ENROLLED
2020 First Extraordinary Session
HOUSE RESOLUTION NO. 42
BY REPRESENTATIVES GREGORY MILLER AND HILFERTY
A RESOLUTION
To urge and request the Louisiana Department of Health to seek approval of a Medicaid
demonstration waiver which would authorize Medicaid reimbursement for inpatient
treatment of serious mental illness in hospitals and psychiatric facilities.
WHEREAS, the decades-long exclusion of Medicaid payments for healthcare
facilities and providers classified as "institutions for mental diseases" (IMDs) is a
contentious feature of our nation's mental health system; and
WHEREAS, the IMD exclusion prohibits the use of federal Medicaid funds for care
provided to most patients in residential mental health and substance use treatment facilities
with over sixteen beds; and
WHEREAS, this funding prohibition was intended to encourage a transition away
from institutionalization of people with mental illness and toward community-based
treatment models; and
WHEREAS, the actual effect of the IMD exclusion has been the creation of a major
barrier in access to care by persons with severe mental illness, as residential and inpatient
treatment are critical components in the continuum of psychiatric care; and
WHEREAS, since November of 2017, states have been allowed to apply to the
federal Medicaid agency, the Centers for Medicare and Medicaid Services, for a waiver of
the IMD exclusion for individuals with substance use disorder and, as of November of 2018,
for individuals with serious mental illness; and
WHEREAS, this waiver allows Medicaid to reimburse IMDs with more than sixteen
beds for treating patients with mental illnesses; and
WHEREAS, Louisiana has obtained an IMD waiver for substance use disorder
treatment, but has not requested an amendment to the waiver to also include treatment for
serious mental illness; and
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WHEREAS, persons in crisis or in need of stabilization or acute care may require the
type of structured inpatient treatment that IMDs provide, and the Medicaid program is a vital
source of mental health funding; and
WHEREAS, lifting the IMD exclusion could help lessen the disparities in access and
funding between outpatient systems and more acute levels of care and thereby reduce this
state's shortage of psychiatric beds; and
WHEREAS, the premise that reducing funds for inpatient care will lower
institutionalization rates disregards the fact that our current system often results in
confinement of people with serious mental illness in institutions such as jails and prisons and
also leads to inappropriate utilization of emergency departments and unspecialized hospital
beds; and
WHEREAS, many people with mental illness in this state who need treatment are
instead being held in jails because there may be no appropriate treatment options available
to them; and
WHEREAS, by seeking an amendment to its existing Medicaid waiver, this state
could secure additional funding for much-needed enhancements to our mental health
treatment system, provide more effective mental health care to individuals with serious
mental illness, and, over time, curtail the number of people with mental illness who are
unnecessarily confined in our jails, prisons, and hospitals.
THEREFORE, BE IT RESOLVED that the House of Representatives of the
Legislature of Louisiana does hereby urge and request the Louisiana Department of Health
to seek approval of a Medicaid demonstration waiver which would authorize Medicaid
reimbursement for inpatient treatment of serious mental illness in hospitals and psychiatric
facilities.
BE IT FURTHER RESOLVED that a copy of this Resolution be transmitted to the
secretary of the Louisiana Department of Health.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
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