Falling Forward: Overcoming the Barrier of Therapy Caps

Oct 2, 2017 | Features, Health Care, Philanthropy Journal

Falling Forward Foundation was crafted to address the specific need around therapy caps limits for health insurance. In the process, the organization gives funding and hope to victims of catastrophic injuries.


Special to the Philanthropy Journal

By Marty Smith

Every year over 1 million Americans suffer catastrophic medical events such as strokes, traumatic brain injuries, and spinal cord injuries. These injuries require extensive rehabilitation, yet many people will not fully recover because their therapy will end when insurance benefits are exhausted. They face a lifetime of disability.

Founded in 2013, the Falling Forward Foundation is the only nonprofit organization in America addressing “therapy caps,” limits on covered rehabilitation found in virtually all (99%) medical insurance policies. After the cap is met, most patients cannot afford to pay for their continued rehabilitation out of pocket. This significant gap in insurance benefits is hurting thousands of Americans, yet few people are even aware of this issue until tragedy strikes.

In 2011, a spinal cord injury paralyzed Falling Forward founder Sam Porrit below the waist. He spent the next two years going through daily physical therapy, eventually learning to walk again with a cane. Unlike many in rehab, Porritt had the chance to recover due to an unknown benefit in his insurance; his policy had no therapy cap. Porritt estimates he received more than 400 therapy sessions, whereas most people with insurance caps generally receive only 30 visits to rehab. “During my recovery, I witnessed the terrible impact of therapy caps. When their insurance ran out, my fellow patients were sent home with disabilities that could have been corrected with additional rehabilitation. I launched Falling Forward to give other people the same opportunity that I had — to continue their rehabilitation and recover to their full potential.”

Today, Falling Forward focuses on two key strategies: providing funding for those in need and advocacy to address the issues surrounding therapy caps. The organization raises money to fund continued rehabilitation for patients after their insurance stops paying. The organization makes grants directly to premiere rehab centers in Colorado, Illinois, Kansas, and Missouri. Porritt explains, “we believe the decisions on how to allocate our funding can best be made by therapy professionals at each rehab center who are working directly with patients and understand their needs.” To date, Falling Forward’s grants have funded the recovery of 75 people. In all cases, additional rehabilitation reduced or eliminated disabilities that were present when the person reached their therapy cap. The results are truly life-changing. Patients have greater mobility, greater independence, are able to live a higher quality of life and, in some cases, have returned to work.

Cayden Hoth paddleboarding after extensive rehabilitation.

Ed Corporal, a high school basketball and volleyball coach suffered two strokes in September of 2013, leaving his entire left side paralyzed. As an athlete, Corporal worked hard to recover, but he was still in a wheelchair when he met his therapy cap. “I wasn’t even close to walking when my insurance ran out,” he says. A Falling Forward grant made it possible for Corporal to continue his rehab for the next two years. Now he is back doing everything he did before, including coaching. “I’m driving, running, back to coaching full-time and also helping with the Kansas University basketball team.”

Cayden Hoth suffered a spinal cord injury in a car accident at the age of 15, paralyzing him from the neck down. With support from Falling Forward, Cayden was able to go through extensive rehabilitation. Today, he is able to walk with no assistance and do many things that other seventeen-year-olds take for granted, including rock climbing and stand-up paddle boarding.

Falling Forward trip to Capitol Hill. Sam Porritt, Senator Dick Durbin, and Ed Corporal.

The organization’s second strategy is advocacy. Currently, Falling Forward is seeking legislation that will reduce or eliminate therapy caps in Medicare (caps were first introduced in Medicare twenty years ago) which ultimately would lead to the same provisions in commercial health insurance. Falling Forward has taken several patients, including Corporal, to Washington to tell their stories to members of Congress. These meetings illustrate the difference between disabilities at the time of therapy cap versus returning to full function after additional rehab. The organization is also working with two coalitions of national organizations advocating to eliminate therapy caps.

Ultimately, research demonstrates that rehabilitation is effective – people regain abilities and are able to live more productive lives – and saves money.  Statistics show that for every $1 spent on rehab care saves $11 in long-term disability costs.

Porritt says, “This is a fight we’re confident we can win. Unlike many other medical issues, we are not looking for a cure.  We know rehab works. We have living proof that people can go from ‘disabled’ to ‘able’. Our patients’ outcomes are proving what’s possible with adequate rehabilitation. We will continue to fund rehab and build the evidence until legislation is passed. Our vision is that someday the barrier of therapy caps will be eliminated and everyone will have the opportunity to recover to their full potential.”

Marty Smith is Vice Chairman of the Board of Falling Forward.  He has deep experience in higher education, currently serving as Vice President for Advancement of Transylvania University.  Marty is a member of the Council for Advancement and Support of Education, and he twice received the CASE Educational Fundraising Award for Overall Improvement.

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