How Medical-Legal Partnerships Can Link Systems to Improve Health Outcomes

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:

About the Model

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:

1. An attorney available to provide free legal services to patients experiencing legal issues affecting their health.
2. Transformation of both the legal and health care institutions by approaching the system in a holistic way, focusing on how each impacts the other.
3. Advocacy for systems-level policy changes that address issues that adversely impact patient well-being.

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.

Impact of the Approach

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.

Implementation in Central Iowa

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:

• LEGAL SERVICES: Building on previously established relationships while growing my professional network is leading to new sources of referrals and has allowed me to represent children whose families otherwise have not heard of Disability Rights Iowa. With the support of each client’s medical provider, all of my cases have had positive outcomes and I’ve been able to help my clients get the medical devices and equipment they need to live safely at home and go to school with their friends.
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• TRANSFORMATION: This partnership also provided me the opportunity to present to the health system’s entire pediatric team that provides physical, occupational, and speech therapy. During this training I shared with the therapists ways in which they could best advocate for their patients, how to help families navigate the Medicaid appeal system, and when to make the referral to my agency. This allows the therapists to empower each family with the knowledge and information they need to make the best decision for their child with a disability going forward.
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• ADVOCACY: While our collaborations have resulted in numerous children receiving the equipment and services they desperately need, there is so much more work to be done to address the barriers families experience in accessing supports that can improve health outcomes. We know many Medicaid-eligible children are simply not receiving the services in which they are legally entitled. This is often because insurance coverage determinations are based upon protocols designed for adults versus the unique developmental needs of children. The MLP model allows our legal and health care organizations to advocate for necessary policy changes that impact the day-to-day lives of mutually shared patients and clients.

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.