Breaking the House of Cards (with Jay Chaudhary)

In this episode, Dr. Matt Biel speaks with Jay Chaudhary, former Director of Mental Health and Addiction for Indiana, about transforming an entire state's behavioral health system. Jay describes the mental health financing system he inherited as "a house of cards built on top of a shell game," where providers were locked into rigid financial formulas that made any deviation potentially catastrophic.

Jay's journey began as a civil rights lawyer launching medical-legal partnerships that placed attorneys directly in healthcare settings to address the social drivers that keep people sick. That experience taught him that clinicians' understanding of their work transforms when they see how much their clients' lives outside the clinic affect them, and more importantly, that "we can do something about it through collaboration."

As state director, Jay discovered that incremental changes were impossible in such a fragile system. His solution was comprehensive: implementing Certified Community Behavioral Health Clinics (CCBHCs) that use cost-based reimbursement, giving providers flexibility to actually respond to community needs. The transformation required not just policy change but alignment across stakeholders, from legislators to law enforcement to providers, all using the same language: "someone to call, someone to respond, somewhere to go."