The Medicaid IMD exclusion is an outdated, discriminatory federal rule that creates significant barriers to treatment for adults with severe mental illness. Under this rule, federal Medicaid reimbursements to states are prohibited for non-geriatric adults receiving psychiatric care in a treatment facility with more than 16 beds. The Governor and the General Assembly should address this parity gap by doing the following:

  • Treat IMD funding as an entitlement. In the past, the State has used the IMD budgetary number as a cap and used tools to lower the total cost of IMD utilization. These arbitrary limits on utilization are put in place regardless of patients’ interests. While the current administration has said verbally that there is no cap, the General Assembly should act now to eliminate any future funding caps through legislation.
  • Eliminate all barriers for Medicaid patients to be placed in an IMD if it is the best medically determined option for them. For example, the State currently requires emergency rooms to receive five denials from non-IMDs for psychiatric patients before placement can be made to an IMD. This “5-denial rule” is both discriminatory to our most vulnerable Marylanders as well as contributory to the boarding of such patients in emergency rooms. Emergency rooms are neither properly equipped to take care of such patients nor is it in the best interests of the State’s health care system to board patients in emergency rooms for unnecessarily long times (sometimes stretching into multiple days to weeks).
  • Fully fund the IMD as requested through the Maryland Hospital Association request to the Governor’s Budget. It is imperative with the increasing need for mental health services that the General Assembly ensure that the most vulnerable Marylanders have access to the treatment they need by fully funding the IMD budget line. Sheppard Pratt requests $45M for the State’s IMD budget.
  • Support stronger enforcement of parity laws by the Maryland Insurance Administration and standardize timely reporting by all carriers. The General Assembly should demand that public and private health plans afford people access to needed behavioral health care and treatment on the same basis. Such services should be subject to the same terms and conditions as care and treatment for any other illness, without regard to diagnosis, severity, or cause. These important steps will further ensure access to behavioral health for insureds under all Maryland insurance carriers.