REPEALING THE IMD EXCLUSION

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The Legal Action Center describes the IMD Exclusion as: "The Medicaid Institutions for Mental Diseases (IMD) exclusion prohibits the use of federal Medicaid financing for care provided to most patients in mental health and substance use disorder residential treatment facilities larger than 16 beds. The exclusion is one of the very few examples of Medicaid law prohibiting the use of federal financial participation (FFP) for medically necessary care furnished by licensed medical professionals to enrollees based on the health care setting providing the services. The exclusion applies to all Medicaid beneficiaries under age 65 who are patients in an IMD, except for payments for inpatient psychiatric services provided to beneficiaries under age 21, and has long been a barrier to efforts to use Medicaid to provide nonhospital inpatient behavioral health services."  

The IMD exclusion is found in section 1905(a)(B) of the Social Security Act, which prohibits “payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases” except for “inpatient psychiatric hospital services for individuals under age 21.” The law goes on to define “institutions for mental diseases” as any “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.” The IMD exclusion was intended to ensure that states, rather than the federal government, would have principal responsibility for funding inpatient psychiatric services. The IMD exclusion has been part of the Medicaid program since Medicaid’s enactment in 1965, and while Congress has had the opportunity on numerous occasions to amend or repeal the exclusion, it has remained largely intact. In addition, the regulations governing the IMD exclusion have not been updated since 1988. 

FINANCING OF TREATMENT AND SERVICES

Institutions for Mental Diseases (IMDs)

The federal government currently denies Medicaid reimbursement for persons otherwise Medicaid eligible who are over 21 and under 65 years of age if such persons reside in facilities designated as “Institutions for Mental Diseases” (IMDs). State hospitals, nursing homes, and residential facilities of 16 or more beds may be classified as IMDs if they provide specialized “mental illness” services, have over 50 percent of their patients diagnosed as “mentally ill,” or meet certain other criteria.

NAMI believes that the application of the IMD rule most dramatically affects persons suffering from schizophrenia and other brain disorders because these individuals tend to fall within the impacted age group and thereby are denied Federal Financial Participation (FFP) in their treatment solely on the basis of where they happen to reside, assuming they would meet all other Medicaid eligibility requirements.

The IMD rule is thus discriminatory and works against the provision of necessary health care for young and middle-aged adults with brain disorders.

NAMI calls upon the United States Congress to repeal the IMD rule and to adopt uniform standards of Medicaid eligibility based upon individual resources and the need for services, rather than upon the location in which services are provided or the residence of the recipient.

The United States Senate is attempting to modify the IMD exclusion.  At present, the bill seems to address only substance abuse and not mental illnesses.  This bill needs to include the treatment of patients with a range of mental health conditions - particularly those with Serious Mental Illnesses. 

Here's a link to the current bill.

https://www.congress.gov/115/bills/s1169/BILLS-115s1169is.pdf

An excellent overview of what needs to be done at the national level to improve conditions for the seriously mentally ill.  Published on 7/16/18 in the Federalist.

http://thefederalist.com/2018/07/16/7-practical-strategies-addressing-americas-mental-illness-crisis/

For Iowans under the age of 18, there is no system that oversees mental health care. Recently, the Iowa Department of Human Services has sponsored two Workgroups tasked with assessing the status of Children's Mental Health Care in Iowa.  The reports of these Workgroups can be downloaded below.  

2016 Report of the Children’s Mental Health and Wellbeing Workgroup's report regarding children’s mental health crisis services.

2015 Report of the Children’s Mental Health and Wellbeing Workgroup