Commentary: WASHINGTON – U.S. Sens. Tom Udall and Martin Heinrich, andU.S. Reps. Ben Ray Luján and Michelle Lujan Grisham announced that the U.S. Department of Health and Human Services (HHS) Office of the Inspector General (OIG) will review the level of access that New Mexicans have to behavioral health services provided through the Medicaid program.
The OIG agreed to a request from Rep. Lujan Grisham, along with Sens. Udall and Heinrich and Rep. Luján, to investigate behavioral health access issues in New Mexico, and will also be conducting a review of four other states. Udall, Heinrich, Luján and Lujan Grisham have previously pressed for increased federal oversight to ensure that vulnerable New Mexicans have timely, consistent access to the behavioral health services they need.
In 2013, the New Mexico Human Services Department suspended Medicaid payments to 15 nonprofit behavioral health providers claiming "credible allegations of fraud." This led to the closure and eventual replacement of 12 behavioral health providers with Arizona-based providers. Four of these replacement providers have left the state, leaving gaps in access for critical behavioral health services under Medicaid for many New Mexicans with serious mental illness and substance abuse disorders. The New Mexico Attorney General subsequently cleared all of the 15 providers from allegations of Medicaid fraud. Recent settlements also show that the initial audit was incorrect and several providers have settled overpayments with the state at a fraction of what was estimated they owed. The most recent settlement was for just $485 of what the Human Services Department initially claimed was $2.8 million in Medicaid overpayments.
Members of the New Mexico delegation released the following statements:
“This was a manufactured crisis that has had tragic consequences for children and families struggling with mental illness, behavioral health issues and substance abuse, who lost access to care altogether or haven’t been able to find steady care. It has also wasted tens of millions of taxpayer dollars and cost dedicated health care workers their jobs as behavioral health clinics across New Mexico have been forced to close or lay off staff due to the disruption caused by the state’s actions,” Sen. Udall said. “Our fragile network of behavioral health providers is still struggling to meet the needs of these patients. I look forward to the results of this study and will continue fighting for improved behavioral health access in New Mexico.”
“New Mexico's behavioral health system was turned upside down overnight when the state unilaterally suspended Medicaid payments for vital services. It's clear that this was a manufactured crisis that dangerously left patients without the care they deserved and had come to rely on, caused hundreds of New Mexicans to lose their jobs, and wasted tens of millions of taxpayer dollars,”Sen. Heinrich said. “I’m glad the Office of Inspector General has agreed to review whether the state is still failing to provide New Mexicans with mental health services they need.”
“Ever since New Mexico’s behavioral health system was needlessly thrown into chaos a few years ago, my colleagues and I have been working to rebuild this aspect of our system of care and ensure steps are taken to prevent such a crisis from happening again,” said Rep. Luján. “While we cannot undo all the damage that was done, we can take steps to protect continuity of care for those who need it, provide due process for providers, and prevent such a crisis from happening in the future. Hopefully, the results of this study will help us improve the behavioral health situation in our state in both the short and long term.”
“Governor Martinez’s Administration not only failed to take responsibility for dismantling the state’s behavioral health system; the Governor refuses to ensure vulnerable New Mexicans have access to services,” Rep. Lujan Grisham said. “I pushed the federal Office of Inspector General since the beginning of this crisis, and we finally succeeded in convincing investigators to conduct a thorough review of those services. I want the OIG to determine where the state continues to fail its mission of providing mental health services.”