By Gabrielle Porter, The Santa Fe New Mexican

New Mexico’s Medicaid middlemen need more skin in the game.

That’s the message from Human Services Department Secretary Kari Armijo, who told lawmakers last week her department is ratcheting up pressure on insurance companies that provide coverage to nearly half the state’s residents to do more to address behavioral health care access.

Armijo told members of the Legislative Finance Committee that fixing those access issues will involve “leaning very heavily” on those firms — known as managed care organizations — to put their money where the largest gaps are.

“They should be making financial investments,” Armijo said at a Wednesday meeting. “We’ve really tasked them with reviewing the behavioral health network, looking at where we need services, making investments. It shouldn’t just be the state of New Mexico.”

Armijo’s department, which overseas Medicaid, is in the midst of overhauling its managed care program, replacing the old Centennial Care system with the rebranded and revamped Turquoise Care. The department itself also is undergoing a major reorganization set to officially roll out July 1, when it will change its name to the New Mexico Health Care Authority.

Most Medicaid patients in New Mexico fall under the managed care program, in which the state government contracts with a number of health insurance companies to organize and manage benefits for members. New Mexico’s four managed care organizations under Turquoise Care are Blue Cross and Blue Shield of New Mexico, Molina Healthcare of New Mexico, Presbyterian Turquoise Care and United Healthcare Community Plan of New Mexico. Open enrollment for Turquoise Care via those plans is ongoing through the end of this month.

Health care accessibility is an issue across the board in New Mexico, where patients often have to wait weeks or months to see providers. But those problems pack a particular punch in the realm of behavioral health.

Armijo said part of the MCOs’ new contracts include more stringent expectations for behavioral health appointment wait times, which will go into effect in July, as well as new responsibilities for the insurers in providing mobile crisis services for children and adults.

“We all are concerned about families experiencing crisis [and] children in state custody,” Armijo said. “Those services will be there to support and wrap around those families who are experiencing those crises.”

Those new appointment standards include:

• A face-to-face appointment should be available within 90 minutes for people looking for crisis care. The previous contracts called for appointments within two hours.
• An initial assessment should be available within seven days of a request for non-urgent behavioral health care. Previous contracts called for assessments within 14 days.

If the MCOs don’t meet those standards, their contracts say the state can impose sanctions, both monetary and non-monetary.

Some lawmakers said they welcomed the new standards, but questioned how they will work.

Rep. Reena Szczepanski, D-Santa Fe, questioned how the insurers will be able to oversee provider wait times when so many patients call providers directly for appointments, rather than using the MCOs’ care coordination services.

“I think about how an MCO would even go about enforcing that with these huge provider networks,” she said. “… How do we know that people are actually getting help faster?”

Armijo said the state is shifting a little-known dynamic within the managed care model. Currently, the insurers perform health risk assessments of people enrolled in their plans. One problem, Armijo said, is that most patients don’t really know what an MCO is or what its role is, so they may not respond to those companies or want to participate in those assessments.

In Turquoise Care, the insurers will delegate more of that work to community providers by contract.

“For pregnant women, for example, you don’t really know who this MCO person is,” Armijo said. “But if someone from their doctor’s office is reaching out and helping, they have the ability to coordinate that care more locally.”

A big adjustment

Szczepanski said in an interview she thinks that shift will be important.

“Anything we can do to make the system easier to access, to make it so that no door is the wrong door for someone to access the health they need” is a good thing, she said.

Rep. Gail Armstrong, R-Magdalena, questioned whether either the MCOs and the on-the-ground health providers really have the capacity to meet those goals.

“I’m wondering, if you’re mandating the MCOs to make sure these appointments happen within seven calendar days, the actual behavioral health specialists that are seeing the people, how are they going to manage that?” Armstrong asked. “Because they’re already overworked, and I would assume, seeing as many patients as they possibly can already.”

Pointing to recent increases in Medicaid reimbursements and expansions of services that can be reimbursed, Armijo said efforts are being made to build out the entire health care system “so there’s not as much pressure on a single provider. But she also emphasized the state is looking to the MCOs to step up financially to support the providers.

“I think it really does require this system to come together and strategically look,” Armijo said. “We really need these carriers who … we’re paying billions of dollars to make those investments.”

Committee chairman Sen. George Muñoz, a Gallup Democrat, said he’s frustrated at how long it’s taking for services to come online in recent years, pointing to the $31 million that was part of the Human Services Department’s budget the agency didn’t spend last year. Referencing six certified community behavioral health clinics expected to come online next year, Muñoz said he doesn’t think they’re enough.

“I don’t know how many years we’ve talked about behavioral health … because of what happened [with] the prior administration,” Muñoz said, referencing the decision under former Gov. Susana Martinez to freeze Medicaid funding to 15 providers due to ultimately unproven allegations of fraud. “But we’re six years into this administration. … It’s not for lack of money. It’s not for lack of resources.”