If you or someone you love receives Alabama Medicaid and lives with a serious mental illness, the state is considering a renewal that could affect access to certain psychiatric hospital services.
Alabama Medicaid wants to renew a special federal waiver that helps pay for short-term inpatient psychiatric treatment. The waiver is already in place, but its current approval expires in May 2027.
The state is accepting public comments through November 6, 2026, and two public meetings are scheduled for October 22 and 23.
You don’t need to submit a new Medicaid application because of this proposal. However, if mental health services matter to you or your family, you have an opportunity to share your experience.
Here’s what you should know.
What Is Alabama’s Mental Health Medicaid Waiver?
Alabama’s Serious Mental Illness (SMI) waiver helps Medicaid cover certain short-term psychiatric hospital stays for eligible adults.
Normally, federal Medicaid rules restrict payments for adults ages 21 through 64 receiving care in certain psychiatric facilities known as institutions for mental disease, or IMDs.
This restriction is commonly called the IMD exclusion.
Alabama received federal permission to make an exception through a Section 1115 demonstration waiver.
The Centers for Medicare & Medicaid Services (CMS) originally approved the waiver on May 20, 2022.
It allows Alabama Medicaid to receive federal funding for qualifying short-term inpatient psychiatric treatment that would otherwise be affected by the IMD payment restriction.
The current waiver expires on May 19, 2027. Alabama is now requesting permission to continue the program beyond that date.
You can review the official CMS waiver information.
Who Can Receive Services Under This Waiver?
The waiver is designed for people who meet specific Medicaid and mental health requirements.
You may qualify for services covered by the waiver if you:
- Receive Alabama Medicaid.
- Are between 21 and 64 years old.
- Have a diagnosed serious mental illness.
- Meet the clinical and admission requirements for treatment at a participating facility.
Having a mental health diagnosis does not automatically mean you qualify for inpatient care.
A healthcare provider must determine whether the treatment is medically appropriate, and other program requirements may apply.
Which Alabama Counties Are Included?
The existing waiver authorizes qualifying psychiatric facilities in Baldwin and Mobile Counties.
However, Alabama’s September 2026 renewal notice proposes reimbursement for qualifying IMDs operating in Mobile, Baldwin, and Washington Counties.
This is an important distinction because the proposed renewal includes Washington County, which was not part of the original approved facility coverage.
The state also explains that eligible Medicaid beneficiaries may receive services at participating facilities regardless of which Alabama county they live in.
For example, someone living outside the participating counties may still be able to receive treatment at an eligible hospital if they meet the program’s requirements.
Hospital admission, medical necessity, and availability of services still matter.
Why Does Alabama Want to Renew the Waiver?
The goal is to maintain and improve access to appropriate mental health treatment for Medicaid beneficiaries experiencing serious psychiatric conditions.
According to Alabama Medicaid, the waiver supports both hospital-based treatment and community mental health services.
The state’s goals include:
- Reducing unnecessary time spent in emergency rooms while waiting for psychiatric treatment.
- Reducing preventable hospital readmissions.
- Improving access to crisis stabilization services.
- Expanding coordination between physical healthcare and behavioral healthcare.
- Helping people continue receiving appropriate mental health services after leaving a hospital.
These goals are especially important for people who need more intensive treatment during a mental health crisis.
The waiver is not simply about paying for hospital stays. Alabama also wants to improve how people move between emergency care, inpatient treatment, and ongoing community services.
You can read the state’s explanation in its official renewal announcement.
When Is the Public Comment Deadline?
Alabama Medicaid opened its public comment period on October 7, 2026.
The deadline to submit written comments is November 6, 2026.
This is your opportunity to tell the state how the proposed renewal could affect you, your family, or your community.
You might want to share your experience if you’ve had difficulty finding psychiatric treatment, experienced long emergency room waits, or struggled to access follow-up care after hospitalization.
You do not need to be a medical professional or policy expert to participate.
Public Meeting 1: October 22, 2026
- Date: Thursday, October 22, 2026
- Time: 10:00 a.m. to 11:00 a.m. Central Time
- Location: 501 Dexter Avenue, Montgomery, AL 36104
- Participation: In person, online, or by telephone
Public Meeting 2: October 23, 2026
- Date: Friday, October 23, 2026
- Time: 10:00 a.m. to 11:00 a.m. Central Time
- Location: 7400 Roper Lane, Daphne, AL 36526
- Participation: In person, online, or by telephone
Both meetings offer remote participation options, so you don’t have to travel to attend.
For Webex links, phone access information, and other meeting details, visit the Alabama Medicaid public notice.
How to Submit a Public Comment
If you’d like to share your thoughts about the renewal, you can send a written comment directly to Alabama Medicaid.
Option 1: Submit a Comment by Email
Send your comments to:
PublicComment@Medicaid.Alabama.Gov
You can explain why access to psychiatric treatment matters to you, describe challenges you’ve experienced, or share suggestions for improving services.
Option 2: Submit a Comment by Mail
You can also mail your comments to:
Administrative Secretary
Alabama Medicaid Agency
501 Dexter Avenue
P.O. Box 5624
Montgomery, AL 36103-5624
Written comments must be submitted by November 6, 2026.
The state says written comments will be available for public review, so avoid including private medical details or other sensitive information you would not want disclosed.
What Should You Say?
You can keep your comment simple.
For example, you might explain:
- Whether you or someone you care for has needed inpatient psychiatric treatment.
- Whether it has been difficult to find available mental health services.
- How access to hospital treatment or community care has affected your family.
- What improvements you would like Alabama Medicaid to consider.
You don’t have to support or oppose the entire proposal to share a useful experience.
The purpose of the comment period is to help the state understand how the program affects people who use or provide mental health services.
Do You Need to Reapply for Alabama Medicaid?
No. This waiver renewal proposal does not require existing Medicaid beneficiaries to submit a special application.
The public comment period is about the state’s request to continue federal funding for certain mental health services.
It is not an enrollment period for a new Medicaid benefit.
If you already receive Alabama Medicaid, continue following your regular coverage requirements, including responding to renewal notices and reporting changes when required.
If you need psychiatric treatment, speak with your healthcare provider or contact Alabama Medicaid about available services.
What Happens After November 6?
Once the state comment period ends, Alabama Medicaid can review the feedback and finalize its renewal request.
The request then goes to CMS for federal review.
CMS may approve the renewal, request changes, or deny the application.
There may also be an additional opportunity for public comments during the federal review process.
If approved, Alabama proposes that the renewed waiver begin on May 20, 2027, immediately after the current approval period ends.
However, the renewal has not yet been approved.
The final terms, participating facilities, and any changes to the program will depend on CMS’s decision.
For the latest updates, check the Alabama Medicaid SMI waiver page.
Relief Recap
Alabama Medicaid is seeking federal approval to renew its Serious Mental Illness waiver, which helps cover certain short-term psychiatric hospital stays for eligible adults ages 21 through 64.
The existing waiver covers qualifying facilities in Baldwin and Mobile Counties, while the 2026 renewal proposal also identifies Washington County.
The state is accepting written public comments through November 6, 2026, with public meetings scheduled for October 22 and 23.
You don’t need to reapply for Medicaid because of this proposal, but you can share your experience if mental health treatment access affects you or someone you care about.
For more information about Medicaid changes that could affect your benefits, read our guide to what’s happening with Medicaid.
