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Editorial: Revamped system expands NM behavioral health care

Remember when that $3 million behavioral health audit was so shocking it had to be kept secret from the public that paid for it? And when the targeted 15 agencies lost their Medicaid funding and were reportedly on the brink of shutting down and leaving their tens of thousands of vulnerable New Mexico clients adrift?

What a difference a little accountability and a new, and expanded, Medicaid system make.

Last calendar year, 160,582 New Mexicans got behavioral health services, according to a report from the Human Services Department for the Legislative Finance Committee. That compares to 87,373 in the last full fiscal year (July 2012 through June 2013) before the state-level Medicaid system revamp called Centennial Care.

Some providers named in the 2013 audit have paid settlements to the state without acknowledging wrongdoing in order to move forward and provide care. Some have closed their doors. This week, the Attorney General’s Office charged a former therapist for a Raton behavioral health provider with Medicaid fraud for allegedly providing false billing information to the agency.

Meanwhile, the state has changed the Medicaid system to better coordinate care “to be more patient-centered, to focus on the early identification of health care needs and really treat patients in a more holistic way,” according to HSD Secretary Brent Earnest.

That didn’t seem to be the standard operating procedure pre-audit. The audit alleged $36 million in overbilling, including from a web of six Southern New Mexico nonprofits that had top executives of interlocking companies on the payroll of a billion-dollar-a-year Arizona firm, and from the $23 million-a-year Medicaid-billing powerhouse Teambuilders, an interconnected business model incorporating everything from mental health services to real estate holdings for its officers developed by Santa Feans Shannon and Lorraine Freedle.

Last year, HSD said an initial decline in services provided was likely due to an “overutilization” in the Teambuilder region, and the Centers for Medicare and Medicaid Services found overall, 16 percent more New Mexicans received services post-audit. Now 83.8 percent more New Mexicans are receiving behavioral health care.

While the new 2014 tracking method substituted calendar year for fiscal, meaning there is no comparable figure for calendar 2013, the apparent huge increase in delivered care puts the shock of the audit and of the level of untreated behavioral health issues into perspective.

While some of the growth can be explained by expanded Medicaid eligibility offered by Obamacare and adopted by Gov. Susana Martinez, it would appear that if you hold providers accountable, they deliver more to the people they are supposed to serve.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.

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