What Medicaid/Medicare covers
NO. The Medicaid Institutions for Mental Diseases (IMD) Exclusion prohibits the use of federal Medicaid financing for care provided to patients 21 – 65 years of age, in MH/SUD residential treatment facilities with more than a 16-bed capacity. The exclusion is one of the very few examples of Medicaid law prohibiting the use of federal matching dollars for medically necessary care furnished by licensed medical professionals, based on the health care setting that is providing services. It has long been a barrier to efforts to use Medicaid to provide nonhospital inpatient behavioral health services, and regulations governing the IMD exclusion have not been updated since 1988. (Legal Action Center, 2014)
Maryland IMD Exclusion Waiver: Maryland Department of Health filed a waiver to override the federal IMD Exclusion and it was granted by Centers for Medicare and Medicaid Services (CMS) in 2016.
- As of July 2017, Maryland Medicaid covers up to (2) non-consecutive 30 day stays at residential treatment programs providing 3.3 – 3.7 (detox) level of care within a calendar year. For Medicaid patients who need additional or longer stays, as determined by medical necessity, state grants will kick in to cover gaps that Maryland Medicaid does not cover.
- As of July 2019, coverage for level 3.1 (halfway house) became available.
Hence, Maryland Medicaid is now parity compliant –covering residential detox (2017) and halfway house (2019), even though other state’s Medicaid programs may not be. (Legal Action Center, 2014) For more information regarding these levels of care, see Levels of Care.
NO. Medicare is specifically exempted from the Federal Parity Law, and state laws cannot regulate Medicare. Currently, Medicare has a 190-day lifetime limit for inpatient mental and substance use healthcare. This same limit does not exist for inpatient medical or surgical care. There is pending federal legislation to address this issue, but it has yet to be enacted.