Action Alerts
End the Federal IMD Exclusion to Increase Mental Health Hospital Beds
How many of us have been in crisis only to be told by a hospital that they don't have a mental health bed available, or that it will be 20 hours or more before one becomes available? One of the reasons for this is that there really are only a limited number of beds available for mental health care, because local treatment centers with more than 16 beds cannot get reimbursed by Medicaid. This stems from the days of deinstitutionalization when Institutions of Mental Disease (IMD) were being shut down; the intent at the time was good: to prevent the continuance of poorly-run ineffective large asylums. The care was supposed to be shifted to community mental health centers and local hospitals that offered psychiatric treatment, but the funding was never adequate.
The Medicaid IMD exclusion rule prevents the federal government from providing Medicaid funding to states for services delivered in IMDs to individuals aged 21-64. An IMD is generally defined as a facility with more than 16 beds that primarily focuses on the diagnosis, treatment, or care of people with mental diseases, including substance use disorders.
We have an opportunity in Florida to change this situation and increase the number of mental health beds! Our Florida Medicaid Secretary could apply for an IMD waiver from the federal government. This would allow Florida psychiatric hospitals and other mental health residential treatment centers to be reimbursed by Medicaid for more than 16 beds.
We agree with the NAMI policy and oppose the IMD Exclusion: https://www.nami.org/advocacy/policy-priorities/improving-health/medicaid-imd-exclusion/
In addition, we encourage Florida to review the Ernst & Young Behavioral Health Gap Analysis (Jan. 2025) and ensure there are adequate mental health and substance use treatment beds for civilian and forensic needs.
