Taylor Gavin, a trainee at Café 54, cleans tables at the restaurant. He says his first month working at Café 54 brought much-needed structure to his life. Reduced insurance payments for the recovery-support services have put the program in financial jeopardy.
In the face of a steep deficit, leaders of downtown lunch bistro Café 54 are turning to the public for help.
The nonprofit has seen reduced insurance payments for the recovery support services it offers people with serious mental illness, who can get job training at the American fusion cafe and its mobile food truck, Truck 54.
But the cuts mean by the end of the year, Café 54 and Truck 54 will be short by about $175,000 and at risk of shutting down, taking away one avenue toward a productive life for people with serious mental illness, said Mindy Bernstein, executive director of Coyote Task Force, the 501c(3) nonprofit that runs the cafe and food truck.
“Out of necessity, to keep our doors open, we are coming to the community,” she said.
Fundraising hasn’t been a top priority for the agency in the past, but now, public support will be vital to the program’s survival, said Orlando Montes, program director for Café 54.
“We’ve always had a lot of community support, but we haven’t asked the community, ‘Would you write a check to Coyote Task Force or Café 54?’” said Montes, who has worked with the cafe for nine years. “We have to go to the community now and ask for support. I’ve never been in this paradigm where, in 2016, this might be our last year of operation. It’s unsettling.”
Café 54’s job-training program offers a lifeline for people with serious mental illness, providing steady work, job training and transitional support as trainees move to competitive jobs in the community, Bernstein said.
Training lasts anywhere between three and nine months, depending on what the client needs, Bernstein said.
“The cafe isn’t just about employment,” she said. “We’re also working with individuals on the significant barriers they have that have kept them from becoming employed,” such as low self-esteem.
The downtown lunch crowd has embraced the cafe and its mission, which can have profound impacts on the lives of those its trains, Bernstein said.
“When individuals with mental illnesses are employed in meaningful activity, hospitalization decrease considerably,” she said. “Crisis services go down for that individual. Some people require less medication.”
For 22-year-old Taylor Gavin, who has struggled after an episode of acute psychosis, his first month working at Café 54 brought much-needed structure to his life.
“It’s just nice to go into work every day, having that consistency in my life,” he said. “I didn’t realize how important it was until I started coming here. It makes me feel more responsible for myself, more productive in my daily life.”
After graduating from the job-training program at Café 54 last year, Mo Carnes got full-time employment at Johnny Gibson’s Downtown Market. Carnes has struggled with post-traumatic stress disorder and anxiety for most of her life. Her birth mother lost custody of Carnes when she was 6, and Carnes bounced between foster homes for much of her childhood. Her work experience at Café 54 gave her a new outlook on life, she said.
“Everything they have done for me has made me grow into the person I am today,” said Carnes, now 25. “When I first came here, I felt like I was nothing. I was this small little ant in a big world. It boosted my self-esteem tremendously just to know there were people there (at Café 54) who want to help me.”
Broad changes
Café 54 isn’t the only local behavioral-health program that is feeling the squeeze lately.
For many local agencies, the transition to a new public mental-health system administrator has been a rocky one.
In October, Cenpatico Integrated Care became the new regional behavioral-health authority, or RBHA, for the Southern Arizona region, which includes Pima County.
RBHAs act like managed-care companies, coordinating payment for both behavioral and medical health care for adults with serious mental illness, and covering behavioral health care for children and adults who qualify for Arizona’s Medicaid program, known as the Arizona Health Care Cost Containment System.
Cenpatico — a subsidiary of for-profit Centene Corp., based in St. Louis — contracts with local behavioral-health agencies. The company’s changes — including quotas, reduced reimbursements and stricter interpretations of Medicaid payment guidelines — means a number of agencies are struggling financially, said Clarke Romans, executive director of the National Alliance on Mental Illness — Southern Arizona.
Cenpatico was unable to respond to questions before the Star’s deadline Monday afternoon.
Agencies bill for services they provide under certain billing codes, and Cenpatico has determined that some of those codes are not eligible for Medicaid dollars, he said. The company has told providers they want to ensure proper billing to avoid any potential for Medicaid fraud, Romans said.
It could be that the previous RBHA — the nonprofit Community Partnership of Southern Arizona — was much broader in its interpretation, he said. But whatever the reason, the changes have had a dramatic impact on some providers’ funding, especially those that provide niche services like family support group meetings for people with mental illness, which aren’t reimbursed under the new rules, he said.
“Smaller organizations like NAMI and Café 54 have special focus,” he said. “They don’t have 100 different billing codes. They have two or three, or five. If those get cut off at the knees, you’re pretty much high and dry.”
Cenpatico is taking steps to help agencies like NAMI find alternative sources of funding, Romans said. Bernstein said Cenpatico has offered the service of its grant writers to help Café 54 stay afloat.
The cafe is also planning to certify its staff as recovery-support specialists, which will allow them to bill under a different code, Bernstein said.
“I appreciate the efforts of Cenpatico to help us in many ways,” she said. “They are trying to do their best. I know they are concerned about our programs.”
Hopefully, Cenpatico’s efforts will be enough to keep important programs from shutting down, Romans said.
“The realization is hitting them that it wouldn’t be good PR for all of these beloved organizations to just be blown away,” he said.
