In 2008, Shaun Grady of Lexington learned he had a brain tumor. He was 50 years old, a medical device engineer and married with children.
“I got scared,” Grady said.
Grady’s condition was serious. The tumor, he said, was the size of his fist.
“It was shock and dismay,” Grady said.
He had two successful surgeries to remove the tumors, but was left with a traumatic brain injury requiring years of treatment. Grady said he has balance issues, paralysis on one side of his face, and needed “cognitive rehabilitation therapy” to help relearn the analytical skills that were lost or altered in the process.
Therapy after a brain injury can be costly, continue for years, and in most states, insurers aren’t required to pay for it.
Grady is part of a coalition calling for Massachusetts to pass legislation requiring health insurance plans to include the coverage.
Advocates said a cognitive rehabilitation therapy bill will go a long way toward helping people who have suffered a brain injury from a stroke or a tumor, or a traumatic brain injury from a blow to the head, like a car crash or a hard fall.
“Currently, there is not a requirement that insurance provide that access to care in the state of Massachusetts,” said Victoria Harding, a speech language pathologist and vice president at NeuroRestorative, a national provider of rehabilitation for people recovering from brain injuries.
Effects from a brain injury can include impaired thinking, memory, movement and emotional functioning.
“What we’re really seeking now is advancements in access to care, so that people can avoid a lifetime of disability by having that opportunity to regain the skills that have been lost,” Harding said.
Brain injuries are not rare. According to a study by the Brain Injury Association of Massachusetts, between 2016 and 2018 there were an average of 6,300 inpatient hospitalizations for traumatic brain injuries each year.
For years, the Brain Injury Association of Massachusetts has been pushing to win passage of a bill that would provide cognitive rehabilitation therapy coverage for people with traumatic brain injuries.
Republican state Rep. Kimberly Ferguson and Democratic state Sen. Paul Feeney reintroduced the bill this year. A hearing is expected sometime this spring.
Ferguson was a speech pathologist before becoming a legislator and said she worked with many people with brain injuries.
“I am so hopeful that this is the session that we can finally get this across the finish line. We’ve come close a few times and run out of time or for various reasons, it just didn’t make it,” she said.
One of the reasons prior bills failed was due to opposition from the insurance industry, which has been concerned that any state mandate will drive up insurance costs.
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said in a statement that the proposed bill will add to the cost of healthcare and increase premiums for employers and consumers.
“Massachusetts has among the highest health care costs in the nation,” she said. “Last session, the Legislature passed seven new coverage mandates, raising premium costs by $750 million over the next five years.”
But the Brain Injury Association said if insurers don’t pay for cognitive therapy, a person with a brain injury may not get the rehab they need. In 2016, the Massachusetts Center for Health Information and Analysis, examined the cost of a mandated cognitive rehab benefit and found it would add about $1 a year to most customers’ premiums.
Feeney said all the evidence shows cognitive therapy is effective, so the cost is minimal compared with the benefits.
“The cost of not doing this, the cost of just, you know, kind of kicking this down the road and let somebody fend for themselves without cognitive rehab is enormous for the commonwealth of Massachusetts,” Feeney said.
“Oftentimes if someone doesn’t get rehabilitation, if they don’t get impatient or outpatient rehabilitation, they might not go back to work,” said Nicole Godaire, CEO of the Brain Injury Association. “Their family member might not go back to work and sometimes the state might pick up the cost”
Beyond the costs, supporters of the bill say they hope mandating insurance coverage will bring more cognitive rehabilitation providers to the state to care for people with serious injuries.
Winchester parent Kendra Winner said there’s not a deep enough “continuum of care” in Massachusetts for her 20-year-old son, Aidan McElhinney, who was seriously injured in a car accident in 2023.
“Aidan is nonverbal. Aidan is still minimally conscious. So, we don’t really know what Aidan’s cognitive capacity is at this time,” Winner said.
McElhinney has good insurance, she said, and her son has received cognitive rehabilitation therapy at various hospitals and rehab centers like Spaulding Rehabilitation Hospital in Charlestown..
But as his needs have changed, she’s run out of service options close to home, and had to move him to a rehab center in Maine. She said her next move will be to bring him home.
Shaun Grady, the mechanical engineer in Lexington who had tumors surgically removed from his brain, said he’s living proof that cognitive rehabilitation can improve daily life.
While he never returned to work, he now serves as a brain injury support group facilitator.
“Anything that can be done to help somebody like me or anybody with a brain injury learn how to think better, faster and restore any capability is huge,” he said.
