OPINION: Lawmakers need to create a behavioral health waiver to save lives and money

As a life-long advocate for people with disabilities and a lawyer, I have worked on behalf of thousands of New Mexicans whose disabilities render them unable to manage their affairs.

Some have “developmental disabilities” (DD). Others have “behavioral health disabilities,” resulting from serious mental illness, a substance use disorder or brain injury.

I am writing to urge the Journal and its readers to support House Bill 70, which would create a Medicaid waiver program for people with “behavioral health” disabilities that is comparable to the “DD waiver,” a 40-year-old program that provides permanent supportive housing, case management and wraparound services to 7,900 people with a low IQ score or a specified developmental disability.

The federal government pays 74% of the DD waiver costs through Medicaid.

People with “behavioral health” disabilities, who simultaneously have a low IQ score or another developmental disability, receive “DD waiver services.” But people with a few more IQ points, even those who are far more severely incapacitated, cannot get those services.

As a result, many are homeless and some are caught in a revolving door of being taken emergently to a hospital, detox facility or jail, only to be released without arrangements for follow-up treatment. Each year, several of those severely disabled people die due to neglect. This situation is discriminatory, as well as irrational and cruel.

HB 70, sponsored by state Rep. Tara Lujan, D-Santa Fe, requires the state Medicaid agency, the Health Care Authority, to:

• Immediately begin holding public meetings with persons with behavioral health disabilities and their family members, providers of behavioral health services, the University of New Mexico, advocates for persons with disabilities and county and municipal officials to determine the best way to apply to the federal Centers for Medicare and Medicaid Services (CMS) for authorization to operate a Medicaid waiver program for persons with behavioral health disabilities.
• Appropriate $1.1 million to retain a consulting entity to assist in the development of that application, and to hire four full-time employees to work exclusively to develop and submit the application for a Medicaid waiver program.

Several states operate this type of Medicaid-funded waiver program for people with behavioral health diagnoses. Why doesn’t New Mexico?

This waiver would save New Mexico a lot of money. We currently spend many millions of state and local dollars every year on a few thousand New Mexicans who are chronically incapable of self-sufficiency due to their behavioral health diagnoses, but who don’t meet the criteria for DD waiver services such as fire department and ambulance responses to behavioral health and public intoxication crises, emergency room and urgent care services, hospitalization and drug rehabilitation services, and homeless shelters.

For a percentage of these people, we also pay for police, prosecution, public defenders, courts, jail, probation and parole. Creating a behavioral health waiver program will ultimately save money for state and local governments, because the federal government will pay 74% of the cost.

More importantly, a behavioral health waiver would save lives and substantially reduce numerous social problems resulting from the status quo — where only people who lack the capacity to manage their own affairs due to intellectual and developmental disabilities get the benefits of a home and community-based waiver program.

Now is the time to provide people with similar needs, but who have typical IQ scores, with comparable services, and stop New Mexico’s pattern of leaving them to fend for themselves, causing substantial harm to them and their families and, sometimes, to their local communities.

It is unjust and cruel to devalue people with behavioral health conditions this way, and HB 70 is designed to end that discrimination. If not now, when?