If you are confused about the behavioral health crisis, you\u2019re not alone.\u00a0 Whichever way you see it, it\u2019s terrible.<\/p>\n
Medicaid funds are being withheld from 15 nonprofit behavioral health providers.\u00a0 Except for a few confusing revelations, the public still has only vague allegations about what these nonprofits may have done.\u00a0 If the providers really made fraudulent use of public dollars, it\u2019s shameful.\u00a0 However, it\u2019s terrible for these organizations to be under a cloud without specific charges being revealed; equally, while investigations are ongoing, it might be terrible if their reputations were ruined by having the unproven allegations made public.<\/p>\n
Some of them will go out of business because they can\u2019t afford to operate without their Medicaid funds.\u00a0 The fragile network of local providers will be damaged.<\/p>\n
These organizations provide services to people who really need help, such as autistic children and adults struggling with addiction or mental illness. The services are provided at taxpayer expense both because they help the clients and because they benefit the rest of us.\u00a0 Treatment of behavioral health issues makes it possible for the clients to function in society, keeping them (we hope) out of prison or hospitalization \u2013 which would be much more costly than outpatient treatment — and in some cases keeping the public safe from them.\u00a0\u00a0 We all have a stake in maintaining the programs at a high level of quality.<\/p>\n
We are also hearing allegations against the Human Services Department, and these are equally serious.<\/p>\n
One charge is simply incompetent management.\u00a0 New Mexico provides Medicaid behavioral health services through a managed care model and is paying a company called Optum Health $42 million a year to manage the program, so why didn\u2019t Optum find these problems earlier and correct them through less drastic measures? \u00a0At the recent Legislative Finance Committee hearing, I lost count of the number of times Senator Mary Kay Papen repeated, \u201cForty-two million dollars!\u201d<\/p>\n
The total budget for Medicaid behavioral health is around $380 million, according to Karen Meader of the Human Services Department.<\/p>\n
A more serious allegation is that HSD\u2019s action represents a deliberate attempt to dismantle the existing system of community-based nonprofits and allow for-profit companies to replace them. \u00a0Senator Jerry Ortiz y Pino said it publicly in a recent article on the online New Mexico Compass (nmcompass.com) and pointed to the upcoming planned restructuring of the entire Medicaid program from Salud to Centennial to support his argument. He is a social worker with a 40-year local career and knows the system very well. \u00a0Why, he asked, take such a drastic step when provider contracts will expire anyway in a few months?<\/p>\n
We can hope this charge is proven wrong, just as we can hope that the combined investigations of the Attorney General and State Auditor find little or no wrongdoing by the providers, and that somehow the system will be restored.\u00a0 New Mexico supports home-based small business, does it not?<\/p>\n
A similar situation is unfolding in North Carolina. The state hired Public Consulting Group, the same company that conducted the New Mexico audit, to audit small behavioral health providers.\u00a0 After the dust had cleared, most of the audit findings were not substantiated, but lots of providers were put out of business when their checks stopped coming.<\/p>\n
Knicole Emanuele, a North Carolina Medicaid specialist attorney (who blogs at medicaidlawnc.wordpress.com) represents several local companies that were financially damaged by the audit.\u00a0 She told me she is at work on a lawsuit against the state, PCG, and possibly other parties, to recover the financial damages her clients suffered.\u00a0 This could cost the state millions of dollars if the plaintiffs win \u2013 money that could have been better spent helping people.<\/p>\n
We can\u2019t afford that in New Mexico.\u00a0 Let\u2019s hope it\u2019s not necessary.<\/p>\n
Triple Spaced Again, \u00a9 New Mexico News Services 2013<\/p>\n
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If you are confused about the behavioral health crisis, you\u2019re not alone.\u00a0 Whichever way you see it, it\u2019s terrible. Medicaid funds are being withheld from 15 nonprofit behavioral health providers.\u00a0 Except for a few confusing revelations, the public still has … Continue reading