State Health Care Authority expected to issue new rules governing program on Wednesday
When Dr. Francheska Gurule sees pregnant patients who use drugs or alcohol at the clinic where she works in Albuquerque, she says their “fear has always been very palpable.”
As a family doctor board-certified in addiction medicine and working in the field for the last decade, Gurule says she knows patients worry about the stigma they’ll face when they disclose their drug use. But “the number one reason” they withhold their drug or alcohol use “is because they don’t want their baby to be taken from them.”
“That fear has always existed,” Gurule told Source NM, but has become more marked in the year since New Mexico Gov. Michelle Lujan Grisham ordered the Children, Youth and Families Department to seek immediate custody of newborns diagnosed with fetal alcohol syndrome or substance exposure. No exceptions.
Gurule and dozens of providers signed a December 2025 letter objecting to the directive.
“I am a family doctor, those babies are my patients too,” Gurule said. But she believes she and others who oppose the directive, “also want to keep the moms healthy and safe.”
On June 8, the New Mexico Supreme Court rejected a petition from the ACLU and two state lawmakers asking the state to immediately halt Lujan Grisham’s directive.
But opposition to the order persists, particularly on the front lines among health care providers who treat women with histories of substance abuse.
“Child protective services involvement is a risk factor for maternal depression,” said Dr. Jocelyn Wu, an OB/GYN who’s worked in northern New Mexico and Albuquerque. She pointed to data that shows mental health conditions, including substance use, as the leading cause of death during pregnancy and postpartum in New Mexico. “We have a postpartum mental health crisis on our hands,” she said, noting it was exacerbated by the COVID-19 pandemic.
Gurule echoes those concerns. She worries pregnant patients will avoid doctors’ offices in an effort to keep custody of their kids, and says when moms avoid prenatal care, “they don’t get diagnosed with syphilis so then their babies are born with congenital syphilis, which can be a lifelong debilitating disease. They don’t get Narcan, so they overdose and they die. They don’t get on methadone. They don’t get on buprenorphine. And those are real, real scary outcomes.”
National data supports Gurule and Wu’s fears, showing that patients avoid prenatal care and report higher rates of congenital syphilis on average in states with punitive substance use policies.
New Mexico reports the third highest rate of moms who do not receive adequate prenatal care, according to the March of Dimes. In 2022, New Mexico reported the highest rate of congenital syphilis among all US states. Although the CDC has not released updated congenital syphilis data since 2023, when New Mexico still ranked second nationwide, the state Department of Health in April reported that rates fell more than 30% last year.
The governor’s office stands behind the directive, and Communications Director Michael Coleman responded in a written statement to the questions Source NM posed about the providers’ concerns.
“The governor believes safety is the top priority — and that means giving parents the space they need to recover, while making sure no baby is left in a home where exposure puts them at risk,” he said.
New Mexico’s “substance-exposed newborn strategy exists,” he continued, “because substance-exposed infants and parents alike deserve a rigorous evaluation of whether their home environment is safe before a newborn is discharged into it. In each of the cases where a child was placed in safe care, the determination to temporarily remove them from their parents was made by a judge, based on the state’s risk assessment. The important decision to remove substance exposed newborns from their families is never a unilateral one by the state.”
Awaiting new rulesMeanwhile, the state Health Care Authority is slated to release new rules on Wednesday governing the state’s implementation of the federal Comprehensive Addiction and Recovery Act, as mandated by a separate law passed by the New Mexico Legislature. That law shifted the authority over cases involving substance-exposed newborns from the Children, Youth and Families Department to the HCA. Lujan Grisham signed the law in April 2025, before issuing her separate directive in July 2025.
Responding to draft rules published by the Health Care Authority in April, 40 healthcare providers, social workers, attorneys, former CYFD employees, tribal governments and national and local non-profits shared concerns.
“I have seen first hand how well children do with their own parents. I have also seen how well families do when kept with their kids,” wrote pediatrician Mateo McBatra.
Licensed psychotherapist Bryce Pittenger also wrote about the impact the proposed rules could have on newborns. “For infants, time is not neutral. Prolonged separation during the early attachment window is associated with long-term impacts that are difficult—and costly—to remediate.”
Troy Clark, president and CEO of the New Mexico Hospital Association, wrote that Lujan Grisham’s mandatory directive contradicted the Legislature’s law guiding voluntary plans of safe care, and added that hospitals “need clear and definitive direction about what will be in effect July 1, 2026.”
In response to Clark’s concern, Coleman noted in his statement that the CARA directive “was written to operate within the framework SB42 established, and we have trained and supported on implementation questions as the CARA administration transitions to the Health Care Authority on July 1.”
Providers and others who submitted comments to the Health Care Authority, also voiced concern with the proposed definition of substance-exposed newborns, which included newborns exposed to legal prescribed medications like buprenorphine and methadone and legal drugs like alcohol, tobacco and marijuana.
“That is potentially a lot of people who are super stable in their recovery,” said Gurule, speaking of patients who use opioid agonists to treat their opioid use disorder. It also might include people who “don’t have a substance use disorder,” such as occasional smokers.
Hannah Gillum is one such mother who’s spoken up about her experience grappling with the state’s policy. After receiving a diagnosis of infertility, Gillum had given up on having a child.
“When I found out I was pregnant it was jarring, I wanted it for so many years,” she told Source NM. Gillum said she sought medical care immediately and learned she was pregnant at five weeks gestation. “And I made the huge mistake that I know now of telling them the truth,” which was that she had consumed alcohol and legal cannabis a few days earlier.
The Monday after she gave birth, a CARA case worker reached out and scheduled a home-visit. “And that is when I hear that I am a part of the CARA program,” she said “And I am being forced to be a part of this. And if I don’t comply, they’re gonna refer me to” CYFD.
Gillum said the punitive approach made her reluctant to opt into state programs. “I was already interested in some of those resources [offered through the CARA program] and willing to engage until it became by threat,” she said.
In her decade working as a doula, Melissa Marie Lopez-Sullivan says she’s supported many parents like Gillum who use cannabis, particularly as it’s become medicinally and recreationally legal.
Prior to Lujan Grisham’s order, she said, doing so “was almost a non-issue for most families.” Since the order, “People go out of their way to not test positive or to not disclose.”
Coleman from Lujan Grisham’s office, however, says, any claims that the governor’s directive “would flag alcohol or marijuana use before they are pregnant is inaccurate. Her directive only applies to cases in which one of those substances is being used concurrently with meth or fentanyl.”
Lopez-Sullivan, who serves as director of the New Mexico Doula Association, said the bottom line is that the CARA program “and the way it’s being implemented is eroding the relationship between patient and the provider, and the patient and the healthcare system.” Moreover, “There isn’t any more support or resources available than there were the day before [Lujan Grisham] issued” the directive.
Gurule wishes that instead of seeking immediate custody of substance-exposed newborns, the state would invest in evidence-based practices recommended by the American College of Obstetricians and Gynecologists.
“We don’t have housing. We don’t have substance use treatment in rural New Mexico. We don’t have family-centered rehab,” she said. “This is a chronic medical condition that is treatable.” And there are people who have come out the other side, “safely parenting and thriving as families.”
