Provider Shortages and Limited Availability of Behavioral Health Services in New Mexico's Medicaid Managed Care

Submitting OIG:

Department of Health & Human Services OIG

Report Description:

Medicaid plays a critical role in providing behavioral healthcare. Nationally, Medicaid is the single largest payor for behavioral healthcare. In addition, Medicaid enrollees experience a higher rate of behavioral health disorders-which includes both mental health disorders and substance use disorders-than the general population. In spite of the importance of treating such disorders, many Medicaid enrollees encounter significant barriers when accessing behavioral health treatment. The need for behavioral health services is particularly pronounced in New Mexico-a State that has among the highest rates for suicide and deaths from overdose in the Nation. The Office of Inspector General received a congressional request to look into concerns about behavioral health provider shortages and the availability of care for Medicaid managed care enrollees; these enrollees account for most of New Mexico's Medicaid population.

Date Issued:

Thursday, September 12, 2019

Agency Reviewed / Investigated:

Department of Health & Human Services

Submitting OIG-Specific Report Number:

OEI-02-17-00490

Component, if applicable:

Centers for Medicare & Medicaid Services

Location(s):

Agency-Wide

Type of Report:

Inspection / Evaluation

View Document:

Attachment	Size
oei-02-17-00490.pdf	2.8 MB

Additional Details Link:

https://oig.hhs.gov/oei/reports/oei-02-17-00490.asp

Related Open Recommendations

Recommendation Number	Recommendation Status	Significant Recommendation
6035	Open	Yes
CMS should identify States that have limited availability of behavioral health services and develop strategies and share information to ensure that Medicaid managed care enrollees have timely access to these services.
6036	Open	No
New Mexico Human Services Department should take steps to expand New Mexico’s overall behavioral health workforce.
6037	Open	No
New Mexico Human Services Department should increase behavioral health providers’ participation in Medicaid managed care.
6038	Open	No
New Mexico Human Services Department should review its standards governing access to care and determine whether additional standards are needed for behavioral health providers.
6039	Open	No
New Mexico Human Services Department should improve access to transportation for Medicaid managed care enrollees needing behavioral health services.
6040	Open	No
New Mexico Human Services Department should work with State partners to strengthen access to broadband in rural and frontier counties.
6041	Open	No
New Mexico Human Services Department should expand the use of telehealth to increase the availability of behavioral health services.
6042	Open	No
New Mexico Human Services Department should take steps to increase adoption of electronic health records and participation in the State Health Information Exchange by behavioral health providers.
6043	Open	No
New Mexico Human Services Department should identify and share information about strategies to improve care coordination.
6044	Open	No
New Mexico Human Services Department should expand initiatives to integrate behavioral and primary healthcare.

Recommendation Number

Recommendation Status

Significant Recommendation

Additional Details

6035

Open

Yes

CMS should identify States that have limited availability of behavioral health services and develop strategies and share information to ensure that Medicaid managed care enrollees have timely access to these services.

6036

Open

New Mexico Human Services Department should take steps to expand New Mexico’s overall behavioral health workforce.

6037