Chaos from the state’s sudden suspension of Medicaid funding for behavioral health care providers last year befuddled patients and led them to abandon care, while caregivers employed by the firms lost years of seniority in their transition to out-of-state companies, a federal report says.
The newly released report offers the first outside review of the turmoil that mental health advocates say ensued after the Martinez administration halted funding to 15 providers across the state last June and replaced them with Arizona companies.
State Human Services Department officials made the move following an audit they said revealed allegations of Medicaid fraud and overbilling. The audit has not been released to the public, but it has come under fire by the State Auditor’s Office for the way it was conducted. And some of its results have been contradicted in an ongoing investigation by the Attorney General’s Office, which already has cleared one of the New Mexico providers.
The federal report, by the Centers for Medicare and Medicaid Services, claims the number of patients receiving mental health services declined by 23 percent in the four months following the shake-up. It said declines in some areas of the state were even sharper, falling by almost 60 percent.
The state Human Services Department sharply disputes the findings, which were issued in December and made public this week. The details of the report were first reported by the Albuquerque Journal.
In a letter to the Centers for Medicare and Medicaid Services last month, Human Services claimed the total number of people receiving behavioral health services had increased by 16 percent. The department acknowledged a decrease in the number of children receiving services under a program known as Behavioral Management Services, but it attributed some of that decline to children successfully transitioning out of the program.
The department also said the original numbers of patients could have been inflated due to overbilling.
A spokesman for CMS did not respond to questions from The New Mexican on Thursday. CMS is a division of the U.S. Department of Health and Human Services.
Democrats on Thursday jumped on news of the report to criticize Gov. Susana Martinez.
“It contradicts the fact that [the state Human Services Department] said the transition of behavioral management services to out-of-state companies was smooth and problem-free,” said Sen. Jerry Ortiz y Pino, D-Albuquerque.
He said lawmakers are frustrated that the Human Services Department did not share the report with the Legislature, where the transition was a frequent topic during the 30-day session that ended last month, even though the department was aware of it in December.
While the patient numbers may be in dispute, at least one of the ousted providers says the report offers an accurate reflection of the disorder that followed the transition.
Patsy Romero, chief operating officer of Easter Seals El Mirador in Santa Fe, said people receiving behavioral health services and their families are easily lost when their relationships with trusted caregivers are disrupted.
“The types of families that we serve are very fragile, and a lot of kids and families desperately need these services but are not getting them anymore,” Romero said.
The federal report supports her assertion. It noted that interruptions in care caused by the transition, including delays in patient records reaching the new providers, jeopardized mentally ill people.
“Inconveniences of this nature result in patient mistrust, and eventual reluctance to participate in treatment and recovery,” the report said.
Staff from the terminated providers also went through upheaval, according to the federal report. Of the former agencies’ 1,427 displaced workers, 1,243 were hired on by the replacement providers, but their morale was low and they expressed resentment over losing seniority and time off that they had accrued during years of service to their previous employers.
Romero, choking back tears, said her emotions drift between anger over the fraud investigation and the abrupt termination of her nonprofit, and deep sadness for the patients and caregivers whose lives had changed.
“To this day, none of us know what we did wrong,” she said. “But what’s more important is that we can’t have people with mental illness and substance abuse issues going without their care. They can be a danger to themselves and others in the community. It’s irresponsible.”
Contact Patrick Malone at 986-3017 or pmalone@sfnewmexican.com. Follow him on Twitter @pmalonenm.