As a disability rights attorney focused on Medicaid advocacy at Disability Rights Iowa, I know where my clients, specifically my youngest clients, need help the most. For the Medicaid-eligible kids I serve, they need things like wheelchairs and specialized medical beds—the things that make their lives safe and accessible and allow them to interact with the world in a way similar to you and me. Unfortunately, these are sometimes expensive items that Medicaid Managed Care organizations do not always want to approve as necessary. And the parents of my clients don’t always know that they need an attorney when their Medicaid claim is denied.
But do you know who might know? Their medical provider.
When I became a Mid-Iowa Health Foundation HealthConnect Fellow, I knew exactly where I wanted to focus my efforts—on creating a medical-legal partnership with a local health care system.
A medical-legal partnership is a formal collaboration between legal and health care professionals to help patients address social and environmental factors that contribute to health disparities.
Here is what I’ve learned about how medical-legal partnerships can change the system of care and improve outcomes for children and families:
Medical-legal partnerships (MLPs) are a well-documented and evidenced-based model of addressing the social determinants of health, or factors that greatly influence health outcomes.
The MLP model contains three basic components:
The beauty of the MLP model is in its flexibility. While some MLPs are broad in the types of patients served and the types of legal needs addressed, others are more narrowly tailored to a specific patient population and a finite set of health-harming legal issues. This approach allows each legal services organization and each health care provider to tailor the MLP to meet the needs where they see them most.
MLP programs operate nationwide in 138 hospitals and health systems and 37 children’s hospitals. MLP programs reduce health care costs and, more importantly, they improve patient outcomes. A recent study indicated that children with developmental disabilities served by an MLP had improved access to education resources, reduced family financial burden, and lowered health care costs. Significant research data indicates that MLP programs decrease emergency department visits, decrease admissions, and improve both patient health and provider satisfaction.
After eight years of working on disability rights cases with Medicaid clients, I have had the privilege of working with many health care advocates in our community. These relationships allow for a regular flow of referrals of families who need legal support and opportunities for greater collaboration. They also have led to pursuing a more formal partnership with a local health care system.
Through the HealthConnect Fellowship, I’ve been working closely with leadership from the health care partner to establish an MLP in a sustainable way that allows for growth and longevity. While the model has not been fully integrated into the health care system just yet, the process has allowed me to begin to implement the core tenants of the MLP model:
Children across central Iowa have already benefited from our referral system, and have received the care they are legally entitled to, because of the partnership between Disability Rights Iowa and their medical team. But the partnership’s ability to impact long-term systems change requires future commitment and investments to achieve sustainability. With greater community support for this kind of model, we’re confident in our ability to increase our advocacy efforts, which will allow us to make an impact in even more children’s lives. In the meantime, Disability Rights Iowa and our health care partner will continue to work collaboratively to serve Medicaid-eligible children in our community, because we know together our work leads to healthy, happy kids.
Teenagers in jumpsuits lying on yoga mats, their eyes closed, their bodies still. This is the image Megan Hoxhalli describes as remarkable for juvenile detention, a place where youth arrive shaken, dysregulated, and scared about their future.