The Los Angeles County Board of Supervisors unan­im­ously passed a motion by Supervisors Kathryn Bar­ger and Hilda L. Solis at its Feb. 5 meeting to urge the state of California to apply for a Section 1115 Medicaid waiver that would expand coverage for inpatient mental health treatment.

“Medicaid is the largest payer of mental health ser­vices and expansion of this coverage would be critical to those who are in need of treatment,” Supervisor Barger said in a statement. “It is imperative that we use this opportunity to dem­on­strate that mental health treatment should be a permanent and ongoing priority that is worthy of both federal and state investments.”

According to the super­visors’ motion Medicaid is the largest source of fund­ing for mental health and substance use disorder ser­vices, However, the fed­er­al Institutions for Men­tal Disease exclusion rule pro­hibits states from using Medicaid funds for in­pa­tient residents of an IMD who are between the ages of 21 to 64.

An IMD is described as “a hospital, nursing fac­il­ity, or other institution of more than 16 beds that is  primarily focused on treating mental ill­ness, including alcohol and substance abuse dis­orders,” the motion stated.

“Prior to the creation of a the Medicaid program, inpatient psychiatric care was funded by the states. The intent of the IMD exclusion was to prevent states from shifting the responsibility and cost of inpatient psychiatric care to the federal government via the Medicaid program,” the motion states. “How­ever, over the years states have dem­on­strated that they are unable to pro­vide adequate cov­er­age and access for a sig­nif­icant num­ber of low-income in­div­id­uals with chronic and severe men­tal ill­nesses that are in need of psy­chi­atric hos­pit­al­iz­a­tion.”

Under Section 1115 of the Social Security Act, the U.S. Secretary of Health and Human Services has the authority to waive spec­if­ic provisions of health and wel­fare programs such as Med­ic­aid. The wai­ver, which is gen­er­ally ap­proved in five-year in­­ter­­vals, had not previously been available to address the gap in inpatient mental health cov­erage created by the IMD ex­clusion until last year, the motion stated.

In November, the Cen­ters for Medicaid and Medicare Ser­vices  an­nounced that for the first time, the federal gov­ern­ment would begin to con­sid­er state applications for an IMD exclusion waiver.  This would pro­vide Med­ic­aid coverage for IMD treat­ment to those who suffer from a severe mental ill­ness.

“Last week, this board voted unanimously on Su­per­visor Barger’s previous mo­tion to develop a coun­ty­wide plan to expand our in­patient and stepdown men­tal health beds,” Dr. Jon­athan Sherin, dir­ector of the Department of Men­tal Health, said in a state­­ment. “Today’s motion is com­plementary to our ex­ist­ing efforts, and will allow us to right-size our net­work of hospital beds to ensure that the right level of care is delivered to those in need — including not just mental health ser­vices, but also services for ad­dictions and medical comorbidities.”

The supervisor’s motion dir­ects the county CEO to send a five-signature letter to Governor Gavin New­som, the California De­part­ment of Health Care Services, and the Los Angeles County State Leg­is­lative Delegation urging the state to apply for the 1115 Med­icaid waiver to allow for the expansion of Medicaid coverage to the excluded population who are in need of inpatient mental health treatment.

To share your opinion on this article or any other article, write a letter to the editor and email it to or mail it to Letters to Editor, PO Box 4050, Palmdale CA 93590-4050.

(0) comments

Welcome to the discussion.

Keep it Clean. Please avoid obscene, vulgar, lewd, racist or sexually-oriented language.
Don't Threaten. Threats of harming another person will not be tolerated.
Be Truthful. Don't knowingly lie about anyone or anything.
Be Nice. No racism, sexism or any sort of -ism that is degrading to another person.
Be Proactive. Use the 'Report' link on each comment to let us know of abusive posts.
Share with Us. We'd love to hear eyewitness accounts, the history behind an article.