Over the past five to seven years, the Centers for Medicare & Medicaid Services has loosened restrictions on the institution for mental disease (IMD) exclusion. Under the IMD exclusion rule, states cannot receive federal Medicaid funding for individuals aged 21-64 with a primary diagnosis of mental illness or substance use disorder in facilities with 16 or more beds where over half of beds serve individuals with a behavioral health diagnosis. Currently, there are 27 states that have waivers to provide addiction treatment in IMDs, and one state has a waiver to provide mental health treatment in an IMD. This . . .