This bill ends the long-standing rule that blocks Medicaid from paying for care in certain mental health facilities called institutions for mental diseases (IMDs) for people under age 65. Today, states can only get this paid for in limited ways, like special waivers. Under this bill, Medicaid could cover those services directly.

If a state covers IMD care, it must also build up help in the community. That includes more access to outpatient treatment; crisis call centers; mobile crisis teams; community crisis response with law enforcement and other first responders; observation or assessment centers; and ongoing services like intensive outpatient programs, assertive community treatment, and integrated care models such as Certified Community Behavioral Health Clinics. States must improve data sharing and coordination among physical health, mental health, and addiction providers and first responders; screen patients for other health conditions; have strategies to reach adolescents and young adults in crisis; use review policies to ensure care is at the right level and in the least restrictive setting; and report yearly on costs, use, length of stays, and the outpatient care (including medication-assisted treatment) people get after discharge .

• Who is affected: People under 65 on Medicaid who need inpatient mental health or substance use treatment; state Medicaid programs; mental health and addiction providers; first responders .
• What changes: Medicaid can pay for IMD services; states must expand community care and crisis services, improve coordination and data sharing, screen for other conditions, use review policies, and report yearly data .
• When: These changes take effect when the bill becomes law. States that need to pass their own laws get extra time to comply.