Valle del Sol exit means more uncertainty for behavioral health

For 2 1/2 years, Natalie Paynter was an employee at TeamBuilders Counseling Service in Taos, which worked with kids and families who were having a hard time.

Kids might seem depressed or be acting up in school. They might be getting in trouble with the law. They might be using drugs. And the family wants help. Paynter’s job was to help break cycles of trauma and deal with deep-seated issues that can affect many aspects of their lives. For anyone covered by Medicaid, the services were free. Hundreds of families in Taos County took advantage of the help.

In an interview, Paynter said there were plenty of successes, in part because therapists and their clients built relationships founded on trust and reliability. “I saw people get close and get vulnerable and get down into that place of accessing and using support in really challenging family systems,” she said.

But in the last three years, the bedrock of these services has been shaken, some experts say. Agencies have been replaced, staff and clients have been shuffled from one provider to another – and now there’s a fear that the behavioral health services in New Mexico may never fully recover.

In 2013, TeamBuilders and 14 other behavioral health providers across the state saw funding frozen when they were accused by state officials of defrauding Medicaid, the primary revenue stream for these organizations.

TeamBuilders went under, and it was replaced by Arizona-based Agave Health, which hired Paynter and others to continue offering service in Taos and across Northern New Mexico. Then, last year, Agave announced it would stop providing services in the state. A big reason was the company lost $4 million in two years, according to publicly available audits.

For Paynter, that transition meant she was out of a job. It also meant families that relied on Agave were once again shuffled to a new provider, although family members may have already formed a bond with Agave employees.

Valle del Sol —another Arizona firm that swooped in to replace a New Mexico provider that saw funding frozen — agreed to take on Agave patients. But now Valle del Sol is bowing out. The company announced it will cease services in New Mexico in April. Once again, staff and families have been thrust into uncertainty.

For Paynter, the news brings back horrible memories. She knows how hard it will be for Valle staff and its clients.

Agave served several northern communities, including Clayton. Paynter said no provider stepped in to fill the void in that town when Agave left. Families had no obvious option for care. Paynter says staff members were directed to tell clients to call their insurance company. It felt like a cold thing to tell people with whom a provider had worked with for months. The thought of it still brings Paynter to tears.

“It’s so depressing and so scary, especially for children, but also for adults and for these families who you’ve become part of their week-to-week or day-to-day life,” she said. “And now, some of the providers who are going to be leaving Valle, this is going to be their third iteration [moving from TeamBuilders to Agave to Valle]. And for some of those clients, it will be their third iteration. It’s traumatic. It’s traumatic for the providers and it’s traumatic for the families.”

‘Destroyed’

In a phone interview with The Taos News, Agave CEO Kurt Sheppard said the company was leaving the state for financial reasons. Sheppard said the company had millions in losses since it entered the New Mexico market, and it saw no way to stem the tide. Sheppard said the company struggled to break even, in part because it had a hard time recruiting qualified staff and serving extremely rural areas.

Sheppard said neither looming cuts to Medicaid at the state level nor the additional client load it took on from Agave had a role in Valle’s final decision.

But Sheppard acknowledged that no excuse would make the uncertainty caused by Valle’s exit any easier for clients.

“This is a tough decision, one that we don’t feel good about,” Sheppard said. “But how bad we feel about it doesn’t take away the trauma.”

At last count, Sheppard said the company served about 2,300 clients across New Mexico, including 164 at the Taos office.

As of last week, it wasn’t clear what options would be available to Valle patients. In an emailed statement sent Jan. 4, Kyler Nerison, a spokesman for the New Mexico Human Services Department, said the agency’s “top priority is protecting access and maintaining care for those who need it.”

Nerison offered a similar statement — almost verbatim — when Agave left.

The spokesman did not respond to requests for interviews with staff members who oversee behavioral health services.

Despite yet another disruption in provider service, Nerison said access to behavioral health services has increased 75 percent statewide since 2013. But some in the behavioral health field paint a much less sunny picture.

“The behavioral health system in New Mexico has been destroyed,” said Dorothy Forbes, who worked for Easter Seals El Mirador in Taos until 2014, when that organization saw Medicaid funding frozen and was replaced by Valle del Sol.

Forbes worked with Easter Seals for six years. In that time, she said the nonprofit often operated at a loss, but it managed to get by because it was community based and could keep costs low.

The allegations of fraud threw the company into a tailspin. Even after the New Mexico attorney general cleared each of the providers of any “pattern of fraud,” Forbes said it’s impossible to put the pieces back together.

By April 2016, when the last of the providers were cleared of any significant fraud, the controversy had taken on an overtly political tone. Democrats have called Republican Gov. Susana Martinez “reckless” for freezing funding. The Martinez administration countered that the Democratic attorney general’s conclusion “reeks of bad politics” and allowed the agencies to “get away scot-free.”

Beneath the political rancor and wonky debates over health care funding, Forbes said the impact to children and their families has been devastating. And she said those impacts will reverberate.

Organizations like TeamBuilders and Easter Seals, then Agave and Valle del Sol, are on the front lines of helping kids overcome difficult circumstances and give them a shot at a successful, happy life, Forbes said.

Filling the void left by an outgoing provider isn’t as simple as a new provider stepping in. Those families that were once willing to open themselves up to help may be too jaded to open up again. And those working in the field may be fed up with the turmoil and stress of worrying about their jobs and their clients’ lives.

Forbes says she’s stunned the turnover of providers hasn’t gotten more people in an uproar, considering the impacts will likely be felt by entire communities. Classrooms may become more disruptive if kids who need help don’t get it. Some in the behavioral health field worry that incidents of substance abuse, violence and crime will only get worse if people, especially kids, lose their safety net.

“For any one of us to think there is an ‘us’ and a ‘them ‘— the folks that need behavioral health services and the folks that don’t — we’re lying to ourselves,” Forbes said. “If you haven’t been personally impacted by this behavioral health shake-up that is continuing to happen in waves, then you just need to wait a little bit longer. It’s not a matter of if. It’s a matter of when.”