We Must Fix CARA

 

We know that since the New Mexico Legislature passed CARA law in 2019 - at least 49 infants and children who were born substance exposed HAVE DIED due the failure of this program.*

In Fall of 2023, the New Mexico Legislative Finance Committee released a formal Program Evaluation on the Implementation and Outcomes of the Comprehensive Addiction and Recovery Act [CARA].

Overall findings: "Healthcare professionals are developing more than a thousand safe care plans a year for new mothers giving birth to babies exposed to drugs and other substances, but many substance-exposed newborns are falling through the cracks and follow-up for those mothers with plans is often ineffective."

KEY FINDINGS FROM THE REPORT:

"The state’s implementation of its CARA policy has substantive gaps"

  • The vast majority (>85%) of CARA families are forgoing voluntary support services as suggested under the 2019 NM CARA law and are not receiving voluntary support services for substance-use treatment

  • CARA-related case management, screening, and identification of substance-exposed newborns should be improved

  • CYFD is requesting more staff to support CARA in-house, despite ongoing challenge with capacity, duplicative services, and unclaimed federal funds.

  • New Mexico’s plan of care policy is not achieving its intended purpose of ensuring the safety of substance-exposed newborns: nearly a third of CARA mothers and families have had a prior substantiated case of abuse or neglect, indicating previous system efforts to support the family have not prevented subsequent substance-exposure to those newborns

  • Almost half of families with a plan of care are not referred to substance use treatment and only 15 percent accept referrals.

  • State law does not require CYFD to assess families with substance-exposed infants who decline substance use treatment. 

  • Even when families accept services, the state does not regularly track whether families follow through with treatment and services

  • Families who accept services on a plan of care often do not participate in those services

  • The CARA portal database is inadequate for case management and tracking safety and well-being outcome measures; meanwhile the current proposed fix of an email to the department is even worse

  • DOH and CYFD have not evaluated CARA since its first year, limiting information and accountability.  

  • New Mexico hospitals are under-identifying substance-exposed newborns by up to 40 percent. 

  • CYFD is not systematically evaluating its process for screening CARA families at SCI

  • Not all newborns exposed to substances received a plan of care according to an analysis of the state’s Medicaid claims for 2020 and 2021. 

  • Many CARA families are not aware a plan of care was created for them.

LFC REPORT IN THE NEWS MEDIA:

Most New Mexico families with infants exposed to drugs skip subsidized treatment, study says Associated Press - October 27, 2023Most New Mexico families with infants exposed to illicit drugs, marijuana and alcohol in the womb have been forgoing subsidized addiction treatment and other voluntary support services since the state's shift in 2020 that halted automatic referrals to protective services, a new study indicated on Friday. The Legislature's budget and accountability office told a panel of lawmakers that New Mexico's revamped response to substance-exposed newborns does not fulfill its purpose of keeping newborns safe and directing families to treatment, as parents miss or decline services ranging from mental health counseling to home visits by nurses aimed at improving the health and development of infants.https://apnews.com/article/new-mexico-drug-addicted-parents-newborns-f30ef2676a58690f292dfb725c762df5

Report says CARA shortcomings are putting children at risk (Includes video)KOB - October 27, 2023The 2019 law requires the state to create a plan of care to get families help, while keeping them together. However, over the last four years, 4 Investigates discovered those efforts have fallen short and many young children have ultimately paid the price of their parent’s addiction.
    “A vast majority of these families don’t appear to be getting services, given the whole safety net of the process that’s the part we’re most concerned about.” - LFC Evaluation Teamhttps://www.kob.com/new-mexico/report-says-cara-shortcomings-are-putting-children-at-risk/

Legislative report says program to protect babies exposed to drugs is failingSanta Fe New Mexican - Oct 28, 2023The Children, Youth and Families Department came under fire again Friday as lawmakers discussed a report that recommends removing the agency from overseeing a struggling program meant to help babies who were exposed to drugs in the womb.
Only 4% of families with a newborn identified as exposed to drugs participated in home visits and only 26% participated in early intervention services, according to the report prepared by Legislative Finance Committee staff and discussed by the lawmakers on the committee at a meeting Friday morning.
About half of families are referred to substance abuse treatment, and only 15% accept referrals, the report found.https://www.santafenewmexican.com/news/local_news/legislative-report-says-program-to-protect-babies-exposed-to-drugs-is-failing/article_9e29d2d4-74db-11ee-bc16-4fb20e58c45e.html

Families with drug-exposed infants failing to get treatment under state programAlbuquerque Journal - October 27, 2023Every month, 100 or so infants in New Mexico are born having been exposed to drugs. When they go through withdrawal, they can tremble, cry too much, have seizures and sweat. Their long-term development may be threatened. Such cases used to prompt a call from the hospital to the state Children, Youth and Families Department for investigation of abuse or neglect. Instead, health care professionals in the state are now tasked with offering families with drug exposed newborns voluntary plans for services and treatments. But the new type of intervention isn’t working as hoped, according to a new legislative evaluation of New Mexico’s four-year-old program under the Comprehensive Addiction and Recovery Act.https://www.abqjournal.com/news/families-with-drug-exposed-infants-failing-to-get-treatment-under-state-program/article_b144eece-750a-11ee-aaf4-9f91777a1a00.html

LFC report highlights CARA; child advocates and lawmakers upset with findings (Includes video)KOAT - November 01, 2023A new Legislative Finance Committee report is taking a closer look at how our state's comprehensive addiction and recovery act is working. The act, also known as CARA, was adopted in 2019. It said hospital staff must give the parents of a drug-exposed baby a plan of care and send them home. The findings from this LFC report evaluating our state's CARA program are leaving child welfare advocates furious.https://www.koat.com/article/lfc-report-highlights-cara-child-advocates-and-lawmakers-upset-with-findings/45716086

LFC REPORT RECOMMENDATIONS:

As part of their extensive evaluation on CARA, the LFC report includes 6+ pages of data-driven, evidence based solutions. We can only hope CYFD and other sister agencies take these recommendations seriously. 

We encourage our legislators to review the recommendations and propose legislation immediately to address this ongoing crisis.

To address CARA in the next 30-day legislative session beginning in January 2024, the Governor must add this subject to her official call.

It is worthing calling attention to the fact that New Mexico's approach to the federal legislation is unique to New Mexico alone -- and our state's decision to implement this unique approach was a request from CYFD and the executive branch in 2019. Most states have not opted to take a "public health" approach to this legislation. Most states DO NOT involve the MCO's or insurance agencies AT All.

The 2021 New Mexico DOH CARA evaluation report provides historical context on the federal legislation and requirements, as well as what New Mexico chose to do under the request of CYFD in passing this legislation.

From the 2021 DOH Report:

"The essential components of CARA program design (outlined in detail in HB230-2019) in New Mexico are that:

  1. Hospitals create and report POCs (Plans of Care) for all substance exposed newborns

  2. Federally required data around prenatal substance exposures are tracked and reported

  3. Care coordination is provided through the family’s insurance provider (primarily Medicaid MCOs) in order to facilitate access to needed services; and 

  4. A non-punitive approach to prenatal substance exposure by not requiring an automatic referral to Statewide Central Intake at CYFD for child abuse/neglect in the event a prenatal substance exposure is established.

The first two components related to reporting are processes that fulfill federal CARA/CAPTA legislation requirements. The second two components are New Mexico specific, and aim to improve outcomes for families with a substance exposed newborn.

What this means: 

The law that New Mexico created and passed at the request of CYFD and the executive as a priority in 2019 has additional components that are not mandated under federal law. Voluntary plans of safe care are New Mexico law specific; these components could be changed by our state legislature in alignment with the many recommendations from the recent LFC report and also from the recommendations in the 2021 DOH report. 

Solutions exist.

In the 2023 legislative session, the Senate unanimously passed SB150 that would have closed one of the glaring loopholes of the existing CARA law, but unfortunately, SB150 died in the House of Representatives before getting to a final vote.

Another solution that would provide immediate aid to this situation would be to codify "Family in Need of Court-Ordered Services" or FINCOS. In 2015, HB119 passed the House of Representatives overwhelmingly, but died before a senate vote. This bill was brought forth again in 2023 as HB34, and received support from CYFD, but never made it out of its first committee.

Another important bill that was introduced in 2023, was HB221 that would have required universal prenatal screening -- a recommendation that came directly from the NMDOH 2021 CARA report. This bill was killed in its first committee. 🤷🏼‍♀️ ⬇

 

In other states:

In other states, the plan of safe care implementation looks MUCH different than it does here in New Mexico. We cannot find one other state that involves insurance companies (MCOs) in these plans of safe care.

Other states identify and acknowledge that recovery is ongoing; one piece of paper, at one point in time (in the hospital before discharge) is not a solution to ensuring necessary support to keep mom and baby safe and healthy. (It's also no wonder why <41% of families who are "on" plans of safe care" had no idea they were involved in this program. 🙄 

LFC report highlights this -- let's learn from other states and implement some of their best practices:


The Plan of Safe Care Pilot Program in Hudson County mandates that families who qualify and receive a plan of safe care are required and mandated to have contact made to the family by DCFS within 24 hours of the baby being born, and mandate that face-to-face meeting with the family on the plan of safe care must happen within 72 hours. 


In the August 2023 LHHS committee hearing, the UNMH Milagro/FOCUS team brought forward many solutions to our elected officials that would help provide immediate relief to this growing crisis. Two solutions proposed would be to fund and support additional programs for New Mexico pregnant women using opioids and their babies. 

Currently, our state legislature is once again seeing an unforeseen surplus going into our budget year. Reach out to your state legislators and ask them to prioritize and fund supports for our CARA families. This is in addition to the $20 million in unspent funds CYFD is sitting on for behavioral health and the $91 million dollars that Bernalillo County is sitting on from our 1/8th GRT tax for behavioral health.

The money exists to fund and support these programs.

Now we need true legislative will and legislative courage from our elected officials -- and that comes from you - their constituents - hold ing them accountable.  


Serious concerns were voiced about the then-proposed NM CARA were law in 2019:

Watch the full debate here beginning at 12:00pm >>

Watch the original House Floor debate on CARA in 2019 starting at 12:00pm →

Reach out to your elected officials. Ask both your state senator and your state representative to "put CARA fix on the 2024" legislative session. Tell them you care about this issue.

Contact the Governor's Office -- and ask her to put "CARA" on the 2024 legislative call for the session.

This is her decision alone to address and fix CARA legislatively. Please reach out to her office and ask to PUT CARA ON THE 2024 LEGISLATIVE SESSION CALL.

Send the Governor an email :: click here >>

Call the Governor's Office: 
Phone: (505) 476-2200

 
NM Child First