Alabama Section 1115 Institutions for Mental Disease Waiver for Serious Mental Illness Comments

Executive Summary

In comments to the Department of Health and Human Services, the National Health Law Program urges HHS to reject Alabama’s proposed request to waive the Institutions for Mental Diseases (IMD) exclusion. First, the Secretary may only waive requirements of the federal Medicaid Act to conduct an experiment or test a novel approach to improve medical assistance for low-income individuals, and Alabama has not proposed a genuine experiment or novel approach. Second, Alabama asks the Secretary to waive provisions of the Medicaid Act the Secretary does not have the authority to waive. Section 1115 only permits the waiver of those requirements found in 42 U.S.C. § 1396a, and Alabama requests a waiver of provisions outside of 42 U.S.C. § 1396a, including the “Institution for Mental Diseases” (IMD) exclusion. Third, Alabama’s proposal risks diverting funds away from community-based services, undermining decades of progress toward increased community integration. Last, Alabama proposes several reforms that simply do not require any wavier of the Medicaid Act. Such reforms should be pursued outside of the context of a waiver.

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