free standing behavioral health hospitals not taking medicaid

Hi everyone,
This is a question for anyone who's gone to residential treatment and has medicaid. I live in IL. I was looking into a program specifically for self-injury. It was a very good program from the sounds of it! It is at a hospital that's specifically for behavioral health. They accept only children's medicaid up to age 21 and65 and older. When I asked about this I was given information about a NAMI rule from the 1960s. Saying that free standing psych hospitals are not allowed to bill to adult medicaid. This from what I understand was inacted at a time where many people were left long term in probably very poor psych hospitals. It was designed to help people get out of that situation and into the community. Unfortunately things have changed soo much since then. These places that are psychiatric free standing hospitals are providing what seems like wonderful partial hospital programs that are very supportive. And residential programs that are thirty to ninety days that are designed for in depth but short term treatment. Obveously this has changed from the 60s. It's just so unfair that people in most need of services (those on medicaid) are denied residential treatment almost across the board. If you have experiences of being on medicaid and going to residential I'd like to hear about them!

NAMI is a non-profit organization, has no rules anyone has to follow.

Unless you have your Medicaid under a 1115 waiver, you should qualify for what you are looking for -- does not mean particular clinics will necessarily take Medicaid but there should be some that do; call the State Health department and see who takes your insurance in your area: https://www.dhs.state.il.us/page.aspx?item=29728

https://store.samhsa.gov/shin/conten...05-0202-IL.pdf

I sort of knew about this but didn't know the name of it (the Medicaid IMD exclusion) or the background behind it. IMD = Institution for Mental Diseases (lovely archaic terminology there)

"When Congress created Medicaid and the IMD exclusion, it did not want to allocate federal dollars for what was long-term, and in many cases, custodial care, says Covall. States responded by shifting patients away from state-funded hospitals and into psychiatric units of general hospitals, where Medicaid picked up the tab."


What is the IMD Exclusion?

As defined by statute, "[t]he term ‘institution for mental diseases’ means 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."[25]


Current federal law prohibits Medicaid reimbursement for any person over age 21 and under age 65 who resides in an institution for mental diseases (IMD), even for treatment unrelated to mental illness.[26] This prohibition is commonly referred to as the IMD Rule or IMD Exclusion. State and private psychiatric hospitals are IMDs as are nursing homes that specialize in caring for the severely mentally ill.

The text above keeps coming out very large and I don't know how to fix it.

All cites from from "Medicaid considering IMD Exclusion-Alternatives"Medicaid should repeal IMD Exclusion