For the past two weeks, John Wicke has been lying, medically stable, in a hospital bed on the 8th floor of Sparrow Hospital in Lansing.
Any ordinary patient would be discharged to go home by now.
But the 52-year-old Corunna man’s reason for being hospitalized is anything but ordinary.
Wicke can’t go home because Sparrow Hospital is the only place where he can currently get fed, dressed, put on a toilet and frequently moved in bed so he doesn’t form sores that can lead to deadly infections.
Wicke is a quadriplegic, the victim of a horrific car accident in December 2009 that left him unable to move most of his limbs.
For the past decade, Wicke has been living comfortably in an apartment in Corunna, the county seat of Shiawassee County 90 miles northwest of Detroit.
Michigan’s new auto insurance law that went into effect July 1 upended Wicke’s years of stable care by sharply reducing how much his home health care agency gets paid by an auto insurer to provide round-the-clock care.
On July 20, BrightStar Care in East Lansing stopped sending a nurse and caregiver to his apartment because it could not continue losing money on Wicke’s care, said Sonja Hoxie, a case manager for Ambrose Care Management in Okemos, an agency hired by auto insurers to manage care for policyholders.
Hoxie said she contacted every home health care agency that serves clients in Shiawassee County. Most were either closing their doors due to the 45 percent pay cut in the new law, no longer accepting auto no-fault patients or only accepting them if they came with their own caregiver staff given the ongoing labor shortage, Hoxie said.
“Medically, he’s stable and he could be discharged,” Hoxie said sitting bedside with her client on a Zoom video conference call last Thursday. “However, he can’t be discharged home because I don’t have any agency that’s willing to pick up his case without a rate guarantee.”
Wicke had no other choice than to become a temporary resident of Sparrow Hospital on Michigan Avenue in Lansing, about 12 blocks east of the state Capitol building where lawmakers made the fateful decision in May of 2019 to disrupt Wicke’s daily care.
Wicke is among at least 689 auto accident victims whose daily care has been altered by the new auto insurance law, according to the Michigan Brain Injury Provider Council’s tracking data.
Those are only the cases the MBIPC is aware of. There are likely many more from a pool of 18,000 individuals who rely on the Michigan Catastrophic Claims Association (MCCA) for their long-term care.
The MCCA is a state-created entity that manages a $23 billion pool of funds that was supposed to pay for the long-term care and needs of people like John Wicke.
The money is still there, but the health care infrastructure that provided care for Wicke and thousands of other injured motorists is being dismantled by this fee schedule.
As a result of this policy, Michigan motorists are saving $134 per vehicle annually on their car insurance from the reduced MCCA fee.
As a result of this policy, John Wicke can’t live in his home right now because the Legislature opted not to exempt previously injured motorists from the cut in payments to their caregivers.
Case managers like Hoxie have spent days — not hours, days — on the phone this summer with insurance company adjusters trying to negotiate new care arrangements for these catastrophically injured motorists like Wicke.
Some of these injured drivers have relied on family to fill in the gaps of their daily care.
But others like Wicke have slipped through what was once one of Michigan’s strongest safety nets until lawmakers and Gov. Gretchen Whitmer got out the scissors two years ago.
Hoxie said she an agreement in principle with Wicke’s insurer, Waukesha, Wis.-based Partners Mutual Insurance, to move her client to a MediLodge skilled nursing home in the Lansing area.
But that can’t happen until the MCCA approves the new care plan.
“Without having a rate approved, nobody will continue services because they don’t know what their pay will be,” Hoxie said. “The whole billing now is no longer going to the (insurance company) adjusters. It’s going to the audit team (at the MCCA) that they’ve established.”
Something is amiss in Wicke’s case.
MCCA Executive Director Kevin Clinton said Tuesday the organization has not received a pre-approval request for Wicke.
Christopher Markley, a spokesman for Penn National Insurance, an affiliate of Partners Mutual Insurance, declined to comment on Wicke’s case.
“To protect the personal and private information of our customers, we cannot respond to inquiries about claim events,” Markley said Monday in an email to Crain’s.
Multiple case managers I’ve interviewed over the past month say insurance adjusters — some of them in tears — are all giving the same line: They can’t authorize new payments without pre-approval from the MCCA and the MCCA has become the sole roadblock to getting new care plans in place.
“Tell them that’s nonsense,” the MCCA’s Clinton said in an email response.
In many cases, the case managers say the insurance adjusters are approving new in-home attendant care rates above the 55 percent cap written into the law because they realize the cap cuts provider rates deeper than any home health care company can afford to operate at.
“The big-ticket items they run past the MCCA,” said Elizabeth Piner, the president and owner of Ambrose Care Management.
Piner has a case involving a 38-year-old Albion mother of five who became a quadriplegic in an April 2020 car accident.
The woman, Nakeesha Jones, lost her in-home caregivers and is relying on her three teenage children to care for her in a family home that’s not equipped to shower her, Piner said.
Two of Piner’s on-staff nurses, Stacey Krause and Shara Curry, have formed a new home health care company called RN Plus Staffing Inc. with hopes of being to exploit a potential loophole in the 2019 law that seems to only apply the 55 percent rate cap to companies that were in business on Jan. 1, 2019.
As Crain’s previously reported in May, this may be one of the tricks to getting around the 55 percent rate cap — just form a new LLC — though no one knows how the insurers will react to this billing tactic.
“Starting a new company is the pathway, it’s just hard to do,” Piner said. “So anyone new is most likely to survive this.”
On Tuesday, after weeks of wrangling with Lansing-based Auto-Owners Insurance, Piner got Jones approved to live in a two-bedroom suite in a Lansing-area extended stay hotel for $125 a night.
RN Plus Staffing plans to begin immediately proving in-hotel room care for Jones, who requires two-person transfers and must be frequently moved in bed to prevent her skin from deteriorating. Piner’s company was planning to foot the bill for a Two Men and a Truck moving crew to haul Jones’ medical equipment from Albion to Lansing on Tuesday.
“It’s total makeshift,” Piner told me. “But she’ll survive. That’s where we are now. We’re at pure survival mode.”
Jones narrowly avoided going to a hospital this week.
Meanwhile, John Wicke waits — in a hospital bed.
Wicke’s case is begging for someone in the Legislature or governor’s office to have the temerity to call insurance lobbyists on the carpet about the flaws of this law they wrote — and fix it.
The chaos that has ensued since July 1 could be undone by 56 House members, 20 senators and the governor. But they’re still on their summer recess.
When I spoke with Wicke on Zoom, his voice was gravelly as he described his current predicament.
“It’s frustrating,” he said. “I’m doing OK. But I want to get back to my routine.”
His routine included having his nurse aides drive him to garage sales in his handicap van — an escape from the apartment on the weekends.
“In John’s case … so much of his independence was taken from that accident and his independence that he had left was his van, his apartment and being fortunate to have staff that was able to allow him to remain in his home,” Hoxie said. “And now you took his last independence and snatched that from him.”