What is the IMD exclusion again?
Institutions for Mental Disease (IMDs) are inpatient facilities of more than 16 beds whose patient roster is more than 51% people with severe mental illness. Federal Medicaid matching payments are prohibited for IMDs with a population between the ages of 22 and 64. IMDs for persons under age 22 or over age 64 are permitted, at state option, to draw federal Medicaid matching funds.
This is because back when Medicaid first started- states were responsible for the care of people with severe mental illness. The deinstitutionalization of state mental health programs has changed the landscape. Law has changed to give children and seniors Medicaid for IMDs. But until recently adults did not see Medicaid coverage.
The proposed rule on managed care the CMS released last month opens for door for coverage of IMDs for adults.
Just another example of how Medicaid policy is constantly learning and growing.