National Health Law Program Comments on D.C. 1115 Waiver Application

Executive Summary

In comments to the Department of Health and Human Services (HHS), The National Health Law Program urges HHS to reject the District of Columbia’s proposed Section 1115 Medicaid Behavioral Health Transformation Demonstration Program. As part of the demonstration, the District seeks to waive the Institutions for Mental Diseases (IMD) exclusion and to improve the availability of other SMI/SUD services. HHS, however, does not have authority to grant the request to waive the IMD exclusion because the exclusion is found outside of 42 U.S.C. § 1396a and because waiving the exclusion does not constitute an experiment for purposes of Section 1115. Moreover, most of the additional changes the District seeks, including the addition of certain mental health and SUD services, may be achieved through submission of a State Plan Amendment (SPA), rendering the Section 1115 demonstration unnecessary. Because the demonstration fails to comply with Section 1115’s requirements, HHS should deny the District’s request. 

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