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New Mexico Looking to Use Managed Care to Enhance Behavioral Health Services

State Health Department Demands Stronger Commitment from Managed Care Organizations to Improve Behavioral Health Access

May 29, 2024  – In a move to enhance behavioral health care in New Mexico, recently appointed Human Services Department Secretary, Kari Armijo, has announced new standards for managed care organizations (MCOs) tasked with administering Medicaid. Speaking to legislators last week, Armijo expressed the state’s intent to ensure these organizations invest more in addressing the access issues for those receiving Medicaid in the state.

During a session with the Legislative Finance Committee, Armijo revealed that the state would be imposing stricter obligations on MCOs to improve the timeliness and availability of behavioral health care. During a rebrand and revamp of Turquoise Care, the NM Human Services Department is set to introduce tighter turnaround times for patient appointments and mandate enhanced mobile crisis services, signaling a robust approach to tackling service accessibility issues head-on.

“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.”

The revamped system, dubbed Turquoise Care, will replace the outgoing Centennial Care setup, aligning with broader departmental reforms scheduled for implementation on July 1.

The state currently contracts with health insurers such as Blue Cross and Blue Shield of New Mexico, Molina Healthcare of New Mexico, Presbyterian Turquoise Care and United Healthcare Community Plan of New Mexico to manage Medicaid benefits. These firms are now facing increased pressure to ensure that consumers can access needed behavioral health services promptly.

Armijo outlined specific enhancements for MCOs, including a requirement for a face-to-face crisis care appointment within 90 minutes and initial behavioral health assessments within seven days of request. These are both significant improvements over the previous two-hour and 14-day standards, respectively.

Failure to meet these new standards could lead to sanctions, ranging from financial penalties to other corrective measures. This approach highlights the state’s commitment to accountability in Medicaid managed care and its goal of ensuring that consumers get the services they need.

Despite the intentions, some legislators voiced concerns about the practicality of these measures. Representative Reena Szczepanski of Santa Fe questioned the enforceability of the new standards, particularly given the vast provider networks and direct patient-provider interactions that bypass MCO coordination efforts.

In response, Armijo highlighted a shift in strategy, where insurers will work more closely with community providers to ensure that health assessments and care coordination are more integrated and locally focused. This will hopefully help make the health system more accessible and responsive to individual needs, especially in underserved areas.

As New Mexico moves forward with these changes, the focus remains sharply on enhancing the quality and accessibility of care for all Medicaid recipients, particularly those requiring behavioral health services.

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