Find Help, Find Hope!

Advocacy Action Alert: End the IMD Exclusion; Send Emails Now

The following urgent alert has been adapted from an advocacy action call issued by the Mental Illness Policy Organization.   For additional background information on this key issue, please see the links at the bottom of the page including NAMI’s national position statement.

NOTE: Please help us understand the impact of our part in this call by cc-ing the email(s) you send  to .

Great news:

The federal government just made it easier for California and all states to expand hospitalization options for the seriously mentally ill.  But we have to act fast. The new policy allows states to use Medicaid money to pay for some mental illness hospitalizations that were previously excluded from Medicaid reimbursement.

However, in order to use Medicaid to expand hospital beds in California , the state Department of Health Care Services has to apply for this waiver.

Below is a model email to send to the Director of California Health Care Services, Jennifer Kent,, and to the Chief Deputy Director for Medicaid, Mari Cantwell, requesting that California apply for this waiver. Please use the subject line, “Please Apply for the IMD Demonstration Waiver for California.”

Thank you for all you do.

Fill in the info in the brackets < > and send the letter below to your state Medicaid and Health/Mental Health Director

Dear Director Kent and Deputy Director Rockwell:

As < a mental illness consumer/ a mental health service provider/ a family member of someone with serious mental illness/ etc.>, I am writing to urge you to apply for the Medicaid IMD Demonstration Waiver that would entitle our state to use Medicaid funds to pay for needed IMD beds for persons with serious mental illness.  HHS Sec. Azar announced the availability of waivers to Medicaid’s Institutes for Mental Disease (IMD) Exclusion on November 13th and the Centers for Medicaid and Medicare Services (CMS) published formal guidance in letter SMD # 18-011 which is available at

For too long, the IMD Exclusion has discriminated against the severely mentally ill. It is an artifact from an earlier time and is inconsistent with current mental health parity laws. It has forced countless thousands onto the streets, into jails, and into early graves. Because of a lack of IMD beds, some of the most seriously patients often end up languishing in an inappropriate acute care setting waiting for an IMD bed to open up. Tying up acute care beds like this seriously impacts the entire acute care system and contributes to long waits in the ER without treatment for individuals in crisis. Obtaining this waiver  is an opportunity to reduce this continuing disparity and the harm being inflicted on so many vulnerable individuals by the IMD exemption. 

By accessing federal Medicaid funds, our state and counties can reduce the costs of necessary hospitalizations which will help lower rates of homelessness, arrest, incarceration, suicide, and suffering among people afflicted with a serious mental illness, and improve timely access to appropriate levels of care.

Thank you for your attention to this important matter.

<Sign Your Name>

<Insert your complete contact info, address, email address, phone numbers, etc.>

Please ask your friends and family to send their own emails as well. Thank you for all you do.

DJ Jaffe,
Exec. Dir, Mental Illness Policy Org.;
Author, Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.

Background Materials on the IMD exclusion:

NAMI: “NAMI supports modifying a federal law, known as the “IMD exclusion,” to allow Medicaid to pay for short-term stays of adults ages 21-64 in psychiatric hospitals and facilities. Note: IMD stands for “Institutions for Mental Disease,” an outdated term that remains in federal law.”  Read More.

Treatment Advocacy Center (TAC): “We have created a Q&A Summary of the federal government’s recent announcement giving states more freedom to overcome the IMD exclusion and provide desperately needed inpatient psychiatric beds.”  Read More.

National Shattering the Silence Coalition, NSSC,  has produced a more detailed exposition of the IMD problem in their position statement which is available for download here.


Become a Member


Get Involved


Get In Touch