What Is It?
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. It also specifically excludes individuals who are between 22 and 64 years of age.
When Was It Created?
The IMD exclusion has been part of the Medicaid program since Medicaid’s enactment in 1965 and has not been updated since 1988.
Why It Needs To Go…
First and foremost because this legislation is outdated. It no longer serves the public it was once written for. In 2018 we are in need of more psychiatric facilities, with more beds that are able to better serve the millions of people in our country who live with mental illnesses that require professional treatment. People living with mental illnesses should be able to receive treatment in a time efficient and affordable manner, as any other medical issue requires. It has been 53 years since this exclusion was created, society and medicine have advanced tremendously, this exclusion prohibits people from benefiting from medical advances that can potentially be life saving.
Example: West Virginia has 50,000 people living with mental illness yet it only has 206 psychiatric beds available. This is unacceptable and discriminatory. There are not more beds, because hospitals opt to replace unprofitable psychiatric beds with beds that cater to more profitable diseases that require more tests and treatments that will be funded by federal dollars. Currently, the IMD exclusion, prohibits payment for services on so many different technicalities that psychiatric services have been in rapid decline despite our societies rapidly increasing need for them.
How Can You Change This?
Senator Durbin from Illinois has introduced S.1169 – Medicaid Coverage for Addiction Recovery Expansion Act and it has hope attached to it. Senator Durbin wants to expand coverage to those dealing with Substance Abuse Disorders. I truly believe this is a step forward considering our nations epidemic concerning opioid and heroin addiction/overdoses. But it would also be a wonderful time to seize the moment and open up the same treatment options for those living with serious mental illnesses like schizophrenia and bipolar disorder.
It is time to abolish this exclusion all together. Removing it will allow millions of Americans to get the treatment they need to make not only their lives healthier but make our country safer. Simply put – treatment works. Treatment is the difference between being able to care for your family and contribute to society and not being able too. Treatment can decrease rates of incarceration and homelessness. Treatment means the difference between life and death, because those with mental illness have a 17x higher risk for suicide. Treatment means jobs for those who want to enter the field of psychiatric services. Treatment means economic growth as new psychiatric facilities are built and staffed. Treatment means those Americans effected by serious mental illness can enjoy all of the advances in treatment options developed over the past 53 years. It is time to repeal and remove this exclusion.
Treatment does not necessarily mean institutionalization either. Treatment can be varied and include options like Assisted Outpatient Treatment (AOT) or in cases that warrant it longer hospitalization when necessary. The options for treatment should be open and can be varied depending on the individual. It is only ethical that our country make available to all that suffer from serious mental illnesses the same life changing medical treatments others with physical illnesses are able to benefit from. Continuing with this exclusion is discriminatory and hinders people from receiving quality care. It is wrong that a person with a diseased brain is treated differently than an individual with a diseased heart or any other diseased organ.
What Can You Do To Help?
Get involved! In order to make changes we must write to our senators and tell them we are ready for them to remove this exclusion. Using Senator Durbin’s Medicaid For Addiction Recovery Expansion Act as a sounding board, we can express that we feel it is discriminatory to exclude those in the most dire need of that expansion, those living with serious mental illnesses in America. This does not need to be an either/or situation. It should be that all Americans, dealing with mental health issues, should be able to secure quality care regardless of their economic status, ethnicity, sex or diagnosis. It should be as non-discriminatory as all other health care matters in America.
You can speak out by joining other people who are working to revoke the IMD exclusion.
Or you can contact the following people who are Sponsors or Cosponsors of Senator Durbin’s Medicaid Addiction Recovery Expansion Act and request it be expanded to include those living with serious mental illness or that the IMD exclusion be repealed all together.
S.1169 – Medicaid Coverage for Addiction Recovery Expansion Act
|Sen. Durbin, Richard J.[D-IL]|
|Contact||711 Hart Senate Office Building Washington DC 20510
Medicaid Coverage for Addiction Recovery Expansion Act Summary
This bill amends title XIX (Medicaid) of the Social Security Act to allow states to provide medical assistance to adults for residential addiction treatment facility services under the Medicaid program if such services are offered as part of a full continuum of evidence-based treatment services. “Residential addiction treatment facility services” are medically necessary inpatient services provided in an accredited, size-limited facility for the purpose of treating a substance use disorder within a specified time period.
The provision of medical assistance for such services to an individual shall not prohibit federal financial participation for medical assistance with respect to other services provided to the individual within the same time period.
Subject to specified conditions, a woman who is eligible for medical assistance on the basis of being pregnant may remain eligible for residential addiction treatment facility services for specified time periods without regard to eligibility limits that would otherwise apply as a result of her pregnancy ending.
In addition, the bill establishes a grant program for states to expand infrastructure and treatment capabilities of existing youth addiction treatment facilities that: (1) provide addiction treatment services to youths under Medicaid or the Children’s Health Insurance Program (CHIP), and (2) are located in communities with high numbers of medically underserved populations of at-risk youths. At least 15% of grant funds awarded to a state must be used for making payments to rural facilities.
|Sen. Portman, Rob [R-OH]*||05/17/2017|
|Sen. Brown, Sherrod [D-OH]*||05/17/2017|
|Sen. Capito, Shelley Moore [R-WV]*||05/17/2017|
|Sen. King, Angus S., Jr. [I-ME]*||05/17/2017|
|Sen. Collins, Susan M. [R-ME]*||05/17/2017|
|Sen. Manchin, Joe, III [D-WV]*||05/17/2017|
|Sen. Booker, Cory A. [D-NJ]*||05/17/2017|
|Sen. Warren, Elizabeth [D-MA]||05/25/2017|
|Sen. Hassan, Margaret Wood [D-NH]||05/25/2017|
|Sen. Wicker, Roger F. [R-MS]||06/08/2017|
|Sen. Tester, Jon [D-MT]||06/13/2017|
|Sen. McCaskill, Claire [D-MO]||07/31/2017|
|Sen. Klobuchar, Amy [D-MN]||07/31/2017|
|Sen. Duckworth, Tammy [D-IL]||10/16/2017|
|Sen. Feinstein, Dianne [D-CA]||10/17/2017|
|Sen. Blumenthal, Richard [D-CT]||10/31/2017|
|Sen. Sullivan, Dan [R-AK]||11/15/2017|
|Sen. Murkowski, Lisa [R-AK]||11/27/2017|
|Sen. Van Hollen, Chris [D-MD]||04/23/2018|
|Bill||Latest Title||Relationships to S.1169||Relationships Identified by||Latest Action|
|H.R.2687||Medicaid Coverage for Addiction Recovery Expansion Act||Identical bill||CRS||05/26/2017 Referred to the Subcommittee on Health.|
Contact The Senate Finance Committee
The Honorable Orrin G. Hatch
Chairman, Committee on Finance, United States Senate
219 Dirksen Senate Office Building
Washington, D.C. 20510
The Honorable Ron Wyden
Ranking Member, Committee on Finance, United States Senate
219 Dirksen Senate Office Building
Washington, D.C. 20510
Note: Due to security precautions taken by the U.S. Senate, outside mail is delayed 7-10 days; therefore, whenever possible, you may also consider faxing your letter(s) to 202-228-0554.
Senators who’s names appear in red serve on the Senate Finance Committee & The Senate Subcommittee for Health***
Name Address Phone Email Form
|Hatch, Orrin G.(UT), Chairman||104 Hart Senate Office Building Washington DC 20510||(202) 224-5251||https://www.hatch.senate.gov/public/index.cfm/contact?p=Email-Orrin|
|Grassley, Chuck(IA)||135 Hart Senate Office Building Washington DC 20510||(202) 224-3744||https://www.grassley.senate.gov/contact|
|Crapo, Mike(ID)||239 Dirksen Senate Office Building Washington DC 20510||(202) 224-6142||https://www.crapo.senate.gov/contact|
|Roberts, Pat(KS)||109 Hart Senate Office Building Washington
|Enzi, Michael B.(WY)||379A Russell Senate Office Building Washington DC 20510||(202) 224-3424||https://www.enzi.senate.gov/public/index.cfm/contact?p=e-mail-senator-enzi|
|Cornyn, John(TX)||517 Hart Senate Office Building Washington DC 20510||(202) 224-2934||https://www.cornyn.senate.gov/contact|
|Thune, John(SD)||511 Dirksen Senate Office Building Washington DC 20510||(202) 224-2321||https://www.thune.senate.gov/public/index.cfm/contact|
|Burr, Richard(NC)||217 Russell Senate Office Building Washington DC 20510||(202) 224-3154||https://www.burr.senate.gov/contact/email|
|Isakson, Johnny(GA)||131 Russell Senate Office Building Washington DC 20510||(202) 224-3643||https://www.isakson.senate.gov/public/index.cfm/email-me|
|Portman, Rob(OH)||448 Russell Senate Office Building Washington DC 20510||(202) 224-3353||https://www.portman.senate.gov/public/index.cfm/contact?p=contact-form|
|Toomey, Patrick J.(PA)||248 Russell Senate Office Building Washington DC 20510||(202) 224-4254||https://www.toomey.senate.gov/?p=contact|
|Heller, Dean(NV)||324 Hart Senate Office Building Washington DC 20510||(202) 224-6244||https://www.heller.senate.gov/public/index.cfm/contact-form|
|Scott, Tim(SC)||717 Hart Senate Office Building Washington DC 20510||(202) 224-6121||https://www.scott.senate.gov/contact/email-me|
|Cassidy, Bill(LA)||520 Hart Senate Office Building Washington DC 20510||(202) 224-5824||https://www.cassidy.senate.gov/contact|
|Wyden, Ron (OR), Ranking Member||221 Dirksen Senate Office Building Washington DC 20510||(202) 224-5244||https://www.wyden.senate.gov/contact/|
|Stabenow, Debbie (MI)||731 Hart Senate Office Building Washington DC 20510||(202) 224-4822||https://www.stabenow.senate.gov/contact|
|Cantwell, Maria (WA)||511 Hart Senate Office Building Washington DC 20510||(202) 224-3441||https://www.cantwell.senate.gov/contact/email|
|Nelson, Bill (FL)||716 Hart Senate Office Building Washington DC 20510||(202) 224-5274||https://www.billnelson.senate.gov/contact-bill|
|Menendez, Robert (NJ)||528 Hart Senate Office Building Washington DC 20510||(202) 224-4744||https://www.menendez.senate.gov/contact|
|Carper, Thomas R. (DE)||513 Hart Senate Office Building Washington DC 20510||(202) 224-2441||https://www.carper.senate.gov/public/index.cfm/email-senator-carper|
|Cardin, Benjamin L. (MD)||509 Hart Senate Office Building Washington DC 20510||(202) 224-4524||https://www.cardin.senate.gov/contact/|
|Bennet, Michael F. (CO)||261 Russell Senate Office Building Washington DC 20510||(202) 224-5852||https://www.bennet.senate.gov/?p=contact|
|Casey, Robert P. (PA)||393 Russell Senate Office Building Washington DC 20510||(202) 224-6324||https://www.casey.senate.gov/contact/|
|Warner, Mark R. (VA)||703 Hart Senate Office Building Washington DC 20510||(202) 224-2023||https://www.warner.senate.gov/public/index.cfm?p=Contact|
|McCaskill, Claire (MO)||503 Hart Senate Office Building Washington DC 20510||(202) 224-6154||https://www.mccaskill.senate.gov/contac|
|Whitehouse, Sheldon (RI)||530 Hart Senate Office Building Washington DC 20510||(202) 224-2921||https://www.whitehouse.senate.gov/contact/email-sheldon|
|Brown, Sherrod (OH)||713 Hart Senate Office Building Washington DC 20510||(202) 224-2315||https://www.brown.senate.gov/contact/|
Want To Learn More?
To learn more about the Institute of Mental Disease Exclusion please visit the Social Security Administrations Website:
This is a really great PDF Fact Sheet that explains the IMD in relatively simple terms: