This is what you call being “a day late, but not a dollar short.”
On Feb. 26, 2015, the Bernalillo County Commission approved a 1/8 % gross receipts tax increase on a 3-2 vote to fund new behavioral and mental health services to improve access to mental and behavioral health care services in the county. The tax generates approximately $20 million annually.
When enacted, the county commission announced the intent for the tax was to invest the funding “in proven ways to better manage the high cost of addiction, homelessness and mental health problems”. According to a county commission announcement, “these issues impact families throughout the community and drive up the cost of public services, especially at the Metropolitan Detention Center.” The gross receipts tax costs shoppers one cent on a $10 purchase of goods and services.
The 1/8th% gross receipts tax was supposed to be used for the purpose of providing more mental and behavioral health services for adults and children in the Albuquerque and Bernalillo County area. The intent is to provide a safety net system for those in need of mental health not otherwise funded in New Mexico.
Since enactment of the tax in 2015, the tax has generated $91.6 million. The county has spent $20 million of the money but has earmarked the bulk of what it amassed for one-time expenditures. Those expenditures include $30 million for a new crisis triage center, $12 million for supportive housing and $4 million for the Bernalillo County CARE campus, formerly known as the Metropolitan Assessment and Treatment Services center, or MATS. The renovations to the CARE campus when complete will create an outpatient behavioral health clinic and living room space for peer-to-peer counseling sessions.
On February 26, 2015, the county issued a Request for Proposals (RFP) seeking business plans and proposals from the private sector for suggestions on how to create a framework to deliver mental health services to the community. Since 2015, Bernalillo County has collected $89.5 million worth of taxes in the name of behavioral health programming, but there are no plans on how it should be applied.
MILLIONS OF TAX DOLLARS ACCUMULATE BUT NO PROGRAMS
On February 17, 2015, when the Bernalillo County Commission approved the tax, it failed to develop a plan on how all the money would be used, including not identifying services to be provides, location of facilities and qualifiers to obtain the services offered. As a result of having no spending plan or identifying priorities, the tax has been collected but not spent.
Approved programming should eventually cost the county $18.9 million annually, but more than $70 million in tax revenue has accumulated and the amount is growing. According to the latest figures from the Department of Behavioral Health Services, most of that money is encumbered for one-time expenditures including $30 million earmarked for a future crisis triage center and $12 million for supportive housing.
In November, 2019, County Manager Julie Morgas Baca asked the Bernalillo County Commission to approve a resolution that permits “stakeholders, providers, community members, staff, commissioners, or other interested parties” to propose behavioral health service ideas through a website. Up until now, only county staff had been authorized to propose behavioral health service ideas. All program appropriations will require final approval of the County Commission.
According to County Manager Morgas Baca:
“I just really think it needs to be opened up, and we need to realize there’s a lot of people out there who have real life experience. … I want to solicit their input to see how much of a difference we can make in addition to what we’re already doing.” On Tuesday, November 12, the resolution passed by a 5-0 vote unanimous vote.
Margarita Chavez-Sanchez, acting director of the county’s Department of Behavioral Health Services had this to say about the enactment of the resolution:
“I am in favor of the formalization of this process and creating an additional avenue for meaningful community input. … We absolutely welcome the submission of concepts through our online portal for review.”
Since enactment of the tax in 2017, Bernalillo County has approved a mere $10 million toward Behavioral Health Initiative projects with $70 million in tax revenue having accumulated but not spent. According to the Bernalillo County “Public Health Projects” webs site, link provided below, 9 projects that have been approved and committed annual funding of each of those projects are as follows:
1. Transition Planning and Re-entry Resource Center – $1,341,188 in year one; $1,041,188 annually thereafter
“On a daily basis, the Metropolitan Detention Center (MDC) releases individuals back to the community who suffer from a variety of mental illnesses and substance abuse disorders, among other complications. In most cases, the continuity of care provided to these individuals is fragmented, at best, and more often entirely interrupted within the first hours and days following release back to community. The lack of a system for coordinated care as incarcerated individuals’ transition from jail to community contributes to recidivism and impedes efforts to generate more positive health outcomes for these individuals. The project includes funding transition planners at MDC and creating a Re-entry Resource Center (RRC) for an effective front door into a network of services. The operational cost of the project is divided into the two components, with a one-time renovation cost for the RRC, located at the Public Safety Center … .”
2. Mobile Crisis Teams – $1 million BC/$340,000 ABQ
“The creation for this pilot project is a city/county collaboration. The mobile crisis teams will respond to individuals experiencing a nonviolent behavioral health crisis that necessitates a 911-response. There will be three teams formed, one by Bernalillo County and two by the City of Albuquerque. Each team will consist of a crisis intervention unit deputy paired with a masters’ level, behavioral health clinician.”
3. Expansion of the County’s Community Connections Supportive Housing Program – not to exceed $1 million
“This expansion will focus on individuals with behavioral health issues residing in the community who are homeless or precariously housed and is estimated to provide a minimum of 55 housing vouchers with case management service.”
4. Community Connections Re-entry Supportive Housing – $1.3 million from Bernalillo County; $503,000 from City of ABQ
“This project provides intensive case management and services linked with scattered site housing to a target population of homeless or precariously housed persons with mental illness or co-occurring disorders or other disabilities and whose lack of community-based services have resulted in criminal justice system involvement. The program provides high quality intensive wrap-around services and housing subsidies to support the individual’s successful reintegration and long-term stability in the community after incarceration. Providing comprehensive intensive services linked with housing creates community stability and reduces recidivism and is life changing.”
5. Community Engagement Team – not to exceed $1 million
“Community Engagement Teams (CET) help people and their families voluntarily cope with the effects of mental illness and substance abuse disorders, whether individual or co-occurring, in the comfort and familiarity of their homes and communities. The CET helps individuals avoid the criminal justice system and emergency mental health systems whenever possible. The CET in Bernalillo County requires an individualized, recovery-focused approach that promotes wellness, self-management, personal recovery, natural supports, coping skills, self-advocacy and the development of independent living skills. CETs can be considered part of a continuum of services rendered outside institution walls that include assertive community treatment, the crisis intervention unit, crisis outreach and support team, public inebriate intervention, and law enforcement response.”
6. Youth Transitional Living Proposal – not to exceed $650,000
“A new service intended for at-risk youth who are precariously housed or homeless with a mental health or addiction diagnosis. The funding provides youth transitional living services for clients with behavioral health diagnosis who are not currently under any state Children Youth and Families Department, Bernalillo County or other third party-funded program. This funding is available for non-third-party reimbursement.”
7. Reduction of Adverse Childhood Experiences (ACES) – not to exceed $3 million
“Bernalillo County wishes to develop a cohesive system that utilizes all available resources to assist children who have been identified as at-risk by using adverse childhood experiences (ACE) scoring methodology. Through program coordination and the procurement and enhancement of services, Bernalillo County wishes to develop a system that maintains a strong collaboration of professionals who work with children across the full continuum of services for at-risk children and families including primary prevention, identification, early intervention, support and treatment, harm reduction, outreach, and services in children’s homes and within communities. The funding is to pay for services and family supports not currently reimbursed by Medicaid or third-party payers.”
8. Behavioral Health Advisor – up to $140,000 per year
“The behavioral health advisor will provide guidance on the development and implementation of the behavioral health initiative. The behavioral health advisor will provide written standardization of the governance and subcommittee structure, data analysis service evaluations and reports implementation. The behavioral health advisor will provide other services including developing internal staff capacity on understanding behavioral health best practices and targeting and changing new initiatives to continue to meet the needs of Bernalillo County’s behavioral health priority populations.”
9. UNM’s Institute for Social Research (UNM/ISR) Contract – not to exceed $246,553 per year
“Bernalillo County seeks to implement a behavioral health system that measures the effectiveness of implemented programs and constantly strives to improve the performance of programs. In pursuit of this performance management strategy, data analysis and program evaluation will be critical components of the system. Data analysis and evaluation will happen to inform what services are needed and how those services are performing. Data analysis and evaluation will occur to assess the impact of the entire Behavioral Health Initiative on the entire population of users of behavioral health services, including individual program evaluations of the effectiveness of each contracted and/or directly delivered program.”
HOW NEW PROCESS WILL WORK
Under the new ordinance passed by the County Commission, each idea from stakeholders, providers, community members, staff and commissioners will go through a vetting process. A county commission appointed committee will ensure each proposal meets the criteria for an expenditure based on the behavioral health tax language approved by voters. A separate subcommittee of stakeholders and subject matter experts will also review the idea and recommend the next steps.
County Commission Chairwoman Maggie Hart Stebbins said Bernalillo County has been especially “responsible” with the tax revenue but said the previous process was limiting valuable input from many stakeholders. Hart Stebbins acknowledge opening the application process up will likely result in some ideas that are not workable or worthwhile. According to Hart Stebbins, every citizen should have the opportunity to make recommendations for programs that would close gaps in behavioral health services. Hart Stebbins has acknowledged the behavioral tax revenue has not reached the community as was intended.
The commission recently approved up to $6 million in one-time appropriations for startup or capital spending that would create or expand behavioral health services. Providers will be able to apply for the funding through a request for proposals.
DESPERATE NEED FOR BEHAVIORAL HEALTH CARE SERVICES
One of the cruelest things that former Republican Governor “She Who Shall Not Be Named” did was when she ordered an “audit” of mental health services by nonprofits in New Mexico based on questionable information. The audit eventually devastated New Mexico’s behavioral health system.
In June 2013, under the direction of the former Republican Governor, the Human Services Department (HSD) cut off Medicaid funding to 15 behavioral health nonprofits operating in New Mexico. In 2014, more than 160,000 New Mexicans received behavioral health services, with most of those services funded by Medicaid, according to the Human Services Department.
After the audits were completed, the former Republican Administration said that the outside audit showed more than $36 million in over billing, as well as mismanagement and possible fraud. Under the orders of the Republican Governor, Human Services Department agency brought in 5 Arizona providers to take over from New Mexico providers.
In early 2016, following exhaustive investigations, the Attorney General cleared all 15 of the healthcare providers of any wrongdoing and exonerated all of them of fraud. Even though the NM Attorney General found no fraud and cleared the nonprofits of fraud, the damage had been done to the nonprofits. With the Medicaid funding freeze, many of the 15 nonprofits could not continue and just went out of business leaving many patients without a behavioral health service provider.
Lawsuits against the state were initiated by 15 mental health care providers. The administration of Governor Michelle Lujan Grisham has announced it has entered into settlement agreements with at least 10 of the behavioral health care providers whose Medicaid funding was frozen in 2013. The process to rebuild the state’s behavioral health care services will be a slow process that no doubt will take years. Bernalillo County’s efforts for behavioral health programs is critical to rebuilding in part the system destroyed by the previous Republican Governor Administration.
DEPARTURE OF COUNTY COMMISSION CHAIRPERSON MAGGIE HART STEBBINS
On December 10, 2019 it was announced that after 10 years on the Bernalillo County Commission, Maggie Hart Stebbins is resigning from the 5 person commission. New Mexico Governor Michelle Lujan Grisham has appointed as the state’s natural resources trustee. Hart Stebbins has started her job in the $110,000-a-year and said she intends to step down from the County Commission some time mid-January.
Commissioner Hart Stebbins has one year left on her term and she is “term limited” and prevented from seeking a third term. Two highly progressive Democratic candidates have already announced they are running in the Democratic primary for the position and they are Democratic party activists Adriann Barboa and Adrian Carver.
Governor Michelle Lujan Grisham has the exclusive authority to appoint her replacement. Governor’s spokesman Tripp Stelnicki said the Governor will solicit applications, conduct interviews and intends to choose someone who will not pursue the office in the next election as way of “ensuring voters have every opportunity to choose” the permanent replacement.
COMMENTARY AND ANALYSIS
Bernalillo County Commission Maggie Hart Stebbins has been a major force on the County Commission when it comes to behavioral health programs and the behavioral health tax. Once she leaves, a leadership void will be created that will be very difficult to fill when it comes to behavioral health programs.
The county can be commended for the 9 programs initiated including a housing program for releasing inmates into housing, the “tiny homes” project, deploying one or two mobile crisis teams, and adding beds to the campus of MATS, a drug and alcohol detoxification center in Southeast Albuquerque. But far more is needed and sooner rather than later.
It is downright pathetic that after enacting the behavioral health tax on February 17, 2015, and more than $90 million collected in taxes, very little progress has been made with implementing needed mental health care programs. What is difficult to comprehend is that after 4 years of collecting the tax, the County only now is trying to figure out how to spend all the taxes that have been collected.
County Commission Chairwoman Maggie Hart Stebbins, a strong proponent of the mental health tax, admitted the revenue has not made it into the community as promoted and had this to say:
“There are still a lot of people in this community who need services, and we need to provide those services. … That’s what we promised the taxpayers.”
After more than four years of collecting the tax and collecting $90 million in taxpayer funding, the County Commission needs to step up the process, be far more aggressive in identifying and implementing behavioral health programs so desperately needed after the decimation of the all the programs by the former Republican Governor.