Medicaid SMI 1115 Demonstration Waiver Annual Public Forum 2026

The annual forums are a requirement by the Centers for Medicare and Medicaid Services (CMS) for the 1115 Demonstration Waiver under which the SMI program operates. The waiver was originally approved on May 20, 2022. The goal of the SMI Demonstration is to maintain and enhance access to mental health services and continue delivery system improvements for these services to provide more coordinated and comprehensive treatment of Medicaid beneficiaries with SMI. This demonstration will provide the state with the authority to provide high-quality, clinically appropriate treatment to beneficiaries with SMI while they are short-term residents in residential and inpatient treatment settings that qualify as an Institute for Mental Diseases (IMD) in Baldwin and Mobile counties. Alabama Medicaid beneficiaries who are eligible for inpatient behavioral health services will be able to access services via the IMDs participating in the demonstration, regardless of their county of residence. It will also support state efforts to enhance provider capacity and improve access to a continuum of treatments for SMI. During the demonstration period, the state seeks to achieve the following goals which align with the SMI SMDL #18-011:

• Reduced utilization and lengths of stay in emergency departments (EDs) among Medicaid beneficiaries with SMI or Serious Emotional Disturbance (SED) while awaiting mental health treatment in specialized settings;
• Reduced preventable readmissions to acute care hospitals and residential settings;
• Improved availability of crisis stabilization services, including services made available through call centers and mobile crisis units, intensive outpatient services, as well as services provided during acute short-term stays in residential crisis stabilization programs, psychiatric hospitals and residential treatment settings throughout the state;
• Improved access to community-based services to address the chronic mental health care needs of beneficiaries with SMI or SED, including through increased integration of primary and behavioral health care; and

• Improved care coordination, especially continuity of care in the community following episodes of acute care in hospitals and residential treatment facilities.

CMS expects the state to achieve the goals on a statewide basis despite authorizing expenditure authority on less-than-a statewide basis since the state will concurrently implement initiatives that improve community-based mental health care.

Information on the SMI Waiver Program is available at https://medicaid.alabama.gov/content/4.0_Programs/4.2_Medical_Services/4.2.6_Mental_Health/4.2.6.2_SMI_Waiver.aspx.