Daniels’ Mental Health Cuts Will Cost Hoosiers More

An old friend of ALO has brought the following Op-Ed piece by Fort Wayne resident Guy Bayes from Saturday’s Journal-Gazette. The gist of Mr. Bayes piece being that Governor Mitch Daniels is closing a classification for billing to Medicaid for what serves as the lowest cost mental health model presently at work in the state.

The family Clubhouse rehabilitation model, which is how Fort Wayne’s Carriage House works, is the most successful and cost-effective means of recovery from mental illness in America. Regular attendance for each Carriage House member costs about $3,300 a year. In contrast, when someone with mental illness winds up in the psychiatric ward of a local hospital, the cost runs about $2,000 to $5,000 per day. Incarceration in the Allen County Jail costs about $44,000 a year.

Since it opened in 1998, the Carriage House has placed 260 members in transitional employment and more than 200 members in supported or independent employment. Employed members have earned more than $350,000 since 1998, while the staff has helped more than 39 people with higher education.

Fort Wayne Carriage House on Daniels' Chopping Block

For a fiscal conservative who likes to say he doesn’t want to cut service and especially wants to “save what works,” the Governor seems to cut a lot of cost-effective programs while complaining that only his brand of health-care reform will keep costs lower. Here seems to be an example were the Governor’s reasoning is short-sighted.

The Carriage House is in danger because the governor’s proposed budget and new Medicaid plan will eliminate the code used by Clubhouses for billing purposes. If these changes are not amended or pushed back, the Carriage House may cease to exist in July.

The governor’s budget provides money for Indiana residents with developmental disabilities, which is surely necessary, but providing state funding for our most successful and cost-effective rehabilitation program for our citizens with severe mental illnesses is every bit as necessary.

Carriage House members with severe mental illness are unlikely to voluntarily enter hospitals and other more compulsory treatment programs that are very expensive. But with the Carriage House gone, these treatment programs will become the safety net.

Maybe Daniels and his staff are just looking for a term in the code that looks fluffy in hopes of cutting something that will sound unimportant since the accepted name for this type of billing classification is “clubhouse.”

Daniels and his flunkies should show a little more substance and do their research especially in light of some pretty substantial bi-partisan support for this tried and true cost-saving clubhouse business model as exemplified by the remarks of Senator Tom Wyss (R-Fort Wayne) in this September J-G piece entitled Save the Carriage House. This piece came out right before the Governor’s Indiana Commission on Mental Health:

But the Deficit Reduction Act of 2005, aimed at reducing the federal government’s share of Medicaid costs, is shaking up the funding formula. The federal government has advised it is getting away from case-management programs. To comply with the federal rules and avoid the risk of a costly audit finding, Indiana’s Department of Mental Health and Addictions has advised mental health service providers that it can no longer reimburse programs like the Carriage House.

But Fort Wayne’s program is one of only two in the state that faithfully follows the International Center for Clubhouse Development standards, which don’t subscribe to marginally helpful therapies such as independent living classes and others that will now qualify for Medicaid funding.

Executive Director Andy Wilson said the Carriage House won’t change its successful practices to chase the money. Of its $775,000 annual budget, about $350,000 flows through Medicaid. While the Fort Wayne program has been blessed with generous community support from foundations, organizations and individual donors, Wilson said he saw no way it could make up the shortfall. He sees support for the program as a wise investment.

“It’s either spend a little on rehabilitation on one end or spend a ton on the other for hospitalization and incarceration,” Wilson said.

Area lawmakers met with the director and Jane Novak, one of the program’s founders, last month to hear about the Carriage House and the funding problem.

Sen. Thomas Wyss, R-Fort Wayne, said he’s long been familiar with the program and hopes a solution can be found.

“Everyone who was at that meeting recognizes the value, not just because it’s in our community, but because it works,” Wyss said. “I think it has done a tremendous job.”

Whatever the Governor and his administration’s reasoning, we at ALO think they should reconsider and we encourage our Democratic General Assembly members to take note of this issue, before there is no place left for our brothers and sisters who face such difficulties to turn.

Applause to Mr. Bayes for his letter:

The governor’s budget provides money for Indiana residents with developmental disabilities, which is surely necessary, but providing state funding for our most successful and cost-effective rehabilitation program for our citizens with severe mental illnesses is every bit as necessary.

Carriage House members with severe mental illness are unlikely to voluntarily enter hospitals and other more compulsory treatment programs that are very expensive. But with the Carriage House gone, these treatment programs will become the safety net.

Who will pay for the huge new costs of caring for people with mental illness once the Carriage House is gone? Indiana taxpayers.

Please call or write Gov. Mitch Daniels and your local state representatives and senators to change the governor’s unjust plan and budget.

Call Daniels at 317-232-4567; Indiana senators at 1-800-382-9467; and Indiana representatives at 1-800-382-9842.


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