Johanna Catherine Maclean (
Hefei Wen is an assistant professor in the Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, in Boston, Massachusetts.
Health Aff (Millwood). 2021 Feb;40(2):326-333. doi: 10.1377/hlthaff.2020.00404.
The Institutions for Mental Diseases (IMD) exclusion prohibits use of federal Medicaid funds to treat enrollees ages 21-64 in psychiatric residential treatment facilities that have more than sixteen beds. In 2015 the federal government created a streamlined application pathway for state waivers of this rule to allow Medicaid coverage for substance use disorder (SUD) treatment in residential facilities. Nine states received IMD waivers during the period 2015-18. Using data from the 2010-18 National Survey of Substance Abuse Treatment Services, we examined changes in residential and outpatient SUD treatment facilities' acceptance of Medicaid and other types of health coverage, as well as self-pay arrangements and provision of charity care, after states' adoption of IMD waivers. Acceptance of Medicaid increased 34 percent at residential treatment facilities and 9 percent at intensive outpatient facilities two years after waiver implementation. Delivery of medications for opioid use disorder did not increase in residential facilities post waiver but did increase to some extent in outpatient facilities. Our findings suggest that IMD waivers may be an important tool for advancing access to a full continuum of SUD treatment for Medicaid enrollees.
精神疾病机构（IMD）排除规定禁止使用联邦医疗补助基金为年龄在 21-64 岁的精神病住院治疗患者提供 16 张以上床位的住院治疗。2015 年，联邦政府为该规则的州豁免创建了简化的申请途径，允许医疗补助计划覆盖住院治疗机构中的物质使用障碍（SUD）治疗。在 2015 年至 2018 年期间，有九个州获得了 IMD 豁免。利用 2010-18 年全国物质滥用治疗服务调查的数据，我们考察了在各州实施 IMD 豁免后，住院和门诊 SUD 治疗机构对医疗补助和其他类型医疗保险的接受程度，以及自费安排和慈善医疗服务的提供情况。豁免实施两年后，住院治疗机构对医疗补助的接受率增加了 34%，强化门诊治疗机构增加了 9%。住院治疗机构中阿片类药物使用障碍治疗药物的提供没有增加，但在门诊治疗机构中在一定程度上有所增加。我们的研究结果表明，IMD 豁免可能是为医疗补助参保者提供全面 SUD 治疗的一个重要工具。
