Demand an End to the IMD Exclusion

One of the key barriers to care for those who suffer from serious mental illnesses, the Medicaid Institutions for Mental Disease (IMD) exclusion, can only be addressed by a change in Federal Law. The IMD Exclusion, enacted in 1965, as it's commonly known, makes it illegal for facilities to receive federal reimbursement for treating Medicaid recipients with serious mental illnesses if the facility has over 16 beds and the patients are aged 22-64. In this way, the IMD Exclusion prevents treatment for adults with SMI and substance use disorders (SUD) who, because of their illness, do not have employer or private health insurance. This federal law has effectively shut down most of the state psychiatric hospitals over the past two or three decades, leaving a shortage of an estimated 95,000 hospital beds in the country. The result has been human misery in the streets and our jails for these patients, and young people dying tragically from illnesses that could be treated if the IMD exclusion were repealed.

We, the members of the National Shattering Silence Coalition (NSSC), are voices for 11.2 million American adults and 7 million American children living with, suffering from, and dying too young from serious mental illness (SMI) and/or lack of access to care for their SMI. Every day we hear about tragedies that should have been prevented by simply providing access to the proper medical treatment and management of serious mental illnesses.

We have written the following letter to President Trump and Vice President Pence asking for a roundtable meeting to discuss repealing the IMD Exclusion. Please co-sign our letter and help us to end decades of suffering for generations of our youth stricken down in their prime by illnesses that, with early intervention and treatment, would enable them to regain their health and live happy productive lives.

"Dear President Trump and Vice-President Pence:

We, the members of the National Shattering Silence Coalition (NSSC), are voices for 11.2 million American adults and 7 million American children living with, suffering from, and dying too young from, serious mental illness (SMI) and/or lack of access to care for their SMI. Every day we hear about tragedies that should have been prevented by simply providing access to the proper medical treatment and management of serious mental illnesses. We are encouraged that the new Assistant Secretary of the Substance Abuse and Mental Health Services Administration, Dr. Elinore McCance-Katz, shares our passion to improve access to treatment for adults with serious mental illnesses.

One of the key barriers to care, the Medicaid Institutions for Mental Disease (IMD) exclusion, can only be addressed by a change in Federal Law. The IMD Exclusion, as it's commonly known, makes it illegal for facilities to receive federal reimbursement for treating Medicaid recipients with serious mental illnesses if the facility has over 16 beds and the patients are aged 22-64. In this way, the IMD Exclusion prevents treatment for adults with SMI and substance use disorders (SUD) who, because of their illness, do not have employer or private health insurance. This federal law has effectively shut down most of the state psychiatric hospitals over the past two or three decades, leaving a shortage of an estimated 95,000 hospital beds in the country. The result has been human misery in the streets and our jails for these patients, and young people dying tragically from illnesses that could be treated if the IMD exclusion were repealed.

Most sources conservatively estimate 40% of the homeless population suffer from SMI. 1 in 17 adults suffer from a serious mental health issue, and in most cases, it onsets victims in young adulthood. Moreover, SMI is a significant contributing factor to the national suicide rates. In addition, these patients die on average 25 years younger than their peers. These illnesses are treatable, but the IMD exclusion means the illnesses are no longer treated in hospital settings, which may be required for the best outcome for the person with the SMI. Currently, the most typical outcomes for brain disease like schizophrenia are homelessness, incarceration, and death. These are simply not acceptable outcomes for treatable illnesses.

Recent draft bills addressing the opioid crisis included a limited repeal of this law for SUD's only. These are woefully inadequate. SAMHSA already has demonstration grants and waivers that prove that allowing payments to IMDs actually improves treatment outcomes and saves long term costs of frequent readmissions, incarceration, homelessness, and death of our most desperately ill loved ones. Furthermore, the number of beds available for inpatient and crisis treatment can be increased to the necessary level of at least 147,000, a number estimated by the Treatment Advocacy Center in 2006, which found that 50 psychiatric beds are needed per 100,000 population.

These illnesses are biological in origin, like cancer or diabetes or any other illness. It is unconscionable to delay or deny medical treatment. We do not deny treatment to adults with Alzheimer's or Parkinson's Disease, which are also chronic brain illnesses. The IMD exclusion effectively discriminates against those whose brain illnesses are only deemed "psychiatric" and behavioral in nature--by shuttering the facilities that treat them, and by denying them access to quality, long term medical care.

It is long overdue to take meaningful action for the treatment of serious mental illnesses with a full repeal of the IMD exclusion. It is long past the time to end these tragic outcomes and the misery for families of these patients, and for the patients themselves.

We are respectfully requesting a roundtable meeting to discuss the repeal of the IMD Exclusion, to include yourselves, members of the NSSC, congressional leadership and the many other mental health advocates who are knowledgeable on the subject and who have been working to repeal the IMD exclusion.

We have included the NSSC IMD Exclusion Position Statement and references on the IMD exclusion for a more complete discussion of the case for a complete repeal of the IMD Exclusion. We look forward to the opportunity to further discuss with you and your staff this request for a roundtable meeting. Please stand up for our country's most vulnerable population and help bring an end to the IMD exclusion.

Sincerely,

NSSC"