Despite spending increases, report finds NM health care access not improving

SANTA FE — As part of a “secret shopper” study, New Mexico legislative analysts confirmed what many New Mexicans already knew all too well.

The typical new patient has to make six or seven phone calls to book an appointment with a primary care physician and about 14 calls to make an appointment with a behavioral health provider, the Legislative Finance Committee investigation found.

The findings were included in an LFC report on Medicaid released Tuesday that generated a mix of frustration and concern among lawmakers, who have tried in recent years to shore up a statewide health care provider shortage.

Sen. Linda Trujillo, D-Santa Fe, described her own personal experiences with canceled appointments and turnover among health care professionals, saying health care is a “real struggle” for many New Mexicans.

“I don’t even know who my new primary care provider is,” Trujillo said during Tuesday’s meeting of the LFC in Hobbs.

Despite Medicaid spending in New Mexico surging to $10.6 billion annually and recent provider rate increases, statewide health care access and quality have either stayed the same or worsened, the legislative report released Tuesday found.

In addition, New Mexico’s Medicaid enrollment levels have actually decreased over the last several years even as total spending on the joint-federal health care program have continued to rise.

There were roughly 807,000 New Mexico residents enrolled in Medicaid as of August — or about 38.1% of the state’s population.

Before that, the state’s Medicaid enrollment had topped out at about 992,000 individuals in the 2023 budget year, due primarily to temporary federal rules enacted during the COVID-19 pandemic that barred people from being disenrolled.

The 180,000 individuals who were removed from the state’s Medicaid rolls during the roughly two-year period had not filled out the necessary paperwork to remain enrolled, said Alanna Dancis, the chief medical officer for the state Health Care Authority.

She also disputed some of the legislative report’s findings, saying recent state data shows progress on hiring new providers.

Health care in focus as special session nears

The report comes as lawmakers are preparing for a special legislative session in which health care funding is expected to be a primary focus.

Gov. Michelle Lujan Grisham has said she will call legislators back to the Roundhouse on Oct. 1 to approve a state-level response to a federal budget bill signed by President Donald Trump.

While many of the changes in the federal budget bill are not slated to take effect until 2027, state health officials have projected about 90,000 state residents will eventually lose Medicaid coverage due to new work and eligibility requirements.

But the LFC report indicates more state spending might, by itself, not be enough when it comes to increasing the number of New Mexico health care providers and making it easier for state residents to access care.

Over the last three years, legislators have targeted $2.2 billion to increase provider rates and help cover the start-up costs connected with new services, the report found. Much of that funding has been directed to hospitals.

However, that funding infusion did not immediately lead to more providers being hired, as the state lost roughly 1,500 behavioral health providers between 2022 and 2024, according to legislative data.

“The rate increases do not seem to be attracting providers in the way that we’d hoped,” said Allegra Hernandez, an LFC fiscal analyst.

The lack of progress in most areas could prompt lawmakers to pursue other approaches when it comes to health care access, including joining interstate medical compacts.

Meanwhile, the report also found that only about 31% of Medicaid recipients who visit the emergency room due to behavioral health needs, either mental health or substance abuse issues, receive a follow-up within seven days.

The report also included legislative analysts making more than 250 phone calls to both health care and behavioral health providers around the state to gauge access and availability as part of the “secret shopper” study.

That informal study found that 17% of all providers could not be reached either because the phone number was incorrect or the call was not answered.

Reasons for optimism?

Despite the challenges, some lawmakers expressed optimism that a behavioral health system overhaul approved this year will lead to better outcomes in the future.

Under the new system that took effect in July, different regions of the state will have to submit plans on how to prioritize state funding for mental health and substance abuse treatment services. The state’s judicial branch is also taking on a larger role in analyzing and approving those plans.

Sen. George Muñoz, D-Gallup, the LFC’s vice chairman, said the state has had to rebuild its behavioral health system after it was upended by former Gov. Susana Martinez in 2013.

Specifically, the Martinez administration froze payments to 15 behavioral health providers due to alleged overbilling and fraud. But no criminal charges were ever filed and some of the agencies ended up shutting down.

More than a decade later, Muñoz said legislators are still seeking better results for the money they’ve spent.

“I think we’re all puzzled about why this is not happening,” he said during Tuesday’s meeting. “It’s not because we didn’t put the money there.”