We’ve known for years that the Martinez Administration could have chosen to continue funding 15 behavioral health organizations in 2013, even while it asked authorities to investigate allegations of possible fraud, if it wanted to avoid throwing the state’s behavioral health system into chaos.
Now that the Office of N.M. Attorney General Hector Balderas has cleared almost all of those organizations of criminal wrongdoing, criticism of the decision by the state’s Human Services Department (HSD) to freeze their funding is growing louder. The so-called Medicaid freeze put many longtime New Mexico companies and nonprofits out of business and sparked a tumultuous transition for tens of thousands of New Mexicans dealing with issues including depression and suicidal thoughts.
The question of why the Martinez Administration froze funding to the organizations — when it didn’t have to — remains.
The four Democratic members of New Mexico’s congressional delegation in Washington want an investigation. Sens. Tom Udall and Martin Heinrich and Reps. Ben Ray Luján and Michelle Lujan Grisham sent a letter to U.S. Health and Human Services Secretary Sylvia Burwell on Friday asking her agency to look into the situation.
“Attorney General Balderas’s findings confirm our longstanding concern that the well-documented irregularities surrounding HSD’s decision to suspend payments, which was not required by federal law, has undermined the legitimacy of its entire audit process,” their letter states. “Furthermore, HSD denied providers’ due process of law by indefinitely withholding payments while taking deliberate steps to preclude providers from challenging the charges against them. This callously disrupted care for New Mexico’s most vulnerable.”
The only Republican in the delegation, U.S. Rep. Steve Pearce, did not sign the letter.
The Democratic lawmakers wrote that “an overwhelming body of evidence indicates that this disruption was unwarranted and reckless.”
“It takes decades to build a strong system of care in our largely rural, underserved state, where sole providers become vital to the fabric of a community,” the letter states. “For patients who receive mental health or substance abuse treatment, few things are as important as the ability to regularly see a trusted provider focused on providing quality care.”
And although the state claims disruptions in services were nonexistent or minimal, the lawmakers wrote that they have “consistently heard otherwise.”
“Advocates, patients and their family members have told us alarming stories about losing access to quality care, as doctors and nurses have been laid off and clinics have closed across the state,” they wrote. “Out-of-state contractors initially hired to provide transitional services were unprepared, unlicensed, unfamiliar with their new service areas, and slow to provide the full scope of services patients needed.”
Some providers brought in from Arizona to fill the gap created when the state froze funding to the New Mexico organizations didn’t last long.
That included Arizona’s La Frontera, which pulled out of Southern New Mexico after calling the entire ordeal a “nightmare.” The local organization La Clinica de Familia has taken over as Doña Ana County’s primary Medicaid-funded behavioral health provider, but continues to struggle. “Six months into taking over a range of programs from a previous provider, La Clinica de Familia has placed a freeze on accepting certain new mental health clients until April 1,” the Las Cruces Sun-News reported earlier this month.
That’s because of a staffing shortage and “appears to be a symptom of ongoing tumult that has characterized the mental health care community since a mid-2013 shakeup sparked by the state ending funding to a number of previous providers,” the newspaper reported.
The Sun-News blasted the Martinez Administration in a recent editorial.
“The Martinez administration initially said it was required to immediately freeze funding or risk losing all Medicaid money to the state under new provisions in the Affordable Care Act. As dubious as those claims were at the time, they are completely discredited now that the suspected agencies have been cleared by the attorney general.
“We call on the state to release all funding still owed to the former providers, and to end the ongoing attempts to besmirch those agencies based on what we now know are false allegations. We also urge them to provide La Clinica de Familia with the resources necessary to clean up this mess, which they created.”
Many New Mexicans were equally harsh during discussions NMPolitics.net facilitated on Facebook after Balderas cleared most of the organizations of criminal wrongdoing.
“This is why due process is so vital to our system of justice,” wrote Christopher Cardenas of Las Cruces. “Without it the government is just a bully with unlimited power.”
Carol Tuck of Las Cruces agreed.
“I simply do not see a reasonable defense for what happened,” Tuck wrote. “They rushed to judgment and left some of the most vulnerable people high and dry.”
The Albuquerque Journal’s editorial board, which is sometimes friendly to Martinez, also called for “an independent federal investigation” — though the newspaper stopped short of criticizing the governor.
“It should be comprehensive, looking at HSD’s actions, whether fewer, or more, people received services, and the role of the AG’s Office – especially if the claims are as specious as the providers allege,” the Journal editorial states. “New Mexicans deserve to know the truth, and taxpayers deserve to know money spent to serve behavioral health clients is used properly.”
In their letter to Burwell, the four Democratic lawmakers wrote that a “good faith investigation into this issue is long overdue.”
“New Mexicans who rely on Medicaid for health coverage — including behavioral health services — deserve a health care system that delivers high quality care when they need it most,” Udall, Heinrich, Luján and Grisham wrote. “We ask that you use your oversight authority to provide such care for New Mexicans.”
The Martinez Administration called the lawmakers’ letter a “partisan stunt.” A statement from HSD to KRWG Public Media states, “The Feds have extensively reviewed this matter and found that the state acted in accordance with the anti-fraud regulations put in place by the Affordable Care Act. ”
While it’s true that the Martinez Administration had the authority to freeze the Medicaid funding in 2013, the administration has incorrectly insisted ever since that it had no other choice. The question remains: Why did the administration choose a funding freeze that sparked a chaotic transition and disrupted services to some patients before giving law enforcement a chance to determine whether crimes were committed?