Congresswoman Marcia Fudge (D-OH) introduced the Breaking Addiction Act of 2014 (H.R. 5136) on July 17, which would create a five-year demonstration project that allows federal reimbursement to “community-based Institute for Mental Disease” (IMDs) for substance-abuse treatment under Medicaid in up to 10 states. The bill specifically states that the IMD exclusion is a barrier to care and that Congress should reconsider it.
The existing IMD exclusion dates back to the beginning of Medicaid and originally was meant to prevent states from warehousing individuals with mental illness in institutions. However, residential mental health and substance use treatment centers are subject to the exclusion—although hospitals are not. The bill’s authors indicate that current law prevents nearly 15 million Medicaid beneficiaries from receiving the treatment they need and also limits the number of treatment beds available.
The Secretary of Health and Human Services must produce a report on the impact the change would have on the provision of substance use disorder services. With the growing epidemic of heroin use, Congresswoman Fudge and the nine co-sponsors of the bill—all Democrats--believe the project will create a model to expand community-based treatment options for those who need it.