SALUD! Complaints

The Medicaid Managed Care program known as Salud! has now been completely phased in thoughout the state. Advocacy groups, staff from the New Mexico Human Services Division, and managers from all three managed care contractors and their behavioral health components met for several months on a regular basis to discuss issues of access to services and treatment choices. The group, known as the Medicaid Managed Care stakeholders, discontinued their meetings in the spring of 1998.

Since then, information regarding the status of service delivery and treatment denials has been more difficult to determine.

At P&A, we have received many telephone calls from individuals complaining that they could not get services that they felt were medically necessary or that services were being cut back or discontinued prematurely. The greatest number of complaints concern the lack of mental health treatment options which are appropriate to the individual needs, as well as difficulty obtaining assistive technology devices and wheelchairs in a timely manner.

The Salud! contractors, Cimarron, Lovelace, and Presbyterian, and their behavioral health organizations all have contact persons that can be called with complaints about services or ways to file a formal grievance. To attempt to settle a disagreement informally, a good place to start is by calling your Salud! provider and finding out who is assigned to you as the treatment team coordinator. Explain your concerns to the coordinator and consider asking for a treatment team meeting.

You may want to consider seeking assistance from an advocate at P&A if you are unsatisfied with your interactions with your Salud! provider.

Next newsletter: Salud! Medicaid Managed Care and due process or how to file a due process with your Salud! Medicaid Managed Care provider.