Transforming Lives through Mental Health Advocacy

The Medicaid Institutions for Mental Diseases (IMD) exclusion is a 1965 federal policy that limits Medicaid funding for inpatient behavioral health or substance us disorder care in certain psychiatric facilities, creating significant access barriers.

Under Section 1905(a)(30)(B) of the Social Security Act, the federal government cannot pay for Medicaid services provided to most patients in “institutions for mental diseases” with more than 16 beds that are primarily engaged in diagnosing, treating, or caring for persons with mental diseases, including medical attention, nursing care, and related services. This includes facilities licensed or accredited as psychiatric hospitals, or those where mental illness is the reason for institutionalization for more than 50% of patients.

The exclusion generally bars Medicaid from paying for inpatient services in IMDs for ages 21-64.

Medicaid can still pay for inpatient psychiatric hospital services for children under 21.

Over 65: The exclusion does not apply to Medicare-covered inpatient psychiatric care for seniors over 65.

https://www.congress.gov/crs_external_products/IF/PDF/IF10222/IF10222.15.pdf

Even with the opening of the opening of the Southeastern Michigan Psychiatric Hospital later this year, Michigan is facing a mental health bed shortage with approximately 2500 beds. According to the Treatment Advocacy Center (www.TAC.org) 50 beds per 100,000 people is recommended. Michigan is currently at 5 beds per 100,000 people. This has caused long wait times and lack of access to treatment.

How has this affected Chelsea’s recovery? From the beginning, she needed long term treatment and stabilization. With over a year waiting list for access to long term treatment, this was not an option. Instead, we had no choice but to struggle through 13 hospitalizations in 18 months with almost a year inpatient. She had episodes of aggression, catatonia and hallucinations which prompted her to jump from a moving vehicle twice. After many unstable discharges, we finally found the right medication to start her on the path to recovery. We are now 4 years into her illness and she continues to improve. With the proper placement and care, many of the dangerous and even life threating situations Chelsea has faced could have been avoided.

The 1965 IMD exclusion is completely outdated and should be repealed.
Contact your representatives in support of these bills:

H.R.6727 – Repealing the IMD Exclusion Act
119th Congress (2025-2026)
This bill is to remove the exclusion from medical assistance under the Medicaid program.
https://www.congress.gov/bill/119th-congress/house-bill/6727/all-info

H.R.4022 – Increasing Behavioral Health Treatment Act
119th Congress (2025-2026)
This bill repeals restrictions for individuals under the age of 65.
https://www.congress.gov/bill/119th-congress/house-bill/4022?hl=hr4022&s=8&r=1

H.R.5462 – Michelle Alyssa Go Act
119th Congress (2025-2026)
This bill revises the definition of institution for mental diseases under the Medicaid program to exclude institutions having 36 beds or less if such institutions meet certain standards.
https://www.congress.gov/bill/119th-congress/house-bill/5462/all-info