Medical-Legal Partnerships and Public Health Law

 

The NCMLP and NPHL Medical-Legal Partnership Initiative

Both the National Center for Medical-Legal Partnership (NCMLP) and the Network tor Public Health Law (NPHL) support and encourage the use of law to address social and structural determinants of poor health. The organizations accomplish this goal through distinct but complementary approaches: while NCMLP works to spread and support the medical-legal partnership approach as a tool for combatting upstream causes of poor health, NPHL provides substantive legal technical assistance to practitioners to support their public health law and policy efforts. This initiative between NCMLP and NPHL seeks to amplify the impact of both organizations through a collaborative and bidirectional working relationship.

Addressing social determinants of health to improve health equity is a goal shared by public health, health care and public interest legal practitioners. Yet, these disciplines frequently work in silos rather than in tandem: public health practitioners strive to create environments that foster improved population health; health care teams work to mitigate the impact of social determinants of poor health on an individual level; and public interest attorneys advocate for the basic needs of individuals, while pursuing social justice through system level advocacy.

The medical-legal partnership (MLP) approach, which incorporates lawyers into holistic health teams to address health-harming legal needs, provides an excellent model for cross-sectoral collaboration to improve health. When informed by a population health perspective and implemented alongside public health department partners, patient-level efforts can be strategically scaled to achieve population-­level health improvement.

Working with the National Center for Medical-Legal Partnership and with MLPs across the country, the Network provides real-time consultation to MLPs to support their efforts to catalyze institutional and systemic changes that will improve the health of communities. At the same time, the on-the-ground MLP experience can inform the Network about the ways in which laws (or the lack thereof) negatively influence health, such as by enabling hazardous housing conditions or wrongful evictions, or by creating barriers to accessing health care. Through this collaboration, we seek to identify and remediate these types of law and policy gaps and barriers, and focus our efforts on initiatives that can positively impact health and health equity.

Resources

Network Blog Posts about the Collaborative

Improving Health Equity through Collaboration with Medical-Legal Partnerships
Medical-legal Partnerships (MLPs) integrate lawyers into health care settings to assist with patient care by addressing structural problems that impact health. As a result, MLPs help identify ways in which laws harm population health and perpetuate health disparities. But that is only the beginning: MLP practitioners are also key partners in changing harmful laws and practices.

Medical-Legal Partnerships are Public Health Law Issue-Spotters
Differences in implementation and enforcement of certain laws, like housing codes and immigration laws, can lead to poor and sometimes disparate health outcomes among different communities and populations. Medical-Legal Partnerships are uniquely positioned to identify legal failures and gaps and are important partners for public health. Often, patterns in individual health-harming legal challenges reflect a need for population-level intervention.

Network/MLP Collaborative Projects

Issue Brief: Legal and Non-Legal Strategies to Improve Childhood Lead Screening Rates in Illinois and Ohio
One of the collaborative projects that emerged from the NCMLP / Network collaboration has focused on improving lead screening rates in Ohio and Illinois. MLPs in those states recognized that childhood lead poisoning was a pervasive problem, but suspected that the scope of the problem was in fact significantly underestimated due to inconsistent lead screening. The MLPs were already working on legal approaches to reduce lead exposure among clients, but they identified a lack of routine lead screening as an obstacle to pursuing wider-spread legal interventions. In response, Network attorneys developed an issue brief examining existing legal screening requirements in the two states and exploring a range of legal and non-legal solutions. Next steps include disseminating the brief among public health and MLP stakeholders across the two states to identify and pursue the most promising strategies.

Network/MLP Coffee Klatch Discussions:

The NCMLP / Network collaboration paired MLPs from across the country with Network public health attorneys, encouraging these teams to work together to spot issues and patterns that might lend themselves to strategic upstream legal intervention and to identify potential solutions. To facilitate discussion among participants about opportunities for collaboration, the NCMLP and Network hosted several “coffee klatches” featuring brief presentations by regional teams followed by robust discussion among attendees. Slides from the presentations are included here.  

-       Eastern Region/MLP Collaborative Partners October 11, 2017 

-       Mid-States Region/MLP Collaborative Partners  December 13, 2017 

-       Southeastern Region/MLP Collaborative Partners  February 21, 2018 

Scholarship  

Liz Tobin Tyler, Aligning Public Health, Health Care, Law and Policy: Medical-Legal Partnership as a Multilevel Response to the Social Determinants of Health, 8 J Health Biomedical L 211 (2012).

In addition, see the National Center for Medical-Legal Partnership’s extensive curated collection of scholarship and resources for and about MLPs, as well as the County Health Rankings & Roadmaps MLP profile

Webinars

Addressing Socioeconomic Barriers to Health Equity Through Law: A Preview of the 2018 Public Health Law Conference

Social and economic disadvantages create barriers to good health. Laws and policies can contribute to barriers, but can also be used to advance health equity. This webinar from July 26, 2018 previews three sessions from the upcoming 2018 Public Health Law Conference. Panelists will discuss how telehealth can be employed to increase access to health care in underserved communities, how medical-legal partnerships can help address socioeconomic factors impacting health, and efforts at the State level to promote and strengthen benefits for children that are guaranteed by Medicaid. View the playback.

Patients to Policy with Kate Marple, Director of Communications at the National Center for Medical- Legal Partnership
Kate Marple, Director of Communications with the NCMLP, shared her expertise and facilitated discussion during the Network/MLP Coffee Klatch on June 13, 2018. Kate presented on strategies for moving from a patient to policy focus using examples from the NCMLP’s recent story series by the same name (links below).

-        Story 1: Helping Kids Get At-Home Care

-        Story 2: Eliminating Hurdles to Life Saving Medicine

-        Story 3: Keeping Children Safe from Lead Poisoning

-        Story 4: Increasing Nutritional Supports for Newborns

-        Story 5: Ensuring People with Chronic Conditions Maintain Access to Care

Presentation Slides

Working with Medical-Legal Partnerships to Address Social Determinants of Health Oct. 5, 2018
This session from the 2018 Public Health Law Conference provides a brief introduction to the medical-legal partnership (MLP) model, which embeds lawyers in health care teams to address health harming legal needs, and describes opportunities for MLPs and public health practitioners to work together to address social determinants of health through law. Speakers discuss an ongoing collaboration between the Network for Public Health Law, the National Center for Medical-Legal Partnership, and several MLPs across the country aimed at scaling patient-level efforts to achieve population-level health improvement. The session features presenters from Los Angeles and Chicago-based MLPs that involve their local health departments as key MLP collaborators. 

Law As a Key Social Determinant of Health: Accelerating Your Population Health Strategy by Integrating Legal Capacity & Skills Dec. 1, 2017       
In an era of healthcare transformation, where health care practitioners seek tools to improve population health, the MLP approach provides a framework for health care teams, public health practitioners, and public interest attorneys to together identify and address individual health harming legal needs and effect legal and policy change. This presentation at the Midwest Forum on Hospitals, Health Systems and Population Health described this patients-to-policy approach and the emerging evidence of impact. A Chicago-based MLP team described their specific project design, and presenters shared strategies for incorporating a public health perspective into MLP planning and practice to support system change through public health legal interventions.
 

Additional Network Resources and Technical Assistance

Psychologists’ Authority to Diagnoses ADHD To Determine Special Education Eligibility
A requester contacted the Network regarding whether Minnesota law permits psychologists to diagnose ADHD for purposes of determining special education eligibility. In contrast to states like Michigan, Minnesota law currently does allow psychologists to diagnose ADHD for this purpose. The written diagnosis to determine eligibility can be made by a qualified practitioner, including not only a licensed physician, but also a licensed psychologist or an advanced practice nurse.

Medicaid Health Screening Benefits for services provided by Schools
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. A requester contacted the Network to inquire about whether the cost of school-based mental health services would be covered under EPSDT. 

State Coverage of Meals Associated with Non-Emergency Medical Transportation for Children in Medicaid
Access to transportation and nutritious food are essential for children in need of medically necessary health care services. A requester contacted the Network seeking guidance on whether, and how, states cover meals for low-income children when they are traveling for medical care. The Network examined how state Medicaid programs cover certain travel-related expenses necessary to secure examinations and treatment for children who are eligible for the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

Firearm Access and Domestic Violence Convictions
A trauma prevention specialist at a major Massachusetts hospital recently contacted the Network looking for information on law in their state regarding firearm access by those convicted of domestic violence. Specifically, the requestor asked for information regarding the so-called “boyfriend loophole,” a result of the legal definition of a “domestic” relationship in many states that does not include dating partners—that is, couples who never married, never cohabitated, or do not have children.

Early and Periodic Screening, Diagnostic and Treatment - Vision and Hearing  
As states have increasingly turned to managed care entities to fulfill their Medicaid administrative obligations, these companies are charged with affirmative duties to ensure that children receive EPSDT benefits. The Network examine approaches to improving delivery of vision and hearing services in a managed care setting through a series of articles and resources.