'I don't think I've been this stressed': No-fault reforms upend life for Michigan's crash victims
Brian Woodward was more active than most people who can use their feet, friends used to say.
With the help of caregivers who allowed him to navigate life with quadriplegia, the 62-year-old Detroiter was a hunter, fisherman, chorister and regular churchgoer. He did everything he wanted.
That was before this summer, when the latest round of reforms to Michigan's no-fault insurance law took effect. As of July 1, insurance companies pay less for routine, residential care services that people injured in crashes often depend on. It upended the state's home health and rehabilitation industries.
As politicians debate stopgaps, health care providers grapple with cut rates and insurance companies ask for patience, Michigan's crash victims say they remain stuck with few options and fewer answers about the future of their care.
Woodward, who was injured in a crash in the 1980s, used to have a team of 10 attendants in rotating shifts in his home. They helped him with daily needs like bathing, eating and adjusting pillows.
But as the no-fault reforms loomed, the company that employed the caregivers cut their pay, Woodward said. The caregivers couldn't afford to work for less. So they left.
He was hospitalized with a bladder infection in late June and hasn't been home since.
"The only option that we had at that point, because I didn't have anybody to take care of me, was to go to a rehab center, which is where I'm at now," Woodward said. "We're trying to train a team and find people to hire to get me back in my home."
Starting this month, auto insurance companies are allowed to slash the rates they pay for certain services nearly in half.
For services with a Medicare code — think surgery and procedures commonly performed in a doctor's office or hospital — insurance companies can pay 200% of what Medicare pays.
For services without a code, like those performed in residential recovery homes or by attendants who help crash victims eat, bathe and perform other daily activities, companies now pay 55% of what they paid in 2019.
Facing a major revenue reduction, many Michigan home care service providers cut staff, reduced wages or discharged patients covered by no-fault plans.
"Patients are being discharged and displaced from facilities and some are being displaced from their home because the care providers who were coming into their home are no longer able to do that," said Tom Judd, president of the Michigan Brain Injury Provider Council, a trade association for brain injury rehabilitation clinics. "Those who don't have other support systems are really stuck to figure out what they're going to be doing."
Many of the patients who visit Detroit Medical Center Rehabilitation Institute of Michigan have lost the caregivers they rely on, CEO Patty Jobbitt said in a statement. Transportation is included in the revenue cut, so fewer companies exist to drive patients to appointments, she said.
"Patients that were able to live independently with caregivers are now unable to get the basic care needed to keep them in their homes and to avoid health care issues," she said.
But Insurance Alliance of Michigan Executive Director Erin McDonough said companies are working with families and case managers to provide medically necessary care to injured clients.
"Each long-term care case is different and takes time to resolve," McDonough said in a statement. "We encourage families who have heard from their medical providers that care may be ending or changing to reach out to their case manager or auto insurance company if they haven't already done so."
What triggered the cuts
Michigan lawmakers overhauled the state's no-fault insurance law in 2019. The bipartisan measure promised to reduce sky-high insurance premiums and allow drivers to choose their level of medical coverage.
It worked, Michigan Department of Insurance and Financial Services Director Anita Fox said.
The Insurance Alliance of Michigan reported drivers saved a collective $1 billion in premiums and fees since July 2020. The state insurance department found the personal injury protection portion of insurance policies dropped between 15.5% and 53.3% depending on whether drivers chose costly unlimited injury protection plans or cheaper ones with less coverage.
Another benefit: Almost 50,000 previously uninsured drivers have signed up for insurance since the law passed.
But savings for drivers has meant anxiety for people with traumatic injuries who rely on no-fault plans,critics say.
Fox acknowledged crash survivors are concerned about their ability to access care going forward but said they are still entitled to the same level of coverage they had before the 2019 reforms.
"What we don't want is for people to end up without care," she said. "That's our mission right now, to see what issues are being raised about access to care and make sure that insurers are responsive to those concerns, those real concerns of accident victims and their families."
The promise of lifetime benefits is meaningless if there are no caregivers left to help crash victims, said Mary Fradette, a medical case manager in Dexter.
Fradette works with eight clients, all of whom were catastrophically injured in vehicle or motorcycle accidents and have long-lasting brain injuries as a result. All but one of her clients lost in-home caregivers, have been discharged from rehabilitative housing programs or experienced other major disruptions because of the reforms.
In one instance, Fradette hired a client's former caregivers as independent providers after they were laid off by the company they worked for. She's still not sure how much they'll be paid for the work, but it was her only strategy for keeping her client safe.
"You can't just wait and see what's going to happen," Fradette said. "They have catastrophic injuries. If you take away their help, they're either going to get seriously injured or die."
The stakes are exactly that high, said Chalisse Wilson. Her brother, Clarence Golden, who became quadriplegic after a crash on a snowy highway in 2008, needs constant care. He is susceptible to even a slight infection.
"If he was to go into a facility, he wouldn't last six months," Wilson said. "He's that vulnerable."
Wilson of Flint had hoped no-fault reform would not affect Golden, but in late May, she received a letter from a Troy home care company informing her it couldn't withstand the 45% cut. It would no longer care for her brother.
"It wasn't just them," Wilson said. "We called all over the state of Michigan trying to find a home care agency. No one would take Clarence's case. It's such a robust case. They would be investing a lot of money and not sure if they're going to get it back."
Wilson ended her career managing a Citizens Bank call center to care for her brother after his crash. She was told she could be paid for the work, which she did alongside the hired caregivers since his condition is so severe he requires two attendants by his side 24 hours a day.
Like Wilson's, families frequently provide care to their injured loved ones. They took a hit this month, too. Another no-fault reform enacted in July allows insurers to cut the hours they pay family members to care for crash victims to 56 hours per week, although they don't have to.
Wilson's family has not come to an agreement with his insurer for the additional hours. The nightmarish stress of losing those paid hours and his caregivers is the worst she's experienced.
"I don't think I've been this stressed ever in my life," Wilson said. "Even after the initial accident … as devastating as it was, one thing that was assured to us was that they would be taken care of."
What lawmakers are doing
The future for catastrophically injured crash victims is dire, said John Cornack, CEO of the Eisenhower Center, an Ann Arbor rehabilitation facility that is among those facing revenue cuts. Although it will be "next to impossible to stay open" with the reduced rates for people injured in crashes, he said Eisenhower is expanding other services to help diversify its programs.
As post-acute care providers continue to shrink or shut down, he predicted crash victims will end up in nursing homes, hospitals, psychiatric wards, jailed or homeless.
"They're just lost into communities," Cornack said. "That will happen in Michigan over the next two, three years. People will have forgotten all about the catastrophically injured. They won't have a voice anymore."
Michigan lawmakers, under pressure by building concern about crash survivors' futures, decided this summer to set aside $25 million for home health care companies facing a steep cut. They also have floated a plan to study the effect of the fee cut.
The fund will go live on Aug. 13, Fox said.
The state insurance department will have 21 days to review, then approve or deny applications. That puts approvals into at earliest September, two months after the cuts.
The fund will help, Cornack said, but is "way too little and way too late." He said other proposals stalled in the Legislature would be better fixes. A proposal to relax the fee cut is in the Senate Insurance and Banking Committee.
"They harmed a lot of people," Cornack said of the legislators and Gov. Gretchen Whitmer, who signed the 2019 no-fault reform law. "We did advise them that this would be the outcome. They can't say they didn't know."
He also pointed to the Michigan Catastrophic Claims Association, a nonprofit controlled by insurance companies that manages a fund that reimburses insurance companies for claims above $580,000. It's designed to pay for care for people with serious, long-lasting injuries. There was more than $23 billion in the fund last year.
The claims association should release more to pay for crash victims' needs, Cornack said.
For Woodward, the Detroit man who lost his caregiving team, home care is not just the difference between an untethered life in his Detroit bungalow or a confined one in a rehabilitation center or nursing home.
"To me, it comes down to existing or living," Woodward said. "I was living, and now I'm existing."