Medicaid cuts could jeopardize services at Yahara House

People with mental illness find work and community at the Madison ‘clubhouse’

Chewbacca, Yoda and Princess Leia watch over Joe Mannchen and colleagues as they work on their Yahara House computers, some designing birthday cards for fellow clubhouse members.

Taped above each desktop, the Star Wars cutouts distinguish the computers from each other — a more lively equipment tracking method than four-digit codes, Mannchen explains.

“We’re not numbers,” the 15-year clubhouse veteran jokes. “Why should our computers just be numbers in the system?”

The cutouts accent colorful decor inside Yahara House, which overlooks Lake Mendota on Madison’s isthmus. A pride flag, bulletin boards and photos cover bright blue walls of a mansion built in 1902 and once occupied by Adolph Kayser, a former mayor. Hanging beside century-old stained glass: a “Pets of Yaharans” photo display of cats Pumpkin Boy, B.B. King Cat, Mookie, Spock and Purr. Photos of human Yaharans hang elsewhere.

Yahara House, part of the nonprofit Journey Mental Health Center, is a community mental health program focused on building relationships and job opportunities. The clubhouse model reduces hospitalizations and boosts employment in adults with serious mental illnesses, experts and advocates say.

Mannchen, who once edited videos professionally, uses those skills to send updates to members.

“At the risk of being a little saccharine, it brings me joy,” he says.

Other members work in the Yahara House offices, reception desk or its kitchen, the Catfish Cafe. Still others fill temporary jobs at local shops, restaurants and the state Capitol. A bulletin board celebrates three dozen members with permanent jobs.

Wisconsin has few places like this. Yahara House is one of seven clubhouses in the state and just three with international accreditation, according to Clubhouse International’s latest count. Neighboring Michigan has 37 accredited clubhouses.

Medicaid cuts could jeopardize services

Reimbursement from Medicaid, the joint state and federal program to help low-income residents afford care, funds nearly all of the Yahara House budget, says director Brad Schlough.

But budget cuts in Washington may threaten that funding. Seeking to pay for tax cuts and some mandatory spending increases, the Republican-led U.S. House directed the committee that oversees Medicaid and Medicare programs to look for up to $880 billion in savings over the next decade. Medicaid is a likely target for significant cuts.

The Trump administration has already made cuts to COVID-era mental health funding and eliminated an office focused on helping older adults and people with disabilities live independently.

More than one in three U.S. adult Medicaid enrollees have a mental illness. Most in Yahara House rely on Medicaid for services within and outside of the clubhouse.

The clubhouse already struggles financially to serve members waiting to enroll or ineligible for Medicaid support services.

“Clubhouses are intended to be open to anyone in the community with a mental illness. The problem is that the funding doesn’t always follow that,” Schlough says.

When members do join the right Medicaid program, Wisconsin requires hours of recordkeeping for clubhouses to get paid. That contrasts with Michigan, which streamlines payments for clubhouses.

Yahara House members pride themselves on finding solutions. The community is celebrating 25 years of international accreditation this year and has served adults with mental illness for much longer.

Its longest-tenured member is Michael Larscheid at 47 years. His photo hangs on a bulletin board celebrating continuing education. He recently started swimming classes.

While many of his friends have moved or lost touch over the years, Yahara House remains a constant.

“This is my family here,” he says.

An ‘antidote for loneliness’

Larscheid works weekdays in the Catfish Cafe, calling out lunch orders that cost around $1 each.

Mark Benson, a 40-year clubhouse member, joins him, preparing food for about 30 people. Benson researches recipes for twice-weekly desserts that cost 50 cents. In February he debuted a diabetic-friendly pecan pie.

Benson is retired from outside work. But when he first joined, Yahara House connected him with a job at an upscale furniture store.

“I was vacuuming around these like three $30,000 consoles and glass tables,” he recalls. “I had to be very careful where I went. It was a good job.”

People with mental illness sometimes struggle in workplaces that lack flexibility for mental health days, Schlough said. They might also face transportation barriers. Yahara House keeps a list of more flexible Madison-area employers. The clubhouse trains staff for each job, allowing them to fill in when a club member can’t make a shift.

Yahara House also provides safe spaces during the day and on holidays and fosters community through weekly events like karaoke.

Schlough calls clubhouses an “antidote for loneliness.”

Few Wisconsin clubhouses

Despite the advantages, Wisconsin has seen little clubhouse expansion.

That surprised Sita Diehl, public policy and advocacy director for the National Alliance on Mental Illness Wisconsin chapter. She sees the model as underutilized.

Democratic Gov. Tony Evers’ latest budget proposal does not include specific funding for clubhouses, state Department of Health Services spokesperson Jennifer Miller confirmed in an email.

Still, Evers’ budget would expand the state’s behavioral health system, fund suicide prevention, and improve crisis response, Miller wrote, adding: “Supporting people with mental health concerns is a top priority” and that the administration worries that federal Medicaid cuts would harm Wisconsin residents.

Substantial funding changes for clubhouses would require legislative and state health department approval. There are no current plans to seek a new clubhouse waiver, Miller says, adding that expanding Medicaid like other states would boost resources for many services.

Yahara House’s Medicaid reimbursements flow through the state’s Comprehensive Community Services waiver for people with mental health or substance use issues that could lead to hospitalization. That program best accommodates easier-to-document treatments like psychotherapy, which often unfold in hour-long blocks of time, Schlough says.

Yahara House serves members sporadically throughout the day, leaving staff to spend as many as six hours daily logging time spent serving members — necessary for reimbursement, Schlough says. The exercise conflicts with a clubhouse spirit that encourages staff to treat members more as peers than patients.

The clubhouse doesn’t pepper new members with questions about diagnoses and limitations.

“We say, ‘We’re glad to see you,’” Schlough says. “What do you like to do? What are your interests?’”

‘We want to be a right door’

As a life-long Madisonian, Rick Petzke probably drove past Yahara House thousands of times. He didn’t know it could help him until his tour almost five years ago.

He joined and received a temporary job at Hy-Vee.

“They liked me so well, they hired me permanently,” Petkze says.

He regrets not learning earlier about a clubhouse members call “Madison’s best kept secret.”

Joining requires little more than having a mental illness. But it can take members up to four months to properly enroll with the county in the right Medicaid program, and a few don’t qualify, Schlough says.

When members aren’t enrolled? Yahara House eats the cost.

“There are too many wrong doors in this system, and we want to be a right door,” Schlough says.

The clubhouse has few funds for non-reimbursed services, particularly after Dane County cut part of that budget this year, Schlough says. Proposals for the state to allocate $50,000 to each Wisconsin clubhouse failed in consecutive legislative sessions.

The Wisconsin Mental Health Action Partnership wants state lawmakers to appropriate those funds, streamline Medicaid reporting requirements and adopt a clubhouse-specific Medicaid waiver.

The possibility of federal Medicaid cuts could only harm that cause, Diehl says.

Investing in clubhouses could save governments money over time, experts say. Compared to others living with severe mental illness, clubhouse members are less likely to be incarcerated, more likely to pay taxes and less likely to take costly trips to the emergency room.

‘I need to go back to my house’

Jennifer Wunrow left Yahara House for 10 years following more than a decade as a member. During her years away she felt herself “going down” and slipping toward a crisis.

“I need to go back to my house,” Wunrow recalls thinking.

Members greeted Wunrow upon her return, asking where she’d been.

When she secured her own two-bedroom apartment with Yahara House help, members and staff helped her move.

A year later, Wunrow calls herself “the biggest mouth in the house” and helps situate new members.

“I take a lot of pride in this house,” she says. “I love it here.”

Wisconsin Watch is a nonprofit, nonpartisan investigative newsroom.