U.S. Rep. Gabrielle Giffords and two of her employees injured in the Jan. 8 Tucson shooting have federal health coverage, but that's not what's paying their medical bills.

Since they were injured while on the job, medical expenses for Giffords, as well as staffers Ron Barber and Pam Simon, are being paid by federal workers' compensation.

Simon is already back to work, and Barber is recovering from two gunshot wounds, including one to his leg that caused severe nerve damage. Giffords is undergoing intensive rehabilitation in Houston, where doctors said Friday she's "making leaps and bounds" in her recovery.

Members of Congress and their staff, like all federal employees, are covered under the Federal Employees' Compensation Act for "any injury or death sustained in performance of duty," says the U.S. Department of Labor, which administers the program.

The compensation act covers all medical care that the federal Office of Workers' Compensation considers "likely to cure, give relief (and) reduce the degree or the period of disability." Such care would include hospital, rehabilitation and home therapy services "for as long as residuals of an injury continue," federal law says.

The federal workers' compensation law does not cap the amount of medical benefits that may be paid.

Non-federal employees are covered through compensation that's paid by their employers, generally through private insurers, and regulated by individual states. Both the federal and state workers' compensation programs operate on the same principle - providing benefits to cover the injury while the employee relinquishes the right to sue his or her employer.

While state plans vary, federal workers' compensation coverage is in general more generous than what states provide to injured workers, said Max Gest, a Los Angeles attorney who specializes in federal workers' compensation cases.

Since she was injured on the job, Giffords has better medical coverage than many patients who incur brain injuries outside the workplace and must therefore have their medical expenses paid for by regular insurance, patient advocates note.

The Brain Injury Association of America says inpatient rehabilitation costs can range from $600 to $8,000 a day depending on services, and outpatient rehabilitation can cost $600 to $1,000 a day.

Many insurance plans set limits on how much rehabilitation patients may receive, said Mattie Cummins, executive director of the Brain Injury Association of Arizona.

Patients enrolled in the Arizona Health Care Cost Containment System (AHCCCS) - Arizona's form of Medicaid - don't have any outpatient speech therapy coverage, for example.

"When speech therapy isn't provided, it's really a tragedy," Cummins said.

Speech therapy is about more than forming words - it is cognitive therapy that works to rewire the brain, Cummins said. And the problem with insurers setting limits on how long someone may get therapy for a brain injury, she said, is that no two brains are alike, and recovery times vary significantly.

"Brain injury is not an easy rehabilitation. It can take months, years," she said. "We see when people who have really good insurance, the differences are unbelievable."

Cummins said one of her organization's key functions is helping people figure out what to do when they don't have enough insurance coverage for the rehabilitation they need. The Governor's Council on Spinal and Head Injuries sponsors a vocational rehabilitation program that can help, but the program has a waiting list, Cummins said.

And while brain rehabilitation is expensive, it's important, she added. People with brain injuries face an array of challenges, frequently problems with simple tasks that require short-term memory skills.

"It's very complicated, and it's an example of why rehabilitation is so important and so long," Cummins said. "But with it, you may be able to go back to work and have a much better quality of life."

Contact reporter Stephanie Innes at sinnes@azstarnet.com or 520-572-4134.