CSC Featured in Crain's Cleveland Business

An article was published online in Crain’s Cleveland Business that features the advocacy efforts of Cleveland Sight Center, the story of the successful Medicaid coverage of the white cane and recent CARF recognition of these developments. Below is the full article text.

What happens when organizations set very high goals and face seemingly insurmountable challenges? Great organizations find a way. In early 2022, Cleveland Sight Center (CSC) was recognized for achieving a lofty goal — securing Medicaid insurance coverage of the white cane — making Ohio the first and only state in the country to provide such coverage. The story of how the nonprofit reached its goal and earned a prestigious industry accreditation showcases an approach any organization can leverage to triumph over adversity.

When Larry Benders joined Cleveland Sight Center as president and chief executive officer seven years ago, one of his first initiatives was to tackle a fundamental problem for vision rehabilitation facilities nationwide: the lack of insurance coverage. He and his team set out to "fix Ohio," petitioning the General Assembly to cover vision rehabilitation expenses under Medicaid. Years of discussions with legislators ensued.

Realizing it would be impactful to have someone with a vision challenge in the room, he asked former CSC client and current CSC manager of strategic partnerships Alicia Howerton to join the crusade. Her story resonated with legislators, and they agreed the lack of coverage was a problem, but they said it would be very expensive to change, and conversations always stalled there.

It was on a drive to yet another legislative meeting that Larry and Alicia had an epiphany. In frustration, Larry commented, "Even the white cane isn't covered by insurance!" — to which Alicia replied, "Yes, I know. I have been buying them for 20 years. Why aren't they?"

Simply asking "why?" brought the status quo into stark relief. When the white cane came into being in 1933, regulations classified white canes as a means of identification, essentially for the benefit of those who were sighted. Alicia, however, vehemently disagreed with this definition. "My cane is not for identification — it's my freedom and my independence. I cannot even cross the street without it unless I'm with a sighted person." Her cane is a tool crucial to her mobility, safety and independence.

Once Larry and Alicia realized that coverage for the white cane might be something legislators would more readily support, they crafted an analogy to help legislators better understand the inequities in insurance coverage. Imagine this: If you and a friend are in a car accident, and the friend breaks a leg and you lose your sight, you both will have your hospital treatment covered by insurance. When your friend is discharged, he or she will be referred to physical therapy for help learning to walk again, which is covered by insurance. You, however, who can no longer see, have no options for rehabilitation covered by insurance. You need to be taught how to read, dress, cook, work and simply navigate your life — but there is no insurance coverage.

This narrative got the attention of legislators. In fairly short order, the white cane was added to Ohio's Medicaid Rule 5160-10-30 — a rule that had previously only included coverage of "durable medical equipment" such as canes, crutches or walkers, but excluded the white cane.

For the visually impaired, like Alicia, this Medicaid coverage of the white cane is more than fiscal — it's validation. "There is a huge stigma for people who are blind or visually impaired, and confidence plays a big part in being able to accept your vision loss," says Alicia. "Blind doesn't define me — it's just a part of who I am. My cane is a very important tool to be able to navigate life, to be independent and to have my freedom."

Years of advocacy resulting in a significant victory for the visually impaired is an uplifting story. But there's even more to be learned here; namely, specific ways in which organizations can disrupt standard thinking to approach goals from a new angle.

"When you have a culture where people can say, 'I don't think so' or 'have you considered this?' or even just 'why?,' anything is possible," says Larry. "You need to test preset determinations for what is and what is not, for what you know is versus what should be. When you test conventional wisdom, you test inertia. If you're willing to test it, you open yourself to change, and amazing things can happen."

Thanks to the perseverance and adaptability of the CSC team, there are tens of thousands of people in the state of Ohio who have been validated by this seemingly small yet very significant change. CARF, the international accreditation agency with 60,000 programs under review, took notice and recognized CSC for demonstrating exemplary conformance to its accreditation standards as a result of their advocacy efforts — a recognition only given to 2%-3% of recipients. CARF recognizes this advocacy achievement as a model for other states and agencies in the nation.

Einstein is often quoted as saying, "The definition of insanity is doing something over and over again and expecting a different result." If the same approach isn't giving your organization the results you want, it may be time to pivot, change your narrative and find new ways to reach those formidable goals. Take inspiration from CSC's blind and visually impaired clients who are no strangers to formidable, yet eminently achievable, goals. With training, support and tools like the white cane, they can do anything a sighted person can do.