LANSING, Mich. – Courtnie Bush, 16, was never supposed to wake up again, much less smile, stand and walk after she was in a car crash in December.
Her mom Jenna said what Courtnie accomplished since then is nothing short of a miracle and she credits therapists and in-home heath care workers.
“She woke up swinging, I mean she woke up, she gave a thumbs up and she's been progressing ever since," Bush said.
Despite sustaining a traumatic brain injury, Courtnie's made strides to get back to her passions: baking desserts, singing in choir, playing soccer and basketball, and graduating high school with her twin brother. But she and her family are worried a change in Michigan's no-fault auto insurance law will cause her to lose care and momentum in her recovery.
Some businesses providing rehabilitation services to people like Courtnie are alerting families that come July 1, they will no longer provide certain services due to a 45% cut in reimbursement from insurance companies for services that aren't covered by Medicare.
In 2019, lawmakers responded to Michigan’s highest-in-the nation auto insurance premiums by passing legislation giving drivers the option to choose their level of personal injury protection, replacing the state requirement that drivers buy unlimited lifetime coverage. The overhaul also scaled back reimbursements for health providers that treat accident victims and can bill auto insurers much more for the same services than is paid by employer plans or government insurance.
Bush said she feels fortunate that last July, when Michigan drivers were given the choice of what level of personal injury protection they wanted to buy, she kept paying for unlimited coverage.
“When things changed, I knew not to change," Bush said. "I knew the coverage that we wanted to keep and it wasn’t a risk that we were willing to take.”
In order to avoid closing its doors, Origami Brain Injury Rehabilitation Center in Ingham County is limiting its admission requirements to those with less catastrophic injuries, center CEO and President Tammy Hannah said.
“This is the part that keeps me awake at night because we’re serving several residents that are pretty catastrophically injured, they’re succeeding, we’re their family, they were injured several years ago, we're their long-term home," Hannah said. "Origami will not be able to keep operating the way that we operate today for longer than another year.”
Under the new fee schedule, services that Medicare covers will have a 200% reimbursement rate, while more specialized services such as home health care without a Medicare code will be reimbursed 55% of whatever they were charging for services at the start of 2019.
Proponents said the fee schedule came about because providers could charge unnecessarily high fees to insurance providers, overcharging the system. But Hannah said Origami operates on a 7% profit margin.
Families of car crash victims are putting their hopes on similar bills by Sen. Curtis Hertel Jr., D-East Lansing, and Rep. Doug Wozniak, R-Shelby Township, to extend the 200% reimbursement to rehabilitation facilities.
Gov. Gretchen Whitmer, a Democrat who signed the law, has said she is open to a “targeted approach," but the legislation appears dead for now.
Republican Senate Majority Leader Mike Shirkey has said the law should be fully implemented before any changes are considered.
“We will not take up any proposals that would increase costs for drivers, particularly when we lack the data necessary to evaluate such proposals," he said in March.
Wozniak, a lawyer who has focused on elder law and Medicaid planning, said the fee schedule creates a situation where those who charged fair prices in 2019 will have to shut down while bad actors who charged more will survive.
Insurance companies are the winners because if people can't afford to get care and have a loss of income, they're going to switch to Medicaid coverage and the state foots the bill rather than insurance companies, Wozniak said. He estimates that will cost the state $72 million in the first year.
More than 6,000 patients will lose care if the fee schedule isn't changed, according to a survey of more than 110 post-acute care facilities commissioned by the Michigan Brain Injury Provider Council. The survey also said 90% of facilities expect a total of about 4,000 jobs lost.
Lane and Emily Bargeron of Lansing are among the families benefiting from 24/7 home health care after a car crash in 2012 left Lane with a traumatic brain injury and the physical ability similar to a low-functioning quadriplegic.
With two children and one on the way, the importance of at-home health care is invaluable, Emily said. She worries what will happen if her family loses care.
“We’re going to be alone pretty much for the rest of our lives so that’s a huge concern,” Emily said. “It affects every area of our lives, especially if we are going to want to thrive and survive as a family unit and just take on life as normally as possible.”
The Insurance Alliance of Michigan, an insurance industry group, said it expects 25 new auto insurance companies to start providing coverage in the state because of the medical fee schedule, boosting competition and lowering rates.
Executive director Erin McDonough said rates already are lower due to anticipated medical savings. The alliance supports the fee schedule to end “ egregious overcharging ” by health providers, the group said.
The fee schedule is “a kick in the teeth” to the provider industry, said Tom Constand, Brain Injury Association of Michigan president and CEO. The idea of waiting to see if patients lose care and then acting is about as dangerous to human life as removing a stop sign and seeing if it has an impact.
“I resent that the other side, the Insurance Alliance of Michigan is castigating the entire industry of providers as crooks,” Constand said. “These people take care of individuals. These are humanitarians. They take care of these people that need care every day, toilet ,showering, bathing, all of the essential elements of care.”