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Policy, Politics, and Nursing Practice

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Post-print: the version of the article having undergone peer review but prior to being published

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.




Approximately 3.4% of Americans have a mental health condition and suicide is the 10th leading cause of death. While the rate of mental health conditions has slightly increased for adult populations, America’s youth has experienced a significant rise in depression. From 2008 to 2017, occurrence of depression in the adolescent population increased from 8.3% to 13.3%. As adolescents mature into adults; it is likely the rate of mental health conditions for the adult population will rise as well as it is the common thread that binds the “diseases of despair”: drug abuse, alcoholism and suicide.

Arising out of the deinstitutionalization movement of the 1960’s, the Medicaid IMD Exclusion Rule (§1905(a)(B) of the Social Security Act) prohibits reimbursement for Medicaid recipients ages 21 to 64 years receiving inpatient care at a psychiatric hospital with 16 or more beds. Consequently, the rule limits payment for psychiatric treatment to general hospitals and smaller, non-specialized centers, which blocks patients from receiving inpatient care, and transfers the financial burden of care onto psychiatric hospitals.

The IMD Rule is approaching its 55th anniversary. It requires re-evaluation. Although a state waiver process is available, use of this option has the potential to increase the incidence of racial and ethnic disparities across states. Full repeal of the IMD Exclusion Rule could help provide immediate access to inpatient care that is consistent nationwide and be a vital step toward creating financial, treatment and ethical parity for mental health services.


Original publication information:

DuBose, B. M. & Fry-Bowers, E. K. (2020). Achieving Access Parity for Inpatient Psychiatric Care Requires Repealing the Medicaid Institutions for Mental Disease Exclusion Rule. Policy, Politics, and Nursing Practice, 1-27.

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