Supporting 9–8–8 Crisis Stabilization Act
- Sponsor
- Rep. Goldman, Daniel S. [D-NY-10]
- Committees
- Energy and Commerce Committee (primary)
- Last action
- Sep 3, 2026
Bottom line
The bill expands Medicaid coverage for acute mental health and substance use crisis care by exempting specific community-based facilities from a long-standing federal funding exclusion.
What it actually does
This bill amends Title XIX of the Social Security Act (Medicaid) to revise the Institution for Mental Diseases (IMD) exclusion. Specifically, it exempts certified community behavioral health clinics, community mental health centers, crisis receiving and stabilization facilities, and mental health and substance use urgent care facilities from being classified as IMDs for Medicaid reimbursement purposes. It also defines the new crisis facility types and mandates federal guidance and a report on their utilization and impact.
Proponents argue
Proponents argue that this bill is crucial for modernizing Medicaid policy to support the 9-8-8 crisis lifeline by ensuring that individuals experiencing mental health or substance use crises can access appropriate, community-based care. They contend it will reduce reliance on hospital emergency rooms and the criminal justice system for behavioral health emergencies, leading to better patient outcomes and more efficient use of resources.
Opponents contend
Potential concerns could include the fiscal impact of expanding Medicaid eligibility for these services, particularly without a clear cost estimate. Some might raise questions about the consistency of quality of care across diverse state-certified facilities or the potential for federal definitions to limit state flexibility in designing their behavioral health systems.
The bill is concise and its core provisions are clearly stated, making it accessible for a quick and informed review by interested parties.
Section 2(a)(1)
Exempting Crisis Care Facilities from the IMD Exclusion
This provision amends Section 1905(i) of the Social Security Act to specify that, starting the day after enactment, the term 'institution for mental diseases' (IMD) will no longer include certain types of facilities. These include certified community behavioral health clinics (CCBHCs) participating in a demonstration program, community mental health centers (CMHCs) meeting specific Public Health Service Act criteria, newly defined crisis receiving and stabilization facilities, and mental health and substance use urgent care facilities. This change allows Medicaid to reimburse for services provided in these settings, which was previously restricted by the IMD exclusion.
Supporters argue
Supporters argue that this exemption is critical to align Medicaid policy with modern behavioral health practices, enabling states to build robust crisis care systems that are accessible and effective, thereby reducing reliance on more costly and less appropriate settings like emergency departments and jails.
Critics contend
Critics might express concerns about the potential for increased federal Medicaid expenditures without a clear understanding of the long-term cost implications or the capacity of states to adequately oversee the quality of care in these newly eligible facilities.
Tradeoffs
The provision navigates the tension between historical federal cost containment policies (the IMD exclusion) and the contemporary need to expand access to community-based mental health and substance use crisis care, potentially increasing federal outlays in exchange for improved public health outcomes and reduced burdens on other systems.
Section 2(a)(2), subsection (ll)(1)
Defining Crisis Receiving and Stabilization Facilities
This section establishes a detailed definition for 'crisis receiving and stabilization facility' for the purpose of the IMD exclusion. Such facilities must be state-licensed/certified for crisis response, operate 24/7, provide at least 23 hours of observation and assessment followed by 48 hours of crisis stabilization services (including withdrawal management and 24-hour medical monitoring). They cannot deny services based on ability to pay, residence, criminal justice history, acuity, disability, or age, and must offer a sliding scale discount. They must also accept referrals from law enforcement, EMS, and family members, and maintain an average length of stay of less than 150 hours.
Section 2(a)(2), subsection (ll)(2)
Defining Mental Health and Substance Use Urgent Care Facilities
This section defines 'mental health and substance use urgent care facility' as a facility where individuals experiencing a mental or behavioral health crisis can walk in without an appointment to receive immediate crisis assessment services, crisis intervention services, medication, and connection to other appropriate services. This definition is crucial for these facilities to qualify for the IMD exclusion.
Section 2(b) and 2(c)
Implementation Guidance and Impact Report
This section mandates the Secretary of Health and Human Services (HHS) to issue guidance to states within 180 days of enactment regarding the implementation of the IMD exclusion amendments. Additionally, within one year, the Secretary, in collaboration with the Attorney General and other relevant federal officials, must submit a report to Congress. This report will detail the utilization of crisis receiving and stabilization facilities (e.g., number of patients, services, referrals, law enforcement diversion trends) and analyze their association with reduced hospital emergency room admissions, averted psychiatric hospital admissions, and decreased incarceration rates.