When Melinda Montoya worked as a physical therapist in Shiprock, she saw patients that drove hundreds of miles for specialized medical care.
Medical services and access to them for people that live in rural New Mexico is another burden on top of everything else Montoya said her patients experience daily.
“People barely can meet their own needs, like for food, housing,” she said. “To use an extra, however many miles they need to go on gas — especially with gas prices now — it’s almost unattainable.”
Legislation that could send millions of dollars to health care providers across dozens of rural counties where nearly 800,000 New Mexicans live is moving along in the Roundhouse.
The Rural Health Care Delivery Fund intends to allow providers in rural areas to apply for grant funding that could go toward starting up new facilities or expanding services at those that already exist.
It quickly got through the Senate Finance Committee on Tuesday and now heads to the floor next. The proposal is one of Gov. Michelle Lujan Grisham’s legislative priorities.
Sen. Liz Stefanics (D-Cerillos) is the sponsor of the bill. She said this legislation could help solve issues people face to access non-basic medical care.
Stefanics said if more specialty services can be set up in rural areas, people wouldn’t have to worry about long drives to get kidney dialysis or orthopedic surgery, for example.
She added that the legislation could help solve post-surgery care, too. Patients often need physical therapy, a consistent and weekly commitment, but she said that’s another service lacking in rural areas.
“Yes, people might come to the big cities for specific surgeries, but what happens when they go home?” she said. “They need the aftercare.”
Sen. Liz Stefanics (middle) listens during a committee meeting in January 2023. (Photo by Austin Fisher / Source NM)
Stefanics sponsored the bill in part, too, because she wants to meet the need for more behavioral health and substance abuse services in New Mexico’s rural areas.
A previous version of the bill would’ve allowed the agency to give out up to $350,000 per year from a pot of $200 million. The committee substitute of the bill that passed doesn’t specify how much the fund is.
All but five counties in New Mexico could be eligible for those dollars. This is not money for Las Cruces, Albuquerque or Santa Fe. The legislation specifies that only health care providers serving counties with a population of less than 100,000 can apply. That would amount to 28 counties, totaling nearly 800,000 New Mexicans, according to a 2020 U.S. Census — about 38% of the state’s population.
Sen. Crystal Diamond (R-Elephant Butte) was the only committee member to vote against the bill on Tuesday. The only comment she made during the meeting was to confirm that the bill would only cover new or expansive health care services, not anything that already exists.
A barrier that’s hundreds of miles long
Montoya said New Mexico is densely populated in a few areas, like Albuquerque or Santa Fe. This creates an assumption that people have to travel for specialized services, which is currently largely true.
She said hospitals need different, specific equipment that usually isn’t available in rural areas. That makes it less likely that physicians want to work there, she added, not to mention a lack of access to other non-medical services.
“It’s really hard to live somewhere out in the middle of nowhere where there’s not resources,” Montoya said.
Plus, she said, there are housing shortages in these non-metropolitan areas, like in Socorro or Roswell. She said there needs to be affordable housing as part of provider recruitment strategies.
“People going to go work in Roswell, they have a really hard time finding housing, or finding affordable housing, despite whatever they’re willing to pay to get those providers out there,” she said.
The legislation’s funding wouldn’t cover housing expenses. Montoya said maybe it could help providers get funding to do specialty clinics once a month or so in rural areas, at least.
A desert of behavioral health care
Lawrence Medina is the executive director of the Rio Grande Alcoholism Treatment Program Inc. He said there’s a huge issue with substance use all around New Mexico, and this legislation could help with that.
“We’ve always had a problem with substance use disorder and mental health,” he said.
Medina said there are not enough residential treatment centers in the state, which officials often say are too expensive to run.
“That’s not right,” he said. “We do need to have public policy that creates more treatment centers, especially in rural and frontier areas.”
Public health councils struggle for funding in the Roundhouse
There needs to be more focus in general on treating people, he said, and figuring out why people have substance use disorders. He added that there are social and institutional inequities that have led to bad policies that are particularly harmful for people of color and in poverty.
“When you don’t (give) access to people to detox centers, residential treatment centers, transitional living and even crisis stabilization units, we just see kind of the revolving door to the jail and the hospitals,” Medina said. “And it’s very costly.”
He said officials need to figure out how to help individuals within the judicial system so recidivism rates are lowered. “It’s cheaper to help them than to lock them up,” he said.
Medina referenced Lujan Grisham’s inaugural address in January where she said the state will focus on fighting the opioid epidemic and expanding health care services. He said New Mexicans need to now hold the governor and the state’s policymakers accountable to that.
There are still other issues, though.
Medina said there are immediate concerns that need to be addressed, like the health care worker shortage, that play into this bill’s efficacy. Montoya, who worked in a rural region hundreds of miles west of Medina, also saw a lack of workers in rural New Mexico.
“We are in a public and health crisis today that we can no longer ignore,” Medina said.
This story was updated on Wednesday, March 1, 2023 at 9 a.m., to indicate updated funding information in the committee substitute version of the bill that passed.