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Provider shortages and limited availability of behavioral health services in New Mexico’s Medicaid managed care
Provider shortages and limited availability of behavioral health services in New Mexico’s Medicaid managed care
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Reports-in-brief (Promoting Women in Development (Project))
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections, issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, September 2019
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Behavioral Medicine -- statistics & numerical data
Health Workforce -- statistics & numerical data
Managed Care Programs
Medicaid
New Mexico
United States - Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. 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 (OIG) 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. How OIG Did This Review. We analyzed State Medicaid managed care data on the number of behavioral health providers and the number of managed care enrollees by county. We also conducted a survey of selected BHOs that play a critical role in providing services to the State's Medicaid enrollees as well as to uninsured residents. In addition, we interviewed selected providers, State Medicaid agency officials, and key stakeholders. What OIG Found. Despite the need for behavioral health services--which includes treatments and services for mental health and substance use disorders--many counties in New Mexico have few licensed behavioral health providers serving Medicaid managed care enrollees. These behavioral health providers are unevenly distributed across the State, with rural and frontier counties having fewer providers and prescribers per 1,000 Medicaid managed care enrollees. Further, a significant number of New Mexico's licensed behavioral health providers do not provide services to Medicaid managed care enrollees. In addition, most of the State's licensed behavioral health providers serving Medicaid managed care enrollees work in behavioral health organizations (BHOs), which include federally qualified health centers and community mental health centers; however, BHOs report challenges with finding and retaining staff, as well as ensuring transportation for enrollees. As a result, these organizations cannot always ensure timely access for enrollees seeking behavioral health services. These organizations also report difficulty arranging or making referrals for services that they do not provide largely because of the lack of providers. In addition, they report challenges with continuity of care for enrollees, citing limited care coordination and lack of integration of primary and behavioral healthcare, provider shortages, and barriers to sharing health information, such as a lack of access to broadband. Nonetheless, BHOs highlight promising initiatives to increase the availability of behavioral health services, including open-access scheduling, treatment first, care integration, and telehealth. What OIG Recommends. Although this report focuses on New Mexico, it provides insights into challenges that are likely shared by other States providing behavioral health services to Medicaid enrollees, especially in rural and frontier counties. In addition, because of the breadth and depth of these issues, additional support at the national level is needed. Therefore, we recommend that the Centers for Medicare & Medicaid Services (CMS) identify States that have limited availability of behavioral health services and develop strategies and share information with them to ensure that Medicaid managed care enrollees have timely access to these services. We also recommend that the New Mexico Human Services Department expand New Mexico's behavioral health workforce that serves Medicaid managed care enrollees. It should also improve access to services by reviewing its access to care standards and by increasing access to transportation, access to broadband, and the use of telehealth. Lastly, it should improve the effectiveness of services by increasing adoption of electronic health records, identifying and sharing information about strategies to improve care coordination, expanding initiatives to integrate behavioral and primary healthcare, and sharing information about open-access scheduling and the Treat First Clinical Model. Both CMS and the New Mexico Human Services Department concurred with our recommendations.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (47 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 101757663 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101757663