Getting rid of the IMD RULE to build out the High end of the continuum of care

Opinion

Mayors Coffman, Mobolade and Johnston: Mental health services lacking across Colorado

What’s needed is a historic investment in more inpatient beds and additional inpatient facilities.

Guest Column

January 9, 2024

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Val's Take

• Colorado Law Enforcement, District Attorneys and Mayors seem to be largely in agreement with regard to the need for more Residential and Inpatient Options.
• This has been a really hard issue for the Mental Health Community in Colorado and Nationally and by extension the larger Disability Advocacy Community.
• The Medicaid Rule prohibiting the funding of "INSTITUTES of MENTAL DISEASE" has been a disaster.
  • The IMD Rule was supposed to serve as an INCENTIVE for the creation of housing and services in the community --
    • BUT YOU KNOW WHAT --- it's been cheaper for STATES not to provide any of the above or not at the scale needed:  beds, housing and intensive community services.
    • But those COSTS don't go away --- they are SHIFTED to  Cities and Counties. --- That is not just true in Colorado.
      • Further the costs can be horrific.
  •  The IMD Rule has undergone relaxation over the last few years --- and we probably do just need to get rid of it.
  • It would cost the FEDS about $4 Billion Dollars to get rid of the IMD Rule per year, according to a Congressional Budget Office Analysis.
    • This is from Open Minds Executive Briefings-- April 2023
      

Reference: Medicaid: IMD Exclusion | NAMI: National Alliance on Mental ...

Currently, the law prohibits states from using Medicaid to pay for care provided in “institutions for mental disease” (IMDs), which are psychiatric hospitals or other residential treatment facilities that have more than 16 beds.

The Mayors also recognized the importance of Community Mental Health Services as a STEP DOWN from facilities and to provide a more complete CONTINUUM OF CARE.

That is really a wonderful thing --- because this debate has too often been about Hospitals and Facilities versus Community Care.

The DEVIL IS IN THE DETAILS --- but it is encouraging that so many political and community leaders are calling for greater investments on the HIGH END OF THE CONTINUUM OF CARE.