The Board of Supervisors unanimously passed a motion by Supervisors Kathryn Barger and Hilda L. Solis that urges the State of California to apply for a Section 1115 Medicaid waiver that would expand coverage for inpatient mental health treatment.

“Medicaid is the largest payer of mental health services and expansion of this coverage would be critical to those who are in need of treatment,” said Supervisor Barger. “It is imperative that we use this opportunity to demonstrate that mental health treatment should be a permanent and ongoing priority that is worthy of both federal and state investments.”

Currently, there is a significant gap in Medicaid coverage for low income people that are in need of mental health treatment. This gap in coverage is known as the Institutions for Mental Disease (IMD) exclusion and has existed in the Medicaid program since its inception.

In 1965, the Social Security Act was amended to establish the federal Medicaid and Medicare programs. The IMD exclusion was built into the foundation of the Medicaid program via these and subsequent amendments to the Social Security Act. The IMD exclusion as amended prohibits states from receiving Medicaid payments for individuals in an IMD that are ages 21-64. The law defines an IMD as 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 related services.”

In November 2018, the Centers for Medicaid and Medicare Services (CMS) announced that for the first time, the federal government would begin to consider state applications for an IMD exclusion waiver. This would provide Medicaid coverage for IMD treatment to those who suffer from a severe mental illness.

“Last week, this board voted unanimously on Supervisor Barger’s previous motion to develop a countywide plan to expand our inpatient and stepdown mental health beds,” said Dr. Jonathan Sherin, Director of the Department of Mental Health. “Today’s motion is complementary to our existing efforts, and will allow us to right-size our network of hospital beds to ensure that the right level of care is delivered to those in need – including not just mental health services, but also services for addictions and medical comorbidities.”

The motion directs the Chief Executive Officer to send a five-signature letter to Governor Gavin Newsom, the California Department of Health Care Services, and the Los Angeles County State Legislative Delegation urging the state to apply for the 1115 Medicaid waiver to allow for the expansion of Medicaid coverage to the excluded population who are in need of inpatient mental health treatment.