It’s a complex issue without simple solutions, but is also one growing more urgent — how to provide care for thousands of New Mexicans with behavioral health issues, substance use disorders and/or brain injuries who are at risk of institutionalization or incarceration.
Finding a solution has implications for scores of people experiencing homelessness or who are teetering on the edge of life on the streets due to their conditions. There are also public safety considerations as more extreme cases can result in violence or other offenses. Advocates say those who aren’t capable of autonomously managing their affairs are often caught in a revolving door of emergency room visits, detox facilities and jails, only to be released without needed treatment.
One potential solution gaining momentum would be modeled on an existing program: the state’s developmental disability Medicaid waiver program. Proposed legislation for a behavioral health Medicaid waiver equivalent is in the works in advance of the 60-day legislative session scheduled to begin Jan. 21 in Santa Fe.
“We’re trying to create an exact counterpart, but to no longer say you only get it if you’ve got an intellectual disability or a low IQ score, autism or other developmental disability,” Peter Cubra, an Albuquerque attorney who has represented individuals with disabilities for 40 years, said.
While the behavioral health waiver would be primarily funded through the federal government’s Medicaid program, it still requires state funding and support. The federal government covers 75% of the costs in the developmental disability waiver program, while the state picks up 25%.
Cubra said the first step is to secure startup money from the state — about $1 million — to pay for an initial phase of consultants, technical assistance, employee training and to build interest from provider agencies.
The Homeless Coordinating Council, consisting of members from the city, Bernalillo County and the University of New Mexico Board of Regents, recently put its support behind the idea. The council is in the process of drafting a letter to the New Mexico Health Care Authority, seeking support.
“We’ve got the city and the county onboard now, and we have a lot of legislators who are onboard, too,” Cubra said.
Even though the measure comes with considerable costs and legwork, Cubra said it would save local governments money and resources in the long run. He said millions are spent each year to handle behavioral health issues, including first responder calls, emergency rooms and urgent care services, hospitalizations, drug rehab services and homeless shelters. In some cases, law enforcement is involved and there are costs associated with prosecution, public defenders, courts, jails and probation and parole.
Effective remedy
About 6,800 New Mexicans are currently enrolled in the developmental disability waiver program — in place since the 1980s when Congress allowed states to set up waivers for Medicaid to pay for care without institutionalization. Those in the program receive housing assistance, case management and other wrap-around services like day programs, and in some cases, 24/7 supervision.
Proponents of a behavioral health counterpart say it would have those features and potentially others.
For example, some participants in the developmental disability program live in three-and-four person group homes with a staff person. There are also individuals who live independently in an apartment where 24/7 oversight isn’t necessary.
“They’re not just homebound people. They have a case manager who checks on them and then on an as needed basis if something comes up,” Cubra said.
Cubra also thinks the behavioral health waiver program could have an adult foster care component, where a person is integrated into a family home.
“I think that a lot of people with psychiatric conditions and with substance use disorder conditions or brain injury could be served in a home,” he said. “What if we paid a stipend to the family so mom could quit her job and keep that person under their own supervision, like we do for people with developmental disabilities?”
Cubra also believes the behavioral health waiver would make the push to expand court-supervised outpatient treatment for people with mental illness obsolete.
Gov. Michelle Lujan Grisham called a special session in July to expand such a measure, but her plans were met with resistance by lawmakers on both sides of the aisle. The Governor’s Office didn’t respond to a request for comment on whether it would support a behavioral health waiver program.