By Jerry Ortiz y Pino
— When I heard that all 15 of New Mexico’s largest behavioral health providers had flunked a special audit ordered by Human Services Secretary Sidonie Squier, I began muttering to myself. It sounded like another Martinez Administration effort to privatize and outsource New Mexico’s governmental services. I stewed over it until my blood pressure spiked, and I wound up in the UNMH emergency room overnight.
Today I can calmly and objectively assess the situation, keep my blood pressure under control and avoid the ER. But this still looks like a slick movida to privatize our mental health system.
Squier cast an unmerited pall of suspicion over the local, community-based provider organizations, which are the backbone of our system of caring for the mentally ill and the addicted. While there may be close to a thousand therapists and agencies that Medicaid paid for services last year, the 15 who’ve been cast into outer darkness represent more than 85 percent of those behavioral health payments and services.
I have been following the tortured evolution of this state’s behavioral health delivery system for more than 40 years. There were times when we were tantalizingly close to actually having a system that functioned as it was intended; times when an adequately-funded community mental health center in each of seven planning regions of the state seemed not just possible but likely; times when we provided far more services to far more people than we do today.
I have been immersed in the process, possibly even tormented by it.
In the early ’70s at the College of Santa Fe, I trained community mental health workers who were supposed to be the foundation for that era’s system. That plan was uprooted during a change of administrations—before most of those newly trained paraprofessionals could ever find jobs or put their skills and knowledge to use.
In the second half of that decade, I managed the creation of the Title XX network around the state. (Medicare is Title XVIII, and Medicaid is Title XIX—all of the Federal Social Security Act).
Title XX, which a friend always cynically referred to it as “the big federal double cross,” was supposed to provide a steady, dependable source of funding for a new generation of social service agencies. A few of those agencies continue to exist and are among the 15 damaged by Squier. But most of them crumpled under the pressures of boom-and-bust funding cycles, and vanished.
Later in my career I worked for private and public agencies that provided behavioral health services financed by Medicaid. There was a time when Albuquerque alone offered half a dozen different in-patient psych units for troubled adolescents and a dozen or more residential treatment centers for those youth when they finished hospitalization but couldn’t yet return home.
Those halcyon days of Medicaid spending on behavioral health were ended by the introduction of “managed care,” a phantasm that produced neither very good management nor much care at all. But it did slow funding for services to a trickle, and Medicaid executives breathed a sigh of relief. That was in the mid-90s, and it spelled the turning point in service provision in our state.
Since we’ve adopted managed care in behavioral health here, we have steadily reduced the number and length of behavioral health services. We’ve also pinched the providers of those services ever more tightly between unrealistic paperwork and paltry reimbursements. And we’ve generated huge profits for the big corporate managed care companies: Optum and Value Options.
Those two behemoths took turns running our system into the ground while shipping boatloads of money out of state to the delight of their stockholders. They have now been securely placed in the drivers’ seat for the next era of New Mexico’s reinvented behavioral health: Centennial Care.
Centennial Care replaces our old Medicaid managed care program !Salud! beginning on Jan. 1. Yes, just six months before the end of the program and the expiration of their existing contracts, Secretary Squier has abruptly dumped 85 percent of the program providers out on the sidewalk. Her allegations of fraud, even if ultimately unproven, are timed to make sure that this group of providers will not be included in Centennial Care. In effect, she has not only charged and convicted them without trial, she has already executed them.
She’s blocked reimbursements, demanded repayment, brought in newly contracted agencies from (hold your nose) Arizona to take over responsibilities and slandered the agencies’ reputations on the basis of accusations they have not even seen. She has ended their viability. No matter the outcome of the attorney general’s investigation, it will take six weeks to complete, so Squier will have shriveled the programs into non-existence.
And she is doing so by claiming she has no choice. Obamacare, she says, made her do it.
That, at least, must be buried for the gross distortion it is. The Affordable Care Act does have language that forbids payments to providers who are found to have committed fraud. Period. The point, though, is Squier is claiming that was established when Attorney General Gary King accepted her request to investigate. “Credible allegations,” she says, have been made and now her hands are tied.
Not so. She is stopping payments solely because she wants to stop payments. She is tearing down the fragile behavioral infrastructure in this state solely because she wants to tear it down. She is bringing in Arizona agencies solely because she chooses to bring them in.
None of it would have been required if she had simply said, “Serious findings have been raised by the audit. We are working with the AG to determine if they are valid. Until that is established, we are monitoring each and every transaction before authorizing reimbursement. Only when we are sure they are not fraudulent will payments be made. If fraud is established, then we will close the guilty agencies down. Until then, services to these clients must not be interrupted.”
Because she didn’t act in that reasonable manner, I conclude she has other plans for Centennial Care. She’s cleared the deck to make sure the large Managed Care organizations that have been awarded Medicaid contracts in 2014 will provide behavioral health services through for-profit, insurance company-based corporations—not local grassroots outfits.
Optum is a subsidiary of United Health, so they’ll be part of that contract. Value Options has a long record of working with other major Managed Care organizations, so they will certainly have a seat at the trough, serving one or more Centennial contractors. Other big players on the national behavioral scene may be lured in as well, possibly including the Arizona scabs she’s sole-sourced.
The one thing Squier guarantees with her pre-emptive strike is that New Mexico community agencies won’t have a place at the table. The profits to be made are too lofty to cut them in on the action. Instead of fixing the system, she has ensured it will get milked for profit and client needs will take second place to stockholder demands.
Of course there’s more, much more, to say about this. But enough for now—blood pressure’s jumping.
Jerry Ortiz y Pino is serving as state senator for District 12 in the New Mexico Legislature—essentially Downtown Albuquerque, the historic neighborhoods that surround it, the UNM campus area and a portion of the South Valley. A retired social worker, he spent his entire 42-year professional career in New Mexico, working in private and public agencies in seven different cities in the state.