Amy Henney-Planck can’t seem to sleep these days. Sometimes she sits in bed at 2 a.m. and just stares at the ceiling. Sometimes she gets up at 6 a.m. opens her laptop and does research. But the one thing she doesn’t do much is sleep.
Henney-Planck owns an in-home medical care business, A Moment in Time. She takes care of Jesus Arias, who was in a near-fatal car accident 30 years ago and needs 24/7 care.
The problem is, Henney-Planck can no longer afford to continue caring for him. And without her support, it’s unclear what will happen to Arias.
Before this summer, Michigan’s no-fault auto insurance law allowed people who suffered serious injuries in vehicle accidents to receive 100-percent reimbursement for their medical costs. That changed after July 1. In an effort to lower some of the highest auto insurance rates in the nation, the state Legislature slashed reimbursement rates by 45 percent.
Reforms did lower car insurance rates for most people, but they also cut deeply into the profit margins for caregiving companies, like Henney-Planck. According to the Michigan Brain Injury Provider Council, nearly 700 people in the state have lost this kind of care and at least 1,529 health care providers have lost their jobs.
“I lay in bed, and I just think – how much longer can I do this?” Henney-Planck said. “What are [Arias] and his family going to do if we have to pull out?
“My brain just doesn’t shut down.”
The life Jesus Arias lives
Jesus Arias, 68, is wearing a blue, green and yellow patterned bib as he sits at a wooden dining room table. He looks out of the window where the trees line the backyard of his home in Hastings Charter Township. He can’t move much more than turn his head, blink his eyes and say a few words. So he waits patiently for his caregiver Joanna Eckhoff to bring bites of a turkey wrap and Ritz crackers to his mouth.
There isn’t a lot of talking at the lunch table. The hourlong lunch periods are intentionally quiet. Arias has to chew small pieces of food and take his time eating to make sure the meal goes down the right path. He's what they call a silent aspirator. Any distraction could disrupt his digestion, sending food spiraling into his lungs. When his daughter left without saying goodbye, for example, Arias turned his head and tried to speak. But he hadn’t finished swallowing his food and erupted into a coughing fit that sent saliva running down his chin and Eckhoff reaching for a roll of paper towels.
It was a long – but successful – morning of physical therapy for Jesse, as they affectionally call him. He stood up in his standing frame for 30 minutes – the most he has accomplished since his injury 30 years ago.
It’s a cause for celebration and good thing the first activity after lunch is “Jesse’s Time.” Arias lives a regimented lifestyle with his daily schedule marked down to the hour. Wake up at 6:30 a.m. Physical therapy at 9 a.m. Lunch at noon and then “Jesse's Time” after, which could include picking a Western movie from his shelf full of CDs, playing poker or watching horses. He hopes one day to ride a horse, but, first, he needs to work on his core, Eckhoff says.
Arias signals he is ready to watch one of his favorite TV shows, “Two and a Half Men,” by picking up his favorite hat – the one with the emblem of Mexico on the front -- from the dining room table. He brings it to his head, but can’t put it on. Eckhoff reaches over to help. Then they’re off, with Eckhoff pushing his wheelchair, to his two rooms in the back of the house, which is equipped with a hospital bed, floor space for his physical therapy equipment and a couch for his caregivers.
In 1988, Arias and his mother were driving back to Michigan from his father’s funeral in Mexico. Fourteen hours from home, the car hit a patch of black ice on a bridge in Oklahoma City. The car spun out and catapulted backward into a telephone pole. As the pole came crashing down on the car, Arias threw his body over his mother, saving her life. But the pole smashed into his head.
Arias spent the next two months in a coma. It was unclear whether he would live or die. He never fully recovered.
For more than 25 years, he stayed at Spectrum Neuro and Rehabilitation facility. A staff of full-time nurses took care of him around the clock. His medical costs were covered by the state’s no-fault auto insurance law.
Then, in 2016, Arias nearly died in the hospital. He was septic and developed pneumonia. His sodium levels reached dangerous levels and his urine turned black. His condition eventually improved, but his daughter, Julia Arias-Pease, wanted him home in Hastings, where she could see him and help take care of him. She reached out to Henney-Planck, who brought on nine caregivers for Arias.
Everyone noticed an immediate improvement in her dad
In the hospital facility, he was like a “medicated zombie,” his granddaughter Hayden Thompson said. But under the care of A Moment in Time, he started to hold short conversations. He went from being diabetic to losing 170 pounds. He switched from 30 medications a day to just two – a blood pressure pill and an allergy pill.
“He has more personality than I’ve ever seen,” said Thompson, who grew up visiting him in the hospital.
Everything was paid for – from the home health-care workers to her father’s van to the doctor’s appointments to the two-room addition built at their house to accommodate Arias.
Michigan Brain Injury Provider Council Board President Tom Judd called it “the best system of care in the country for auto accident victims.”
The costs of keeping Arias alive haven’t gone away. He has improved with full-time home care, although not enough to live on his own. Physically, Arias-Pease compares him to a toddler.
“He can't do anything for himself but probably itch his eye,” Arias-Pease said. “... So you literally are doing everything.”
Gov. Gretchen Whitmer signed the Michigan no-fault reform bills in May 2019, but Arias-Pease wasn’t worried. She thought her family would be grandfathered into the system.
Two years later, the law went into effect and that was not the case. In-home care providers, including Henney-Planck, had their reimbursement rates cut from 100 percent to 55 percent.
State Rep. Julie Calley, R-Portland, who voted for the bill, said that the Legislature assumed 55 percent would be enough to support caregivers.
Although Calley said she was not involved in the “tough negotiations,” she heard from leadership on the issue that, at the time, they had not received enough “openness” from providers to find a more exact reimbursement rate.
“We thought that percentage was sustainable for long-term care providers, otherwise we wouldn't have passed it,” Calley said. “So it continues to be the intent that those who are grandfathered in will be taken care of. But since it has been raised that that may not be an accurate or sufficient reimbursement rate, now we need to figure out a change.”
'Would our legislators take a 45-percent pay cut?'
Henney-Planck has owned her in-home medical care business for four years.
Before the law went into effect, her insurance company, AAA, paid for her to treat Arias. Her business was reimbursed at a rate of $24 an hour to provide the care. Then she would divvy up $19 to $20 an hour to pay her caregivers and cover the overhead, which includes her own insurance and other liability costs.
It left her with about $4 to $5 an hour for herself. She never made a lot, but she stuck with it and had plans to request more money.
Henney-Planck has 13 other clients, all of whom pay out of pocket. Arias was the only family who paid for his care out of the insurance coverage. Now, continuing to care for Arias is setting back her entire business, but she can’t bring herself to leave him and his family.
“I’m having the hope and the faith that this is going to get worked out,” Henney-Planck said. “… I cannot just walk away from him because I know there is not another agency that’s going to come in and accept 55 percent. So I have done what I could do and made the adjustments that I needed to stay there for a short time before what I have is gone.”
Since the changes in the no-fault auto insurance law, Henney-Planck’s company gets reimbursed at a rate of $13.69 an hour for each worker she sends to help Arias.
That cumulative loss of $10.31 an hour is taking a toll in more ways than one. Every hour she devotes to the care of Arias represents a financial loss that her business is having to absorb. She has lost four of Arias’ caregivers and doesn’t know how much longer she can absorb so much of the cost of caring for him.
The law created a “fee schedule” separating services that Medicare and non-Medicare payable codes could cover. That affected caregivers like Henney-Planck.
For Medicare payable services, such as physical therapy, speech therapy, physicians and nurses, people can receive reimbursement up to 200 percent. But for non-Medicare payable services, such as in-home services and residential care, reimbursement rates were cut by 45 percent.
“It's not reasonable to assume that companies could have withstood that type of reimbursement cuts,” Michigan Brain Injury Provider Council's Judd said, “so what you see is these care providers have no other option than to either close their doors completely … [or] they're discharging their auto-funded patients because they simply can't work at that rate.”
And that’s if the providers are getting paid at all.
Between July 2 and Aug. 18, Henney-Planck’s requests for reimbursements, even at the reduced rate, were flat-out denied by the insurance company, meaning she had no money coming in from the insurance companies to cover Arias’ care.
She made countless phone calls to her insurance company, the Michigan Catastrophic Claims Association and the Department of Insurance and Financial Services (DIFS), but it took more than a month to begin receiving payments again.
Henney-Planck is not alone. Since the passage of the reform, Judd said he has heard of multiple instances where providers were not being paid.
“The insurance companies have a lot of tools in their tool belt to deny and delay claims,” he said. “...It seems like a coordinated effort to kind of wait providers out and chill the post-acute continuum of care. Wait these providers out, they're not going to be able to stay in business and insurance companies and the [MCCA] are going to be off the hook for lifetime care.”
People having trouble with the new insurance rates are encouraged to work out the issues with their insurance companies first, DIFS Director Anita Fox said. If that doesn’t work out, they can file a complaint with DIFS, the state agency that helps to regulate insurance companies.
Fox said DIFS is like a “facilitator,” working between the service providers and the insurance companies.
Since the law passed in early July, Fox said they have received about 60 complaints related to reimbursement rates. As of Sept. 10, a little more than half of those complaints had been resolved.
“By resolved, I mean that there's a medically appropriate care plan in place that meets the family's needs and complies with the policy and the law,” she said. “Again, it may not be exactly what the family wanted.”
In recent weeks, Henney-Planck's financial situation has improved slightly. She has started receiving checks from AAA, even though they have come in at the reduced rate.
Arias-Pease's cousin set up a taco stand during the 28th Street Metro Cruise in Grand Rapids and contributed $1,700 to the $4,053 the Arias family has raised for Henney-Planck in a GoFundMe account.
Still, Henney-Planck gives herself two months before she can no longer afford to treat Arias. She’s frustrated, confused and sleep-deprived.
“Would our legislators, would all these insurance agents, would they take a 45-percent pay cut? Absolutely not,” Henney-Planck said. “But yet, I'm supposed to take a 45-percent pay cut?”
If Henney-Planck can no longer afford to treat Arias, that means his daughter, Arias-Pease, would have to take care of her father 24/7.
Arias-Pease, who has owned and run Creative Designs on State Street for 14 years, said she would have to close her business.
And, if that happens, she gives her family only a month and half until their funds will run out.
“We do nothing but cry,” Arias-Pease said, “nothing but cry.”
Cleaning up the mess
After people in Michigan lost their coverage, the state earmarked $25 million through the Licensing and Regulation Authority to compensate providers for their loss in reimbursement.
Arias-Pease and Henney-Planck said they had trouble finding the form to become eligible for the additional support. They obtained the form only after Calley’s legislative aide emailed it to them.
When they did receive the form, however, it was difficult to understand. The process requires providers to show how much money they requested, how much they received and documents that prove they cannot sustain their business on the amount they were given.
But for people who haven’t received payments at all, they can’t even apply in the first place.
When they do apply, the review process takes 21 days and another seven days after approval for payment – pushing up against the deadline Henney-Planck and Arias-Pease have set for themselves.
At first, Henney-Planck tried filling out the form on her own, but got stuck after it wouldn't register her company. She contacted Calley's office and they connected her with someone from DIFS to walk her through the application.
On Friday, Aug. 27, the Arias family showed up at Calley’s office hours at the Tyden Center. They told Calley their story and asked for her help.
“People aren’t aware of what these other people are living and experiencing – and the hell they’re going through unless they are living it,” Henney-Planck said after the office hours. “And that's what we need to do – get it out there and make more people aware of it.”
During the meeting, Calley recognized that the Legislature had overlooked the providers who had their pay cut by the reform. She pointed to the $25 million as a way to tide people over until they find a better solution.
Calley said they will use the $25 million to “collect data.”
Once that $25 million is given out, the Legislature will receive a report with the data from DIFS to inform the next steps.
“When you enact large reforms like this, it’s not unusual to find that you need to make some changes thereafter,” Calley said. “We’re willing to do that; we just need to make sure that we're doing it the right way.”
Calley did, however, maintain that parts of the new law have worked. The reforms have addressed fraud and waste abuse in the auto insurance industry, she said, one of her main concerns.
“We were the last state to have this unlimited option out there without any sort of ways to rein in the expenses that insurance companies would then have to turn around and pay,” she said.
Before the changes, car owners were required to choose unlimited coverage for Personal Injury Protection, which raised auto insurance rates across the state and discouraged some from buying insurance altogether.
Now, people have the option to choose their coverage and Calley said she has received mostly positive feedback from her constituents.
As a result of the reforms, Fox said rates have gone down across the state and at least 50,000 previously uninsured drivers have obtained auto insurance.
Calley said she has heard of at least 26 new auto insurance agencies opening in Michigan.
Plus, Calley added, there are consumer protections that disallow auto insurers from using factors such as marital status, gender, occupation and credit score to determine someone’s rate.
But for Arias and his family, those details are superfluous.
Without this financial support, his life is on the line.
He's not in any condition to fight for it and that's the point. Fortunately for him, his family and care providers are fighting for him and they're asking the state Legislature to fix the reform.
The time they have is running out.
“It does need to happen now,” Arias-Pease said. “We can't wait.”