# The Effects of Medicaid Section 1115 Serious Mental Illness Waivers on Healthcare Utilization and Suicide-Related Behaviors

> **NIH NIH R01** · OREGON HEALTH & SCIENCE UNIVERSITY · 2024 · $743,837

## Abstract

PROJECT SUMMARY
There is a growing mental health crisis in the US, with the prevalence of clinically significant psychological
distress growing while access to behavioral health services apparently worsening. There has been a
particular shortage in the availability of crisis services and inpatient beds, placing a greater burden on
emergency departments and potentially associated with higher rates of homelessness, incarceration of
persons with serious mental illness, and worse health and wellbeing. The shortage of inpatient psychiatric beds
can be tied in part to Medicaid policies that do not allow federal payment for stays in “Institutions for Mental
Diseases” (IMDs), facilities with more than 16 beds that specialize in behavioral health treatment.
Recently, the Centers for Medicare & Medicaid Services (CMS) created an opportunity for states to apply for
waivers to receive federal payments for stays in IMDs for adults with serious mental illness (SMI) and
children with serious emotional disturbances (SED). Eleven states have received an SMI/SED waiver, and
five are pending. The waivers have the potential to improve crisis care and outpatient mental health care,
potentially reducing emergency department use and boarding, improving the coordination of care, and
reducing suicide and suicide-related behaviors. However, it is not yet clear whether the waivers have led to
changes in services or what state implementations are most successful in improving outcomes.
This comprehensive mixed-methods study will assess the effects of removing the IMD exclusion through the
SMI waivers. The staggered waiver approval process creates a natural experiment to compare states that
implement the waiver to those that do not. Our quantitative analysis will use the Transformed Medicaid
Statistical Information System Analytic Files (TAF), a national Medicaid data set that includes information on
eligibility, enrollment, and claims related to service utilization and prescription use. Our qualitative analysis will
explore state-level factors that may contribute to changes in outcomes. In response to PAR-21-316, our
proposed study will identify policies and factors that affect access, utilization, and outcomes, using large
Medicaid claims datasets and leveraging an existing data management approach to advance our research.

## Key facts

- **NIH application ID:** 10932304
- **Project number:** 5R01MH134842-02
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** Kenneth John McConnell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $743,837
- **Award type:** 5
- **Project period:** 2023-09-20 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10932304

## Citation

> US National Institutes of Health, RePORTER application 10932304, The Effects of Medicaid Section 1115 Serious Mental Illness Waivers on Healthcare Utilization and Suicide-Related Behaviors (5R01MH134842-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10932304. Licensed CC0.

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