The Problem the IMD Law

The Problem the IMD Exclusion

Medicaid for some are not available the alcohol and drug addiction residential treatment facilities for services provided to individuals between the ages of 22 and 64. A law in existence restricts Medicaid reimbursements to Institutes for mental disorders. 

Substance abuse treatment services are not distinguished from mental health services in statute or regulation.  Medicaid and Medicare Services have been linked; substance abuse with mental health. Addictive disorders are now mental disorders.  Institutions in the IMD statute to include community substance abuse non hospital residential treatment are considered institutions. The move to deinstitutionalize mental health patients restricts the resources to community based services. .The exclusion us a bars citizens receiving community based care through therapeutic communities. Therapeutic communities are located mostly in the neighborhoods and communities in which their clients live and work. The Medicaid exclusion jeopardizes the services to the clients.

The IMD exclusion is a barrier to many who need substance abuse treatment. Those with substance abuse disorders must have treatment options available to them, including the services of therapeutic communities. The IMD exclusion blocks the clients to the choice and access to care that is effective. The exclusion limits Medicaid eligible citizens from receiving either no care at all, or less effective care for their addiction.

 If the IMD Exclusion were corrected, many American citizens in the public health, social service, and criminal justice systems could be treated for their disease. 

 Medicaid eligible clients receiving substance abuse treatment in an IMD are not eligible for any medical benefits even emergency care, despite the fact that if the client were not in an IMD, they would be eligible for their Medicaid benefits

About 2 million people who suffer from severe brain disorders are not receiving treatment.  A major reason why so many are not being treated is that, because of the effects of the illness, they lack awareness of their illness. Studies have shown that approximately half of all patients suffering from schizophrenia and bipolar disorder have impaired awareness of their illness. These individuals will refuse to take medication because they do not believe they are sick.

Persons with severe brain disorders are reduced to being homeless persons.  It is estimated that as many as 200,000 are in jail or prison, which means that prisons have become treatment institutes.

The majority of long term and a large number short term hospitals for severe brain disorders in state psychiatric hospitals are without services and treatment.  This is an effective deinstitutionalization. The number of state psychiatric hospital beds has continued to decrease.

With  community services, the majority of persons with severe mental illnesses do not require long term hospitalization, however, a small group still requires the long term care and supervision of a psychiatric hospital but in some areas  they are faced with waiting lists for admission to many of the state psychiatric hospitals.

Deinstitutionalization is a good c idea. Many persons with severe brain disorders who are not currently receiving care can be cared for in community residences as in a group home.

A percentage of individuals with severe mental illness are unable to use community treatment. These people require long term care in an institution.  Those with the most severe, disabling and chronic forms of severe mental illness have had their needs are overlooked in the mass closure of state hospitals unavailable community services.

One major reason leading the states to close their psychiatric hospitals is the Medicaid reimbursement law which is known as the IMD Exclusion. This exclusion prevents a state psychiatric hospital from receiving federal Medicaid funds for its patients. Patients hospitalized on the psychiatric ward of a general hospital or treated in a community setting are eligible for funds. Without federal funds, state hospitals close. The result is the discharging of patients and then closing the state hospitals and states save state money. If a patient then needs to be hospitalized, it is to a general hospital that is not equipped to handle long term psychiatric care. The quality of care is generally not as good as in private or state psychiatric hospitals.

The IMD Exclusion was forced deinstitutionalization as states saved their own funds by closing state hospitals, the funds were reassigned to the Federal Government. Many of the patients should not have been discharged and were not receiving follow up care was disregarded by the states. No changes were made to care for those affected by deinstitutionalization and American citizens are still denied their basic rights, and forced to receive inadequate care.