lack of
behavioral services under Salud! and the shift of untreated children
to the juvenile justice department. The Bazelon Center shares the
Senators' and Representatives' concern. By allowing reinstatement
of Salud!, even for a short period pending restructuring, HCFA is
risking significant harm to children and adults with mental illnesses
who have been denied access to services through Salud!, sometimes
even in life-threatening situations.
New Mexico has a difficult task ahead considering the range and
scope of deficiencies identified and the devastation of the mental
health system in New Mexico in the three and a half years since
introduction of Salud! The Bazelon Center's
analyses of the Salud! mental health program found serious inadequacies
in the availability of mental health services and their quality,
in monitoring data and in grievance and appeals procedures for consumers.
Important questions were also raised about excessive administrative
costs.
State's Fulfillment of HCFA Conditions Could Improve Salud! Mental
Health Services
In a detailed four-page attachment to its letter, titled "New
Mexico Behavioral Health Terms and Conditions," HCFA imposes
mandates that, when fulfilled, could significantly improve access
to and quality of mental health services in New Mexico. We are particularly
encouraged by requirements of an external review focused on behavioral
health services, a 15- percent cap on administrative costs and the
development of an early warning system. One of the consistent problems
has been the lack of accurate and timely encounter data. We hope
that the state's new system will include active involvement by consumers
and providers, along the lines of an effective early warning system
in Pennsylvania. (The Pennsylvania system is so public that its
reports are posted on the web at www.paproviders.org.)
The Bazelon Center and consumer advocates across the state look
forward to seeing significant improvements in Medicaid mental health
in New Mexico.
Bazelon Center Analyses:
PDF Files 
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The Bazelon Center for Mental Health Law is the nation's
leading legal advocate for the rights of people with mental disabilities.
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