LSC and Medical-Legal Partnerships

LSC and Medical-Legal Partnerships

Dozens of LSC Grantees Partner in Innovative Collaborations

Medical-legal partnerships (MLPs) combine health and legal services at a single site of care to address and prevent civil legal problems that affect health. The strength of these partnerships lies in the collaboration between health care, public health, and civil legal aid professionals who don’t normally work together, but collectively engage in trainings, patient care, and policy work. To be more specific, in an MLP, lawyers work with patients to alleviate—through legal intervention—social or other stressors that are impacting their health; doctors, nurses, and social workers receive training on how to screen for possible legal issues that affect their patients’ health and well-being.

As a result of their joint efforts, according to the National Center for Medical-Legal Partnership, “problems are detected sooner than they would be in a crisis-driven civil legal aid setting, health care providers have a critical resource for treating patients who are made sick by their environment, and both professions are in a better position to detect systemic problems and inform healthier public policies.”

Hundreds of health care and legal institutions across the country have developed MLPs to help children, the elderly, veterans, and people with chronic illnesses get and stay healthy. These partnerships are taking off as health care providers increasingly acknowledge their positive effects for patients and health care workers alike.

Clinicians reported improved patient health outcomes and greater compliance with medical treatment as a result of MLP services

National data on medical-legal partnership activities was compiled in a survey by the National Center for Medical-Legal Partnership for the 2016 calendar year.

Key findings include:

  • One in three health care organizations with active medical-legal partnerships are now health centers, contributing to an increasingly diverse MLP landscape;
  • One-third of health care organizations with medical-legal partnerships include funding for these activities in their operating budget;
  • In 2016 alone, MLP legal partners collectively trained more than 11,000 health care providers in MLP services and health-harming legal needs; and

Currently, at least 40 of LSC’s grantees operate MLPs. Here are some examples:

Legal Aid of Arkansas’ Medical-Legal Partnership

In 2009, the Walmart Foundation and the Walmart Legal Department donated $100,000 to Legal Aid of Arkansas and the Arkansas Access to Justice Commission to better assist low-income Arkansans in getting the help they need.

An MLP was then formed in 2011 between Walmart, Arkansas Children’s Hospital, and Legal Aid of Arkansas, through which Walmart attorneys provide free legal services to patients and their families. Since then, more than 700 patients have been referred through the hospital, and over 120 Walmart attorneys and professional staff associates have volunteered approximately 1,400 hours on various pro bono projects, including patient cases worth more than $200,000 in free legal services.

Due to the success of the partnership—the first of its kind between a large corporate legal department and a major hospital, as well as Walmart’s first foray into free legal services—more are on the way. After Arkansas, Walmart funded an MLP between Texas Children’s Hospital and Houston Bar Association’s Houston Volunteer Lawyers in 2012, and it wants to create a national network of MLPs at children’s hospitals. Children’s hospitals are also increasingly embracing the partnerships.

For more information on Legal Aid of Arkansas’ medical-legal partnership, view the PowerPoint slides from the organization’s presentation on “Innovations in Civil Legal Aid” at the 2015 NLADA annual conference here

How the Alaska Legal Services Corporation Was Able to Receive a Multi-Year Grant to Expand Its Medical-Legal Partnership Efforts and Improve Capacity-Building

The Alaska Legal Services Corporation (ALSC) has 12 offices across the state and fewer than 30 attorneys, who serve approximately 6,400 low-income Alaskans per year. Forty-five percent of these clients are Alaska Natives, whose access to justice can be hindered and exacerbated by the isolated areas where they live.

In October 2016, ALSC partnered with New Mexico Legal Aid and DNA-People’s Legal Services on the Navajo Nation to apply for a grant from the federal AmeriCorps program to start a network of medical legal partnerships (MLPs) in tribally operated health care facilities in six states. The joint project was awarded $273,000 over a three-year period as part of the Obama administration’s investment in tribally sponsored AmeriCorps programming. It will fund legal fellows to work with health care providers at six tribally operated health care organizations in Alaska—specifically in Anchorage, Fairbanks, Juneau, Sitka, Kenai, and Nome—to “identify and treat domestic violence, housing, income maintenance, and disability/aging-related problems.”

Not only does this initiative provide a lawyer in or near a health care facility in a collaborative effort to facilitate the referral process and combat health-harming social conditions, but it is also a significant addition of six attorneys—a 20 percent increase—to ALSC’s team of approximately 30 attorneys.

This project likely wouldn’t have existed, though, if it were not for a conference on Native American health held about two years ago on the Navajo Nation in the southwestern United States.  That is when ALSC Director Nikole Nelson learned about the Navajo Nation’s MLP with DNA-People’s Legal Services in Arizona. Such a collaborative effort, she realized, would be a great fit for Alaska and its widespread population.

After a year and a half of hard work, the project got funding and became part of a six-state public and private investment that includes 14 new sites and 14 legal fellows who will support each other as they work in MLPs in tribal communities in New Mexico, Arizona, Nebraska, Oklahoma, Utah, and Alaska.

Looking to the future, it is possible that additional partnerships in Alaska may be formed over the course of the three-year project, modeled after the MLP between the Navajo Nation and DNA-People’s Legal Services and the other 300 MLP’s across the country.

Breast Cancer Projects

Legal Aid of Nebraska’s Breast Cancer Legal Hotline

Struggling through an illness such as breast cancer is never easy, especially when money is tight.

One of the few legal aid organizations to have such a program—Atlanta Legal Aid Society is another—Legal Aid of Nebraska’s (LAN’s) Breast Cancer Legal Hotline provides access to free civil legal advice, service, and representation to breast cancer patients and survivors, regardless of income.

The hotline, started in 2013 with a grant from Susan G. Komen Nebraska, is an important part of LAN’s medical-legal partnership (MLP). The partnership initially began in 2009 with funding from Nebraska Medicine. The hotline is available five days a week from 9 a.m. to 12 p.m., and is staffed by a paralegal who is solely responsible for intake and litigation support.

The hotline is all-encompassing too, in the sense that any breast cancer patient or survivor can call in to receive legal assistance—as well as representation—on a number of issues. These issues may include but are not limited to consumer law, family law, public benefits, employment discrimination, and end-of-life issues. This enables patients and survivors to focus on their health and healing instead of being worn down by the stresses of their legal situation. To put LAN’s work in context, one particular case involved helping a client who was in an abusive relationship get a divorce while she was going through chemotherapy. 

The organization’s work has also shifted in terms of location. LAN has been able to identify the areas that need help the most based on which places have higher incidences of breast cancer. For example, they frequently serve clients in Omaha, part of Douglas County, which has nearly double the number of breast cancer cases annually than the second-closest county, Lancaster County. (Omaha, the largest city in the state with a population of approximately 446,618, also has a poverty rate of 16.8 percent.)

These data paint a complicated picture, specifically of the prevalent need and LAN’s efforts to meet it. On the one hand, need is often tied to socioeconomic status. According to the Centers for Disease Control and Prevention:

A person’s [socioeconomic status] (SES) affects his or her ability to get health care. A person with more education is more likely to get a job that pays well and provides health insurance and paid sick leave. People who have higher incomes and health insurance are more likely to get tests that can find cancer early, and get the right treatment if cancer is found. So people with a higher SES often have higher cancer survival rates.

People with a low SES are less likely to get cancer screening tests. So their cancer is often found at a later stage when it causes symptoms. Even if their cancer is treated, patients are less likely to survive cancer that’s found after it has advanced.

On the other hand, LAN has been actively working to meet the need, and it has been making progress. In fact, LAN’s MLP has grown from one department in one hospital to all five of Omaha’s major hospital systems, including two neighborhood clinics. And, according to a PBS NewsHour segment on the MLP in September 2015, Nebraska Medicine’s payments to LAN have increased from $25,000 to more than $200,000 a year.

Atlanta Legal Aid Society’s Breast Cancer Legal Project

For the past 12 years, Atlanta Legal Aid Society’s (ALAS) Breast Cancer Legal Project (BCLP) has provided legal assistance to low-income people living with or affected by breast cancer who are dealing with issues related to employment; Social Security disability; short- and long-term disability insurance; access to health care; housing and landlord-tenant, consumer, and debt issues; public benefits; end of life and estate planning; and more. (In Georgia, breast cancer is the leading cause of cancer incidence among females in the state and accounts for 31 percent of all new cancers in women.)

Shortly after the project started, in 2005, the Greater Atlanta Affiliate of Susan G. Komen for the Cure gave it funding. Since April 2010, ALAS has received seven grants from Komen Atlanta, totaling $337,403.

Notably, the BCLP was the first project in the country to do what it does: provide direct legal services specifically to low-income breast cancer patients and survivors. It now serves around 150 clients per year through a variety of means and operations, including:

  • Phone intake from 9 a.m. to 12 p.m., Monday through Thursday
  • On-site intake and consultations
  • Specialized outreach, similar to that done in medical-legal partnerships, on the second and fourth Thursdays of each month from 1 p.m. to 3 p.m.
  • Targeted outreach to specific areas of the community to reach more breast cancer clients, and working with health care providers in those areas
  • Continuing legal education (CLE) estate planning training to pro bono attorneys
  • Estate planning case referrals to pro bono attorneys through the private bar, which allows for a better use of the staff’s—five attorneys and two paralegals—time on the project
  • Collaboration with local and national cancer advocacy and resource organizations, as well as several local medical centers
  • Community-based training and education

For more information on ALAS’ Breast Cancer Legal Project, click here

Learn More About Our Medical-Legal Partnership Panels

Video: LSC Congressional Briefing: How Medical-Legal Partnerships Assist Victims of Opioid Addiction 

  • Representative Susan W. Brooks
  • Representative Joseph P. Kennedy
  • Representative Fred Upton
  • John G. Levi

Video: Board of Directors Meeting: DC-Panel: Addressing the Legal Needs of Low-Income Veterans through Medical-Legal Partnerships

  • James J. Sandman
  • Nan Heald
  • Lara Eilhardt

Article: Five Things the Civil Legal Aid Community Can Learn from Medical-Legal Partnership

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