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At this county health center, a lawyer is just what the doctor ordered

Emily Alpert Reyes, Los Angeles Times on

Published in Health & Fitness

Although the upcoming transition has stirred questions, the California Department of Health Care Services said that under the new CalAIM system, medical-legal partnerships will be embedded in other services.

Dennis Hsieh, chief medical officer for Contra Costa Health Plan, said one path could be including lawyers alongside social workers, nurses and community health workers on the "enhanced case management" teams for envisioned for patients under the new system.

"It's making sure that lawyers are seen as — and thus paid for as — an indispensable part of case management," he said.

The National Center for Medical-Legal Partnership estimates that there are now more than 500 such programs across the country — a huge surge from the roughly 75 programs that existed when the center was created a decade and a half ago.

Funding has been a persistent challenge for such programs, said Bethany Hamilton, co-director of the center. Nearly two-thirds had received money through foundations or other philanthropy, according to an analysis released by the center, but such funding often has an endpoint. Using the kind of money that L.A. County has tapped is relatively unusual.

Historically, the U.S. health care system hasn't been focused on the "upstream drivers of health" that medical-legal partnerships address, said center co-director Joel Teitelbaum, a professor of health policy and law at the George Washington University.

 

"It's really a sick care system rather than a health care system," Teitelbaum said. "Making that shift is a huge matter."

UCLA is still assessing the program underway in L.A. County, but such efforts have widely been credited with improving health outcomes: Asthma patients who got legal help forcing their landlords to clean up mold and clear out roaches were less likely to be hospitalized, one study found. Another study found that veterans in such programs in Connecticut and New York saw significant improvements in their mental health.

In L.A. County, health officials say the legal assistance helped a teacher get thousands of dollars in unemployment benefits she was initially denied; enabled a patient to get a power wheelchair that had been erroneously denied by his health plan; gotten astronomical bills covered through Medi-Cal and Medicare; and ensured tenants could avoid eviction and stay in their homes.

Having an attorney stationed in a clinic makes it more likely that people will get that help, because "many people don't realize that the issues they're facing are legal issues," Joolharzadeh said. For instance, she said, a patient who comes in coughing might not connect that to black mold in their apartment or realize they have legal rights to get that mold removed.

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