Medicaid Incentives Hollow Psychiatric Capacity

Federal Medicaid rules (the IMD exclusion) plus state budget choices and hospital revenue incentives push serious‑mental‑illness care out of specialty psychiatric hospitals and into general hospitals or nowhere, producing clinical shortfalls and inefficient costs. Fixes that rely on fines or investigations miss the root: reimbursement structure and profitability tilts that make psych beds scarce. — If true, changing federal/state reimbursement or rebuilding psychiatric hospital capacity is a tractable lever with big effects on safety, emergency care, and state budgets.