N.M. must take care when terminating DD Waiver providers
When it comes to reevaluating its contracts with providers who serve those with developmental or intellectual disabilities, the state needs to tread very carefully — especially considering the overbroad and devastating shuttering of behavioral health providers a decade ago, as well as the more recent impacts of COVID-19 and pandemic closures on providers and clients.
Last week, the Department of Health announced it had terminated the behavioral health contracts of four agencies that provided services to a client who suffered serious injuries while under the supervision of an at-home caregiver employed by Albuquerque-based At Home Advocacy Inc. Corrales-based A New Vision Case Management, Albuquerque-based Lynn Barbour LLC and Los Ranchos-based Sylvester & Company had their contracts terminated because they were part of the interdisciplinary team providing services to the injured client.
Those four terminated agencies were delivering services to 708 people in the DD Waiver program, leaving a large void as they work to place their clients with other approved providers by an April 30 deadline. Considering that the most recent information on the DOH website says there’s a 13-year wait list, that’s a Sisyphean task.
Gov. Michelle Lujan Grisham described the client’s injuries as “horrific,” although few details have been disclosed. The client was part of the state- and federally funded Developmental Disabilities Waiver program, which enables people to receive various types of services in the community as an alternative to institutional care.
In the wake of that case, the governor this week announced a sweeping plan for state employees to conduct in-person wellness checks within a month on all of the 6,000 adults who receive care as part of the DD Waiver. The governor said more than a thousand clients have already been interviewed, resulting in a handful of cases of possible abuse or neglect, including three cases where clients died and cases of malnourishment.
The governor is prudent to commission a “deeper look at the entire system,” and state officials are asking anyone who suspects abuse to report it to Adult Protective Services Statewide Intake at 1-866-654-3219.
But the governor also needs to be prudent in her actions regarding the providers following the wellness checks.
Gigi Chinisci, whose son has received services from A New Vision Case Management and Sylvester & Company for more than a decade, called those two terminations an “extreme knee-jerk reaction.”
“I agree individuals need to be held accountable and justice served, but don’t throw out the baby with the bath water,” Chinisci wrote in a guest column published in the March 19 Sunday Journal.
Because of a single act, she wrote, “hundreds of caregivers, therapists and social workers have lost their jobs and the 708 clients’ lives have been upended.” Chinisci has a point: We’ve seen this before. The Human Services Department under then-Gov. Susana Martinez abruptly froze Medicaid payments to 15 nonprofit mental health providers in 2013 after an audit showed overpayments and possible fraud. Some of the New Mexicobased providers, which were replaced by five Arizona companies hired on no-bid emergency contracts, were forced to close, resulting in hundreds of job losses in the sector.
The consequences were devastating with treatments for substance abuse or mental health issues ending without warning. Then-Attorney General Hector Balderas cleared the 15 nonprofits of Medicaid fraud in April 2016, but his office uncovered a total of $1.16 million in overbilling. And patients and providers were stuck in the crossfire. N.M. families have long had agonizing waits for developmental disability services; too often the wait exceeds the potential client’s lifespan. Cutting off four agencies serving hundreds of clients won’t help families awaiting help.
And this comes on the heels of the governor’s COVID-19 lockdowns, when thousands of New Mexicans with developmental disabilities got reduced services.
Legislators have examined tapping funding to move all on the waiting list into services, but we need providers as well.
Abusing developmentally or intellectually disabled folks is despicable and intolerable, but denying vital services in an overreaction is no better. History shows the state must be careful when it comes to cutting off providers.