SB 428 would direct the Department of Community Health to submit a Section 1915(c) waiver request to CMS by December 31, 2026, to authorize Medicaid reimbursement for home and community-based services (HCBS) for adults over 21 who need mental health services but do not require institutional-level care. Eligibility would be determined based on risk factors, including hospitalization history, psychiatric crises, emergency department visits, prior incarceration, and homelessness.