Medicaid IMD Exlusion Rule
The ImD RULE & ADMIN. Enforcement of Disability civil Rights Laws
GETTING RID of the IMD RULE "Could Be" the best thing for people with "Mental Illness" If it is paired with strict administrative enforcement of disability civil rights laws.
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We need to get rid of the IMD Rule BUT we have to hold the STATES' Feet to the FIRE when it comes to complying with these DISABILITY CIVIL RIGHTS LAWS -- like the ADA & Olmstead, Parity, & Medicaid Network Adequacy. CMS already has the authority to do that -- but they are NOT doing it. The US Dept. of Justice (DOJ) enters a smattering of cases around the country ---- but we have LARGE SCALE NON-COMPLIANCE BY THE STATES. Here in Colorado we are largely reduced to addressing State Mental Health Policy deficits by Federal Lawsuit or maybe we can engage in ad hoc raising of the taxes in select counties or cities. So the IMD rule was designed to encourage States to seek Medicaid funding for intensive treatments in the Community. Well, most States like Colorado did some of that BUT NOT near enough & they largely don't pay for the bed space that is needed either. Well, the Disability Community's role in all of this is NOT PRETTY, either. It is only within the last 5 years major National Stalwarts of the Mental Health Disability Law Community could even acknowledge that there were a lot of people with Mental Illness in the Criminal Justice System. THOSE ARE the BAD PEOPLE -- DON"T STIGMATIZE PEOPLE with "MENTAL ILLNESS." [Of course, the complicated reality is that jails & prisons are populated by a large number of people with cognitive disabilities, especially executive functioning deficits, as the result of a diverse number of issues and combinations of issues: mental illness, brain injury, substance use issues, developmental disabilities, etc.]. There are TENS of Millions of people in the US with these issues and the vast majority are not in the Criminal Justice System. BUT the vast majority of those in the Criminal Justice System have one or more of those issues. CRIMINAL JUSTICE REFORM IS A DISABILITY RIGHTS ISSUE. Getting rid of the IMD Rule will hopefully allow States to address the BED SPACE issue. Right now, a lot of prosecutors and judges ALREADY KNOW that A LOT of the PEOPLE before them have a brain injury or a mental illness or a substance use issue -- BUT with no place to send these people, and judges unwilling to release them to the Community in some cases-- those people go to PRISON. If we have learned anything from the IMD Rule it is that we CANNOT RELY on mere "INCENTIVES" to get states to do what they should do, or for that matter COMPLY WITH THE LAW. Further, People with Disabilities need something A LOT more timely & less costly than resort to the FEDERAL COURTS which is what people with disabilities are reduced to in Colorado and most States. DOJ can't even afford that on a widespread basis. FEDERAL COURTS are important -- but we need FEDERAL ADMINISTRATIVE PROCESSES that can largely handle enforcement of these Federal Laws through the requirements of comprehensive & specific data requirements and plans on the part of STATES to bring services to SCALE @ each level of the CONTINUUM OF CARE. THE POWER OF THE PURSE: State's like Colorado should NOT get their FULL FEDERAL MEDICAID MATCH if they are not in compliance or engaged in a PLAN OF CORRECTION regarding compliance with:
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