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Photos by Karen Francisco | The Journal Gazette
Carriage House staff member Britney Bastress confers with Clubhouse member Orlando Torres as he handles a phone call Tuesday. The Carriage House, 3327 Lake Ave., continues to struggle with the state’s failure to allow Medicaid reimbursement for its mental health rehabilitation services.

Costly Clubhouse standoff

Fort Wayne’s Carriage House helps adults seeking recovery from mental illness, as surely as Ortho NorthEast helps people seeking recovery from a physical injury or illness.

“You would not expect ONE to offer therapy as a charity, but that’s exactly what’s expected of a psycho-social rehabilitation program,” said Andy Wilson, Carriage House executive director.

That’s been the expectation since July 2010, when the state’s top health administrators reinterpreted Medicaid guidelines to eliminate reimbursement for Clubhouse programs, the evidence-based model meticulously followed by Carriage House. That’s left the successful program depending on donations and fundraising to continue services that allow many of its members to become productive tax-paying citizens. While Fort Wayne is fortunate to have Carriage House, other Indiana communities have lost their Clubhouse programs or have been unable to start them because of the Medicaid issue.

If Gov. Mike Pence is looking for a slam-dunk way to reduce state spending, he can direct Indiana’s Office of Medicaid Planning and Policy to clarify guidelines so that Medicaid will cover the cost of Clubhouse-model therapeutic services. It’s a standoff that has nothing to do with Medicaid spending or the federal health care law. And it’s an opportunity to do the right thing for taxpayers and Hoosiers affected by severe mental illness.

Inexplicably, the previous administration stonewalled on attempts to give Clubhouse programs a dependable source of funds, and legislative leaders failed to include language in the 2011 budget bill directing them to do so. State officials ignored an appeal from Judge David Avery of Allen Superior Court and other top officials, including Sheriff Ken Fries, Mayor Tom Henry and Superior Court Judge John Surbeck.

“We want you to clearly understand that we as a community believe the Carriage House is a vital partner with Park Center, NAMI, (the Crisis Intervention Team) and others in offering care to the mentally ill in Fort Wayne,” they wrote in February 2011. “It would not cost the state any additional dollars and would very likely save the state by avoiding an additional increase in emergency room and inpatient hospital costs. Not to mention the likely increase of costs of law enforcement and incarceration for the mentally ill.”

Despite the state’s position, Carriage House has continued its good work. About 400 members actively participated last year – building self-confidence, gaining work experience in running the Clubhouse and experiencing a sense of belonging. Sixty members found jobs, another 18 started college and 50 settled into homes or apartments. Those are impressive numbers for a population facing tremendous barriers to employment and everyday life.

The cost for a member is about $3,600 a year, according to Wilson, the executive director. That’s the equivalent of about three days of inpatient hospital care. If Indiana were to follow the lead of other states and clear the way for reimbursement, about $70 million in Medicaid funding would return to the state’s economy and leverage millions more in wages, taxes and savings from health costs and more.

Gov. Pence: Here’s a great opportunity to do the right thing.