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Privatizing Mental Health Sent Me to the ER

Photo Credit: Andrew Mason via Compfight cc

Photo Credit: Andrew Mason via Compfight cc

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.

13 thoughts on “Privatizing Mental Health Sent Me to the ER

  1. Thanks for the story…. this situation is quite dire, scary, cruel, and with long lasting negative impacts. Ugh.

  2. Your blood pressure and mine! I knew there was more to this story that wasn’t getting aired out. I didn’t realize the background of how it tied in with the implementation of the Medicaid expansion. Sleaze and greed. Their loyalty is to the corporations, and New Mexico has mighty few of them big enough to catch their attention. Hence, pump the money out of New Mexico as quickly as possible.

  3. seems to me that their was a problem in the mid 90′s when it went to managed care and when did Optum and Valued Option take over. Since the mid 90′s there could have been a grass roots disdain for how managed care was gutting the system. Why wasn’t there? More than likely politics. Gary Johnson a Republican 1995 to 2003, Democrat Richardson 2003 to 2011, Republican Martinez 2011. Isn’t the New Mexico House and Senate a Democratic Stronghold. Why were they sitting on their hands when Optum and Valued Option took over.

  4. Jerry’s critique is excellent, and I would add some background. The state itself has acknowledged that its mental health services delivery system has long been inadequate and in crisis. So have they done anything to strengthen it? No! Rather, they have given an out-of-state company a contract to find alleged “over-payments” to struggling community providers, and paid the company based on the amounts they allegedly “uncovered.”

    I have read HSD’s highly self-serving summary of the charges against the providers, and they range from the ludicrous (for example out-and-out besmirching some workers for allegedly causing a client’s suicide) to the more mundane (for example citing incidents where some providers were allegedly too slow in responding to requests, and too weak with record-keeping — charges that would cause the termination of Secretary Squier’s Department and its Medicaid managed Care Organizations if applied TO THEM.

    So now the private companies that have been paid handsomely for MANAGEMENT and OVERSIGHT of the system remain in place, and many additional millions of dollars that could go to desperately needed SERVICES are going additional, out-of-state private contractors, under no-bid contracts.

  5. What Susana Martinez doesn’t realize is that if she ever wanted to run for president or advance her political career. She is killing it. Healthcare providers are not stupid and they are intertwined with all the community ( voters). They can see that this is her doing. Not the obamacare. In glad she is messing up. Squier is nothing but a puppet.

  6. Yes she has chosen to, the language is found to HAVE committed fraud none of these agencies have been proven to HAVE committed anything except trying to continue operating while not being paid. All based on an audit by commission performed by a company under investigation for fraudulent practices. The latest is her pet companies from Arizona if you have managed to read any of their contracts have been charged with determining if there was fraud committed, when did criminal investigations move to using behavioral health agencies to investigate rather than law enforcement officers. Of course since these are Secretary Squiers pet companies they will find or create something against these agencies and any others that have the audacity to speak out against the mismanagement of her office and OptumHealth.

  7. Not only is this affecting the behavioral health consumers, it is also affecting individuals with developmental disabilities, brain injuries, and individuals with alcohol and/or substance abuse issues.

  8. Can we get this published in the New Mexican? Maybe on the editorial page? Or has it already been published in the paper? I have been suspicious about this auditing report from the beginning and am quite upset about it too. I feel angry and helpless.

  9. Most of these agencies were monopolies within their regions created by the Department of Health via Value Options and OptomHealth during Richardson administration. I guess that they didn’t pay for this during current administration thereby causing audit.

    • Sorry Gary but this is only true within the constraints of the size of the communities served and if you discount the private practitioners also providing services
      . For instance Valencia county has or had three agencies providing services, all three have been strong advocates for the consumers rights in behavioral health. All three have and would have been in opposition of the involvement of private for profit corporations being involved in the administration of public health funds. Public health funds are there to provide services for those in need and not to provide shareholder profits for out of state corporations.
      As it is it will be a moot point because one of the agencies is now bankrupt due to actions taken against it without due process of law as defined by the Constitution and Bill of Rights of the United States and has been stolen from the CEO and board of directors to be handed to an out of state corporation To add insult to injury not only did the state give them decades of another groups life’s work but they are paying the CEOs of the agency taking over $300.oo an hour to do so. Now it’s been a long time since math class but that translates to 624k a year plus a free corporation. The other two agencies do not expect to last the rest of the month.
      To my mind there are two issues here both of them very grave. First the undisrupted continuation of services for the consumers of behavioral health services and Two are we going to allow petty local government officials disregard the constitutional rights of the management of these agencies. In other words do you value your freedom enough to also defend it at home? because if we allow them ignore constitutional rights in this area they will ignore them in other areas and in the end we will have no freedom and no rights.

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