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Medicaid program seeks federal waiver to expand drug treatment options

July 28th, 2015 by WCBC Radio

The Department of Health and Mental Hygiene (DHMH) is seeking a federal waiver from the Institution for Mental Diseases (IMD) Exclusion (also known as the “IMD Exclusion”). This waiver would significantly expand the scope of treatment options available to Medicaid enrollees with substance use and mental health disorders. “This waiver would allow adult Medicaid enrollees to receive services in private IMD facilities that are dedicated to treating their specific needs and would promote access to high-quality, specialized care.” said Shannon McMahon, DHMH’s Deputy Secretary for Health Care Financing, which houses Maryland’s Medicaid program. “The waiver also would allow the state to leverage federal funds for these services.”


The federal IMD Exclusion prohibits Medicaid reimbursement for adults between the ages of 21 and 64 who are receiving services provided in “a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care and treatment of individuals with mental diseases.” Because of this non-payment policy, many Medicaid enrollees with acute psychiatric and addiction treatment needs are referred to hospital emergency departments and general acute care inpatient units, rather than smaller, community-based specialized providers with expertise to care for these individuals. 

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