The U.S. House of Representatives introduced bipartisan legislation to remove long-standing Medicaid funding restrictions that have limited behavioral health treatment access. The Increasing Behavioral Health Treatment Act (H.R. 4022), introduced on June 20, aims to provide states and counties with greater flexibility to meet growing behavioral health needs by reforming the Institutions for Mental Disease (IMD) exclusion policy.
The IMD Exclusion and Its Impact
The Medicaid Institutions for Mental Disease (IMD) payment prohibition has long restricted funding for behavioral health treatment in certain facilities, forcing states and counties to find alternative approaches or forgo treatment options. The Increasing Behavioral Health Treatment Act would remove this restriction for states that submit a plan to increase access to outpatient and community-based behavioral health care, expand the availability of crisis stabilization services, and improve data sharing and coordination among physical health, mental health, addiction treatment providers, and first responders. Counties play a pivotal role as the safety net for behavioral health services, with about two-thirds of the U.S. population relying on county-based behavioral health services through more than 750 county-supported or operated behavioral health authorities. In nearly every state and the District of Columbia, at least one mental health facility is operated by a county, local, or municipal government.
Financial and Administrative Burden on Counties
The IMD exclusion policy creates administrative complexities and financial burdens on counties. Without reforms, patients continue to be diverted from capable mental healthcare institutions, leading to an overreliance on emergency departments or leaving residents with no care at all. Counties help finance and administer Medicaid services, the largest funding source for behavioral health services in the United States. As behavioral health needs grow, the restrictions prevent counties from utilizing existing facilities and infrastructure to provide timely and comprehensive care. Enactment of this legislation would reform the payment prohibition that has long been a barrier for counties seeking to serve individuals experiencing mental health or substance use crises.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.naco.org/news/us-house-representatives-introduces-legislation-expand-medicaid-coverage-behavioral-health