Despite some growth, N.M.'s behavioral health system still lacking, analysis says

Jul. 16—The number of behavioral health providers offering Medicaid services has been slowly on the rise over the last few years.

But, a state analyst told lawmakers this week, much of that growth came from a single managed care network, under an insurer no longer in the Medicaid game in New Mexico — and in any case, it's not enough to meet the needs of the state.

"We are improving our networks ... within Medicaid. We are increasing providers out there," said Eric Chenier, principal analyst for the state's Legislative Finance Committee during a Monday meeting in Socorro. "But one issue with that ... is that most of the providers that we've added within Medicaid's network over the past year or two [were] within Western Sky."

Western Sky Community Care used to be one of New Mexico's "managed care organizations," insurance companies contracted by the state to organize and manage benefits for certain Medicaid patients. The company bid on a new contract last year but received the lowest score among the bidders during an evaluation process and wasn't recommended for a new contract.

"They kind of built up this network," Chenier said. "It's been doing a lot better, but now we're losing them."

Chenier offered a dreary view of New Mexico's beleaguered behavioral health system, which for years has struggled to meet the state's needs, particularly for the low-income Medicaid population. In some ways, that system is still rebuilding more than a decade after former Gov. Susana Martinez's administration froze Medicaid funding to 15 behavioral health providers due to allegations of widespread fraud. No fraud was ever proven, and the state has since paid settlements to several of those providers.

But some lawmakers on Monday expressed frustration with the lack of progress.

"I don't know how many years we've talked talked about since the last administration rebuilding mental health," said Sen. George Muñoz, a Gallup Democrat and chairman of the Legislative Finance Committee. "I mean, we're throwing everything but the kitchen sink ... and I don't really know how to fix it from here on forward."

Chenier didn't offer specifics about how many of the newly added behavioral health providers were only credentialed through Western Sky's network and not through New Mexico's other managed care organizations. But, he said, one barrier to the state's efforts to pump up the ranks of its behavioral health providers is the red tape those professionals have to push through to serve Medicaid patients.

"Currently, providers must become credentialed ... through each managed care organization separately before seeking reimbursement from the managed care organization," Chenier said.

Among other recommendations, Chenier said Medicaid should be required to implement a "single credentialing" process where a provider — like a therapist or a counselor — only has to go through one credentialing process to receive reimbursements for Medicaid patients, no matter which managed care organization the patients belong to.

"Single credentialing ... would allow providers to just go to the department, get credentialed there, and then it would reduce a lot of the bureaucratic kind of work that providers have to do," Chenier said.

New Mexico leaders have made efforts to bolster the state's fragile behavioral health system in recent years, including a 25% increase in funding since the 2022 fiscal year and a focus on bolstering workforce, building capacity and increasing Medicaid rates, Chenier said.

But challenges remain.

The state's Interagency Behavioral Health Purchasing Collaborative, created in 2004 as a single statewide behavioral health system, has been without a CEO since last year, Chenier said.

And the state ranks 47th in the country for youth substance use disorder and 42nd for youth with a major depressive episode, according to Chenier's analysis. For overall mental illness prevalence in both adults of all ages, New Mexico ranks 36th.

"We still do rank pretty poorly on a lot of these kind of key behavioral health metrics," Chenier said.

While lawmakers have been spending more on improving behavioral health services, Chenier said when it comes to building out provider networks, the managed care organizations — which hold hefty state contracts — have a responsibility to make those changes. And, he said, state leaders need to hold their feet to the fire to do it.

"[The state should be] overseeing those performance targets, making sure that they meet those performance targets and if they don't ... enforcing those penalties," Chenier said.

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