U.S. Sens. Tom Udall and Martin Heinrich, and U.S. Reps. Michelle Lujan Grisham and Ben Ray Luján asked the U.S. Department of Health and Human Services to hold a public forum within two weeks in New Mexico to hear from those affected by the state-ordered shift from local providers to Arizona nonprofits.
While the state says there have been no gaps in service, “we are alarmed by the increasing reports to the contrary from advocates, providers, consumers and families regarding significant disruption to access to quality care,” the lawmakers said in a letter to HHS Secretary Kathleen Sebelius.
The letter was not signed by the fifth member of the delegation, Republican Rep. Steve Pearce. A spokesman in Pearce’s office could not immediately say what his position on the issue is.
The state Human Services Department in late June abruptly cut Medicaid funding for behavioral health services to 15 New Mexico nonprofits – it later restored funding to one of them – citing an audit the department said showed $36 million in overbilling, mismanagement and possible fraud.
The audit findings – which were not released to providers or the public – were turned over to the state attorney general to investigate.
The HSD contracted with five Arizona companies to step in, and some are already in the process of taking over the local providers – forcing out their CEOs but apparently re-hiring many employees. The nonprofits treat the mentally ill and addicted.
“We’re working to root out waste, fraud, and abuse in the Medicaid system and are following the proper procedures, which have been outlined by the federal CMS (Centers for Medicare and Medicaid Services), upheld by a federal judge, and confirmed by New Mexico’s attorney general,” said Enrique Knell, a spokesman for Republican Gov. Susana Martinez.
“Our priority has always been to ensure the continuity of care for clients and that’s why HSD is working to make sure these transitions are as smooth as possible,” Knell said Wednesday.
The lawmakers’ letters said they “have heard from constituents and their caregivers, all of whom are anxious, fearful and confused about what to expect. They have had appointments delayed and cancelled, and changes in providers with whom they had relationships of trust.”
“We have also heard from multiple sources that a significant number of clinical staff have the left the programs and, in some cases have left the state entirely,” the letter said
The congressional delegation said the “sweeping change” warrants immediate and comprehensive oversight by the federal CMS “to ensure that the integrity of this process is maintained.”