Comments are off for this post

NAMD Statement on Medicaid IMD Exclusion

For Immediate Release
March 17, 2016

Washington, DC – Yesterday, the Senate Health, Education, Labor and Pensions (HELP) Committee took an important step to strengthen the nation’s mental health delivery system. NAMD applauds the HELP Committee’s focus on the Medicaid Institutions for Mental Diseases (IMD) exclusion and echoes the call of many policymakers, providers and patient advocates to repeal this wrong-headed policy.

NAMD has a consistent record of supporting repeal of the IMD exclusion, which prohibits federal Medicaid funds to pay for inpatient services to individuals residing in IMDs. The policy rational for this payment exclusion may have made sense when Medicaid was created in 1965. The exclusion, however, has little to no relevance in the current context of state Medicaid programs and mental health delivery systems. In fact, in Medicaid programs across the country this policy is doing more harm than good.

The IMD exclusion undermines access to appropriate services for individuals in crisis and vulnerable populations with mental illness diagnoses. While Medicaid beneficiaries can receive physical health services in a wide range of inpatient facilities, individuals with behavioral health conditions cannot access specialized inpatient behavioral health services, even when they may be most appropriate to meet their needs. It also unnecessarily complicates the care experience for such individuals.

In addition to the personal cost, the exclusion drives up otherwise avoidable system costs that are ultimately born by taxpayers, such as inappropriate use of expensive emergency room services, and other perverse incentives.

State Medicaid Directors are advancing transformations in the behavioral health delivery system to produce better outcomes for patients and address historical bifurcation in care delivery. They are focused on integrating primary care and behavioral health services, expanding capacity for the continuum of services that will lead to improved health outcomes, and empowering individuals to make decisions that will improve their well-being.

We remain committed to working with Congress and other policymakers as they advance reasonable solutions for this outdated policy.


The National Association of Medicaid Directors (NAMD) is a bipartisan, nonprofit, professional organization representing leaders of state Medicaid agencies across the country. NAMD members drive major innovations in health care while overseeing Medicaid, one of the nation’s most vital health care safety net programs, which covers more than 72 million Americans. NAMD serves as the voice for state Medicaid directors in national policy discussions, supports state-driven policies and practices that strengthen the efficiency and effectiveness of Medicaid and actively monitors emerging issues in Medicaid and health care policy. Learn more at and follow NAMD on Twitter @statemedicaid.

Comments are closed.