Support the Michelle Alyssa Go Act

Support the Michelle Alyssa Go Act (H.R. 5462)

Support bipartisan legislation to modernize the Medicaid Institutions for Mental Diseases (IMD) exclusion by raising the bed cap for federally reimbursable inpatient psychiatric facilities from 16 to 36 and requiring facilities to meet nationally recognized, evidence-based care standards. This would allow behavioral healthcare providers to accommodate more patients, making counties and communities safer and healthier. NACo formally endorsed this legislation.

Why it Matters to Counties 

Counties are the backbone of America’s behavioral health safety net and help finance and administer Medicaid, the largest single funding source for behavioral health in the United States. The Michelle Alyssa Go Act would reform the IMD exclusion that currently undermines counties’ ability to serve their most vulnerable residents. 
Under current law: 

• Patients are often turned away from county-operated facilities due to the bed cap, creating gaps in care and placing unsustainable pressure on emergency departments 
• Medicaid-eligible residents may be denied access to necessary inpatient treatment due to IMD restrictions, worsening health outcomes and increasing long-term costs 
• Jails and emergency rooms, not treatment facilities, become the default response for individuals experiencing acute mental health crises

Current Landscape

• H.R. 5462 — Michelle Alyssa Go Act: Reintroduced September 18, 2025 with bipartisan support. Pending in the House; no Senate action yet. NACo formally endorsed this legislation in October 2025. 
• IMD Exclusion — Existing Law: Medicaid prohibits reimbursing care in psychiatric facilities with more than 16 beds. This policy was created in 1965 without major reform to present day. 
• Broader Landscape: The January 2026 White House Executive Order on Ending Crime and Disorder has created momentum in this policy space, but without the passage of H.R. 5462 or similar legislation, the IMD exclusion remains in place.

Implications of Inaction

Without passage of the bill, county jails, emergency rooms and budgets will continue to bear compounding costs of untreated behavioral health disorders: 

• Rising costs: ER visits and repeat hospitalizations cost far more than sustained inpatient care, with the burden falling on counties, states and federal programs.
• Increased incarceration: Jails will remain the default behavioral health response, driving up corrections and healthcare costs for counties, while keeping individuals out of the appropriate treatment. 
• Worsening health outcomes: Residents who can't access timely inpatient care face higher rates of relapse, deterioration and preventable death — while emergency departments and jails absorb the overflow, leading to overcrowding and increased county spending.

NACo’s Ask

NACo urges Congress to: 

• Pass H.R. 5462: Co-sponsor and advance this bipartisan legislation to raise the Medicaid-eligible inpatient psychiatric bed cap and enable counties to expand treatment capacity 
• Include IMD reform in broader Medicaid legislation: In future healthcare legislation Congress should ensure IMD exclusion reform is included in any final package
• Protect behavioral health funding: Oppose cuts to Medicaid or federal behavioral health funding that would further constrain county behavioral health systems and compound the harm of the IMD exclusion