Cuts could affect substance abuse services
SANTA FE — In a legislative session that has been dominated by fiery debates over bills intended to crack down on crime, a quieter discussion has been taking place outside the spotlight. The topic: Just how deeply to slash funds to the state agency that provides mental health and substance-abuse services to the poor in New Mexico.
Mental health advocates say the two issues are closely related. Some experts worry that the flurry of crime bills supported by Republican Gov. Susana Martinez and GOP lawmakers will increase the state's prison population at a steep cost to taxpayers. And while tumbling oil prices have undercut tax revenues that New Mexico relies on to help fund more than $6 billion in state government services, behavioral health care programs meant to treat addicts instead of imprison them are facing potentially severe cuts.
Both the governor and the Legislature have asked for a reduction in spending on the Human Services Department’s Behavioral Health Services Division, which has been critical in funding substance-abuse prevention programs across the state. But while the governor’s request calls for a 1.2 percent cut, the Legislature is looking for a 19 percent cut to the division, seeking instead to shift some of its costs over to Medicaid, which is jointly funded by the state and federal government.
"I appreciate that they describe it that way," Human Services Department Secretary Brent Earnest said of the legislative recommendation, "but really overall, the recommendations from the executive budget provide more support for those services" provided by the division, services he said he'll do his best to protect.
As the House of Representatives prepares to adopt a new budget as early as this week based on lower revenue projections, Earnest said he anticipates his department could face even lower funding. Human Services is asking for the largest budget increase of any state agency because the federal government will begin stepping down the amount it contributes to the state's Medicaid expansion.
"We anticipate that the House budget is going to require some changes for Medicaid," Earnest said in an interview Saturday.
Cuts to behavioral health could impact people like Lauren Reichelt, health and human services director for Rio Arriba County, home to the nation's highest rate of heroin overdoses. Reichelt worries that further cuts will only hurt a state she says already faces a shortage of specialists and case managers who could help prevent a substance abuser who is released from detention from falling back into drug use.
Recently released offenders, she said, face higher risk for overdose deaths because they sometimes mistakenly believe their bodies can handle the same levels of a substance they took before landing in prison.
"We're spending a tremendous amount of our resources on our jails," she said. "Basically, we're warehousing people just like old 17th-century asylums."
On Saturday, she led a group that included recovering addicts on a walk from the Shrine of Our Lady of Guadalupe to the Roundhouse where, in front of Gov. Martinez's office, they placed candles and buttons of people with behavioral health issues who have died.
Talk of cuts comes as the state's mental health care system is still recovering from a 2013 shake-up in which the Martinez administration accused 15 behavioral health providers of defrauding the Medicaid program, effectively shutting down a network of providers that served 85 percent of the state's Medicaid population being treated for such services.
Attorney General Hector Balderas has not yet announced results of criminal investigations into 12 of those providers, but his office has already cleared three of them from criminal wrongdoing.
His office also is asking for increased state funding to cover costs of Medicaid fraud investigations.
Martinez has led the charge in urging lawmakers to crack down on repeat violent offenders and other tough-on-crime measures. At the same time, however, she said in her State of the State speech two weeks ago that preventing crime "also means working to prevent people from becoming criminals." She said her administration would use behavioral health care dollars "for new crisis triage centers, mobile crisis response teams and community behavioral health clinics."
And Martinez's administration currently is considering terminating a contract with OptumHealth, the company that initially sparked the behavioral health shake-up in 2013, according to legislative budget reports. Administration officials told budget analysts that the Behavioral Health Services Division could save up to $6 million over time by taking over the services it now pays OptumHealth to provide, including addiction treatment that isn't funded by Medicaid. Martinez has asked for 10 new state positions and over $400,000 in state funds so the state can transition off the Optum contract.
Martinez in 2013 implemented a new version of the state's Medicaid program, called Centennial Care, that integrates physical and mental health services.
"There's no health without mental health," Wayne Lindstrom, CEO of the state's Behavioral Healthcare Collaborative, a Cabinet-level panel that represents 15 state agencies and the Governor's Office, said in an interview.
But, as in the past, state lawmakers are running into budget constraints that have health care providers and others on the front lines worried about cuts to key services that have helped drug abusers out of a multigenerational addiction scourge that's torn at the social fabric of the state.
Behavioral health care providers such as Tiffany Wynn, executive director of the Santa Fe Mountain Center, have been sharing information about the potential cuts so they can lobby against them this week. A talking-points sheet distributed by providers, based on discussions with officials, says that $8 million in cuts to the Behavioral Health Services Division proposed by the legislative budget would impact 25 programs and 20,000 clients. Transitional living services, housing and the New Mexico Crisis and Access Line -- which helps New Mexicans in mental health emergencies and makes referrals to providers -- are facing more than $1 million in cuts, the providers fear, which could mean provider agencies would have to shut down. Wynn on Saturday cited studies that show every dollar spent on substance-abuse treatment saves taxpayers $7 due to reduced prison and medical care costs.
Many substance-abuse prevention services have not historically been eligible for coverage under Medicaid, which covers a medical detox that might prevent an overdose death, but sometimes not social detox that could allow an addict's mind and body to heal.
That's changing on both the federal and state levels. Becky Kenny, spokeswoman for Blue Cross Blue Shield of New Mexico, one of the four managed care companies that in 2013 contracted with the state to compete for Medicaid patients, said in an email that its Medicaid plan has "always offered residential treatment for drug abuse for Centennial members with complicating medical issues as a value added service.
"In addition, based on one of the more significant changes in the Mental Health Parity and Addiction Equity Act (MHPAEA) final rule, BCBSNM expanded its coverage for mental health and substance use disorder services provided in residential treatment centers for all New Mexico members," she said. The new federal law that calls on insurance companies to cover mental health treatment in similar ways it does physical health care.
The four managed care organizations have hired employees like Russell Liles, a manager of UnitedHealthcare's Behavioral Health Recovery, Resiliency, and Peer Support New Mexico Health Plan.
At a behavioral health care summit held at The Lodge at Santa Fe on Friday, Liles shared his story of recovering from addiction with an audience of mental health professionals, advocates and recovering addicts. The Legislature can give all the money in the world, he told the gathering, but if people's attitudes don't change about recovery being possible then nothing will change.
Historically in New Mexico, managed care companies the state has paid to distribute and manage Medicaid cash have been reluctant or unable to cover more expensive services to treat mental health and substance-abuse problems, shifting state money to provide coverage for physical healthcare services instead.
Reichelt said she's worried that shifting funding from the Human Service Department's Behavioral Health Service Division to Medicaid will remove funding that's helped establish services to treat those with substance-abuse disorders, such as mobile crises response units, which are not covered under Medicaid.
Reichelt has seen firsthand the damage caused by addiction in a county that has an overdose death rate 10 times the national average. She's not short of tragic stories of children being shot by an addict breaking into a home to steal syringes.
But there's hope. With the help of outside money, Reichelt said, Rio Arriba County has built a network of services. Now the problem is connecting those services so those in need of treatment may receive it seamlessly. Currently, she said, a substance abuser must complete eight days of detox and needs medical clearance before he or she is eligible for a lengthier stay.
"But we don't have detox anymore," she said.
Rio Arriba County officials have been relying on the Hoy Recovery Program, which houses 36 beds in its Paseo de Oñate facility in Española, for substance abusers and pregnant women in emergencies. Ambrose Baros, executive director of the program, said the state's Behavioral Health Services Division supports critical services that are not covered under Medicaid.
And the substance-abuse problems in Rio Arriba County often require complex treatments. Heroin and opioid painkillers aren't the only drugs causing overdose deaths in the Española Valley. Often, multiple substances are to blame for overdose deaths, Baros said.
"A lot of the addicts that we're seeing are poly-substance," he said. "So they're not only using heroin, they're using meth. Or they're using alcohol with meth, you know, or just pills, Xanax or benzodiazepine, meth. And so there's a lot of that poly-substance withdrawal going on, and medical detox has to be monitored closely by medical staff so it's primarily done in the hospital."
He said his organization would like to work with the hospital more so such drug abusers can detox in a social setting.
"That's what the Behavioral Health Services Division funds pay for," he said. "They pay for the sub-acute detox, the short-term, long-term, transitional living. It pays for case management, for 911 crisis mobile units to go into communities. So it picks up a lot of service that is definitely needed in communities that we really can't afford to have cut. And right now, there are gaps of service that Medicaid does not pay for."