Health Center-Based Medical-Legal Partnerships: Where They Are, How They Work, and How They are Funded

Williamson A, Trott J, Regenstein M
Publication Year: 2018
Patient Need Addressed: Other
Population Focus: Medicaid beneficiaries, Vulnerable/disadvantaged
Intervention Type: Partnership
Type of Literature: Grey

The integration of legal services in health centers through MLP has the potential to resolve some of the most intractable social problems that our nation’s vulnerable and underserved patients face. Health centers represent the fastest growing sector for MLP adoption across the healthcare system; the number of health centers operating MLPs in 2016 represents nearly double the number in 2014. Today, 113 health centers operate MLPs, and 38 additional health centers are planning new MLPs. This issue brief from the National Center for Medical-Legal Partnership describes how and where these partnerships operate, and how state primary care associations are supporting these programs. It also discusses how health-center based medical-legal partnerships are financed, with a spotlight on four states that integrate financing for legal services in Medicaid payment arrangements.

Insights Results

Overview of model

  • Medical-legal partnerships (MLPs) embed legal professionals in healthcare organizations to address unmet civil legal needs, including health insurance/public benefit denials, substandard housing conditions, unmet educational accommodations for children with special needs
  • Health centers with MLPs typically partner with a local civil legal aid organization or law school to provide legal services to patients with health-harming social needs at the health center free of charge. Health center staff systematically screen patients, either using paper screeners or an EHR, for unmet social needs during clinical appointments
  • Some health centers are using PRAPARE to screen for social determinants. When an unmet need is identified, the patient is referred to in-house services. Primary care associations can convene organizations to support the growth of MLPs in states. In 2016, they were actively involved in 9 states (HI, IA, MI, MO, MT, NC, OK, PA, and TX)

    Key takeaways/implications

    • In some cases, the primary care associations help coordinate services throughout the state or secure funding. Budgets vary by partnership. Half fund the MLPs in the organization’s operating budget. Many rely on foundations, external grants, and charitable donations to support MLP activities
    • The majority of the financial support for an MLP comes from the legal partner organization, which may draw from funding sources including legal foundation funding, government contracts or other external grants, Interest on Lawyers Trust Accounts (IOLTA) funds, Legal Services Corporation (LSC) funding, law school contributions, law firm support, and other charitable donations. HRSA also supports MLPs as an enabling service and provides technical assistance and other educational resources. Some states have pursued innovative financing mechanisms, for example:
      – Colorado set up 7 Regional Care Collaborative Organizations, 4 of these reimburse for legal services at 2 health centers for a small PMPM add-on payment. In OR, the pilot MLP was funded by Richmond Clinic and Health Share of Oregon, the largest coordinated care organization (CCO)
      – In Indiana, EseknaziHealth offers MLP services in 5 health centers through a 2-year contract with a Medicaid managed care entity. The contract gave a fixed amount to the centers and its legal partner. All patients at the health center are eligible for services
      – In California, LA County released an RFP for “Whole Person Care Los Angeles” a pilot program that is part of the state’s 1115 waiver demonstration. $500,000 in funding is provided for MLP legal services, technical assistance, and training for the first year