Trying to Shape Up After a Shake Up

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By Lance Chilton

It wasn’t very good to begin with. Then, on June 24, 2013, it was thrown into complete chaos in an office in Santa Fe. “It” was the behavioral health “system” in New Mexico, and the Santa Fe meeting, informing 15 New Mexico providers of behavioral health services that there were “credible allegations of fraud, waste and abuse” in their Medicaid billing, and that Medicaid payments to them would cease They were told that they must continue to provide services to all of their clients (without payment) until their caseloads could be assumed by the Arizona companies that would come in to replace them.

New Mexico behavioral health care had been “held together by bandaids and chewing gum,” Española social worker/mental health provider Ambrose Baros said after a screening of a film about the debacle called The Shake-Up last week – originally scheduled for in-person viewing and switched to online due to the coronavirus epidemic. Alongside Mr. Baros, other panel participants included behavioral health provider and administrator Patsy Romero, State Senator and social worker Jerry Ortiz y Pino and Lieutenant Governor, and former teacher and state senator Howie Morales. The session was ably led by West Side Democrats chair Ellen Coplen and Bernalillo County Democratic chair Flora Lucero.

Where previously behavioral health services were hard to get, especially in rural areas of the state, after the shake up and the manifest failure of the Arizona companies to provide services or to retain the state’s limited behavioral health practitioners, there were virtually no services available.

Senator Ortiz y Pino synthesized the results: desperately short of services, those with mental illness and substance use disorders turned increasingly to drugs and alcohol, which fueled a need for cash and led to a spike in loss of life and to crime. We’re still dealing with the results, despite an increasing effort by the Michelle Luján Grisham administration to provide resources to mending the torn safety net.

Most of the accused providers, having little or no income, ceased operation and went bankrupt; the film shows former Albuquerque Hogares, Inc. leader Nancy Archer weeping quietly as she described the death of her agency. In 2016, Attorney General Hector Balderas cleared all of the agencies of all of the allegations, but it was too late for most.

As Lieutenant Governor Morales said, “it was a reminder of New Mexico’s darkest days. We need to make sure it never happens again.” Ms. Romero praised Senator Mary Kay Papen for introducing and getting passed a bill (2019 Senate Bill 41) to assure Medicaid providers’ transparency and due process if they are ever again accused of fraud or abuse.

There’s much more detail to be seen in the excellent film and the measured but powerful response from the panelists. Ms. Lucero promised that the film would be made available to local Democratic groups and that a video of the entire presentation would be available at bernalillodems.org. Indeed, we must learn from the bitter lessons here.