Peer-Reviewed Research on the Impact of Medical-Legal Partnerships
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Benefits for Patients
This article published in AIDS and Behavior examined the impact of MLP services for housing, employment, and public benefits on the adherence to medical treatment and viral load suppressions of people with HIV compared to treatment-as-usual. 202 people with HIV in Philadelphia, Pennsylvania, were part of the study. At 3-month follow-up, MLP participants were significantly more likely to achieve viral suppression.
A two-year evaluation of Kaiser Permanente’s (KP) multi-state medical-legal partnership sheds light on how healthcare and legal sectors can work together to address housing instability and what it takes to implement these partnerships effectively at scale. The findings, published in Health Services Research, reveal that the MLP expanded access to legal services and delivered services efficiently. Eighty-two percent of legal cases were resolved with fewer than five hours of attorney time.
This article published in the Journal of Law, Medicine & Ethics reports outcomes from one medical-legal partnership from the perspective of patient-clients. Patients who received legal services had improvements in physical health, including asthma control, and mental health benefits, such as reduced anxiety. MLP involvement also reduced caregiver stress, enabling parents to focus on their child’s health.
The Georgetown University's Cancer Legal Assistance and Well-being Project launched in 2020 as a medical-legal partnership that works with health care providers at a Washington, D.C. safety-net hospital to treat the health-harming legal needs of historically and intentionally marginalized patients with cancer. Preliminary data support the estimate that the project has secured over $700,000 for patients in the form of insurance coverage, disability benefits and other income supports, paid leave, and debt relief. The findings were published in the Journal of Health Care for the Poor and Underserved.
In this paper, authors discuss ways in which use of data and quality improvement methods at a Cincinnati-based medical-legal partnership (MLP) have facilitated advocacy at both the individual and population levels as healthcare and legal teams collectively pursue better, more equitable outcomes. The MLP team saw a 38 percent reduction in hospitalizations among children referred to the MLP and were able to recover $1.36M in public benefits for patient-families. The MLP was also able to make system-level upgrades to housing (e.g., pest control, new roofs, and ventilation improvements) affecting 700 families after identifying patterns through data sharing and legal advocacy. And MLP partners streamlined SNAP enrollment processes at the county and state levels, driven by advocacy based on observed patterns of delayed benefit access. The findings were published in the The Journal of Law, Medicine & Ethics.
This study, based on interviews with medical-legal partnership personnel in 10 states, found that having legal staff on-site built healthcare providers’ confidence around addressing health-harming legal needs through effective cost of care conversations, improved patient outcomes, and increased return on investment for health systems. Findings were published in Clinical Nursing Research.
The study describes the impact of a medical-legal partnership (MLP) between Pisgah Legal Services and the Mountain Area Health Education Center, which serves rural North Carolina counties, over a 24-month period. The MLP was successful in helping to address multiple social needs faced by patients that contribute to worse health status and outcomes. Monetary benefits to patients were $309,902 plus an additional $174,733 from tax returns and the Earned Income Tax Credit. The findings were published in the North Carolina Medical Journal.
The study evaluated the impact on health outcomes and health care utilization of a MLP housed in a large federally qualified health center in Colorado (MLP-CO). Clients screened for I-HELP™ needs were surveyed at baseline and six months post-enrollment. Overall, 61.4% attributed great/moderate improvements in their health care experience to the MLP-CO.
A study conducted in Greater Cincinnati, Ohio, between 2012 and 2017 examined the effect of referral to a medical-legal partnership on hospitalization rates among urban, low-income children. Researchers found that the median predicted hospitalization rate for children in the year after referral was 37.9 percent lower if children received the legal intervention than if they did not. The research was published in Health Affairs.
The study examines whether a medical-legal partnership (MLP) could impact asthma exacerbation rates in a vulnerable urban population at an academic children’s hospital. In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. The findings were published in the Journal of Asthma.
This study assessed the benefits provided by the Health Law Partnership (HeLP), a medical-legal partnership (MLP) in Atlanta, Georgia, to pediatric patients with neuro-developmental disabilities and their families. Over two and half years, legal services led patient families to obtain/retain benefits exceeding $4.9 million in total value. State Children’s Health Insurance Program (SCHIP) and other health-related assistance resolved cases resulted in an average benefit value of $18,925 per case, followed by SSI and education cases with an average benefit value of $9,585 and $5,336, respectively. Findings were published in The International Journal of Health, Wellness, and Society.
A pilot study at Rutgers showed that, following a medical-legal partnership intervention, parents had improvements in perceived stress.
A study of an intervention among youth with type 1 diabetes, which included medical-legal partnership counsel as a key element, found that 30 percent of youth accepted legal counsel. Youth enrolled in the program were found to demonstrate significant improvement in their glycemic control after one year of the intervention, as compared to youth not enrolled in the program.
Researchers from Yale School of Medicine and the Department of Veterans Affairs – Connecticut examined the outcomes of veterans who accessed legal services at four medical-legal partnership sites in Connecticut and New York from 2014 to 2016. Researchers observed significant improvements in Veterans’ housing, income, and mental health.
This article is a review of observational studies, published from January 1993 -January 2016, to investigate the capacity of medical-legal partnerships to address legal and health disparities. The authors identified 13 articles for qualitative analysis from an initial pool of 355 records, four of which directly addressed the impact of MLP intervention on patient wellbeing and/or patient utilization of health care services.
Drawn from in-depth interviews with 72 patients, this study investigated the outcomes of medical-legal partnership (MLP) interventions and compared results to similarly disadvantaged participants with no access to MLP services. Results indicate that participants in the MLP group were more likely to achieve adequate, affordable, and stable housing than those in the comparison group. Study findings suggest that providing access to legal services in the healthcare setting can effectively address widespread health disparities rooted in problematic housing.
Researchers at Cincinnati Children’s Medical Center examined how local agencies that enforce housing policies can partner with the health care organizations to pinpoint potential clusters of high asthma morbidity. Article describes how integrated housing and health data revealed areas and patients at-risk for asthma-related emergency visits, providing opportunities to offer targeted interventions.
Working within a medical-legal partnership, an urban hospital-based pediatric practice standardized criteria for providers approving medical need utility certification requests. Authors compared prior-year utility certification requests and approvals (pre-intervention) with the intervention year for families who reported energy insecurity on a waiting-room screening questionnaire. Between the first and second years of the study, certification of medical need approvals increased by 65 percent, preventing utility shut-offs for 396 more families with vulnerable children.
A randomized control trial at Boston Medical Center, a large urban safety-net hospital, incorporated medical-legal partnership services into an intervention for families of healthy newborns receiving primary care. Low-income families assigned to the intervention group were found to have an increase in use of preventive health care and had greater access to concrete support. The results were published in Pediatrics.
This article in the Journal of Health Care for the Poor and Underserved shares the results of a three-year study examining the impact of medical-legal partnership services in an academic pediatric primary care setting at Cincinnati Children’s Hospital Medical Center. There were positive legal outcomes in 89 percent of referrals affecting nearly 6,000 cohabitating children and adults, and translating into nearly $200,000 in recovered back benefits for those individuals.
Low-income children are more likely to suffer worse asthma outcomes because of their socioeconomic status and environmental exposures. During a seven-year study, a medical-legal partnership at Children’s Healthcare of Atlanta addressed legal problems of asthma patients and their families. As a result, families experienced reduced stress and received a total of $501,209 in financial benefits.
This article examines how a pediatric-based medical-legal partnership in Cincinnati, Ohio, identified and treated a cluster of 16 substandard housing units. Of the 45 children living in those units, 36 percent had asthma, 33 percent had developmental delay or behavioral disorder, and 9 percent had an elevated lead level. The MLP was able to make repairs to the majority of the units and improve home environmental conditions for these children.
An Arizona study assessed the stress levels of patients before and after receiving legal services and found that medical-legal partnership intervention led to a reduction in perceived stress and an improvement in overall wellbeing. The findings were published in the Journal of Health Care for the Poor and Underserved.
A study in New York City analyzed the effects of medical-legal partnership services that forced landlords to provide better living conditions for adult patients with asthma. It found that the number of Emergency Department visits and hospital admissions declined post-MLP intervention, and that all patients had reduction in medication due to increased wellbeing. The findings, published in the Journal of Asthma, indicate that legal care is effective in bringing about substantial symptomatic and objective improvements in adult asthma patients.
A medical-legal partnership at Children’s Healthcare of Atlanta saw 76 children with sickle cell disease over a six-year period to assist with a range of legal issues. It was found that MLP services resulted in a range of social and financial benefits for families.
A 36-month study was conducted in California to examine the impact of clinic- and hospital-based legal services on fifty-four families in a pediatric setting. The results, published in the Journal of Health Care for the Poor and Underserved, showed that two-thirds of respondents reported improved child health and well-being due to increased awareness and use of free legal services and increased access to food and income supports. The study suggests that adding a legal aid attorney to the medical team can increase access to legal and social services and decrease barriers to care.
This article in the Journal of Clinical Oncology discusses a New York City-based medical-legal partnership that integrated legal interventions into cancer care. Patients reported stress reduction, positive effects on family and financial situations, and improved adherence to medical treatment.
Benefits for Healthcare Delivery and Healthcare Costs
This article published in the Journal of General Internal Medicine describes ways that medical-legal partnership services can reduce hospitalizations and save on health care costs. It details steps to integrate medical-legal partnership activities into value-based healthcare financing streams.
This article published in the Journal of Health Care for the Poor and Underserved reports on a study of 110 adult patients admitted to a safety-net public hospital beyond medically predicted length of stay. Each adult was assessed for health-harming legal needs and referred for MLP legal services if indicated. The assessment found that lack of guardianship was specifically associated with increased excess length of stay. Over a one year period, the MLP was able to reduce length of stay for some patients and cost-analysis showed savings in excess of $200,000.
A medical-legal partnership at an academic medical center (AMC) in North Carolina measured the detailed cost savings it provided to the AMC through the provision of legal services to its patients. MLP partners identified guardianship-related delays as the primary driver of extended lengths-of-stay at the AMC. When an MLP attorney was able to expedite guardianship proceedings, they reduced a patient’s lengths-of-stay by approximately 20 days. This led to an annual cost savings of $1,237,500 for the AMC based on an average cost of $825 per day for the hospital for 75 patients requiring guardianship services. Cost savings from these reduced lengths-of-stay alone exceeded MLP program costs by over threefold. The findings were published in The Journal of Law, Medicine & Ethics.
In this paper, authors discuss ways in which use of data and quality improvement methods at a Cincinnati-based medical-legal partnership (MLP) have facilitated advocacy at both the individual and population levels as healthcare and legal teams collectively pursue better, more equitable outcomes. The MLP team saw a 38 percent reduction in hospitalizations among children referred to the MLP and were able to recover $1.36M in public benefits for patient-families. The MLP was also able to make system-level upgrades to housing (e.g., pest control, new roofs, and ventilation improvements) affecting 700 families after identifying patterns through data sharing and legal advocacy. And MLP partners streamlined SNAP enrollment processes at the county and state levels, driven by advocacy based on observed patterns of delayed benefit access. The findings were published in the The Journal of Law, Medicine & Ethics.
A study conducted in Greater Cincinnati, Ohio, between 2012 and 2017 examined the effect of referral to a medical-legal partnership on hospitalization rates among urban, low-income children. Researchers found that the median predicted hospitalization rate for children in the year after referral was 37.9 percent lower if children received the legal intervention than if they did not. The research was published in Health Affairs.
The study examines whether a medical-legal partnership (MLP) could impact asthma exacerbation rates in a vulnerable urban population at an academic children’s hospital. In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. The findings were published in the Journal of Asthma.
A recent study examined the impact of unmet legal needs on hospital readmission rates at the SIU Family and Community Medicine inpatient service at Memorial Medical Center in Springfield, Illinois. Data from 2500 hospital discharges were analyzed alongside unmet legal needs identified through an interview-based screening tool. The results show that unmet legal needs appear to be an independent risk factor for hospital readmission.
This article reviews recently promulgated Internal Revenue Service regulations for nonprofit hospitals seeking tax exemption and a new estimate of national hospital community benefit spending, and analyzes how they point to the value of hospitals working with community partners to address the social determinants of health. It then explains how unmet legal needs function as health determinants, and suggests how hospitals’ participation in medical-legal partnerships can address those needs.
A one-year pilot study of high-need, high-use patients at Lancaster General Health showed that 95 percent of patients studied had 2-3 civil legal problems each. The study, published on the Health Affairs blog, also found that when those problems were addressed, inpatient and Emergency Department use dropped 50 percent, and overall health care costs went down 45 percent.
A study in New York City analyzed the effects of medical-legal partnership services that forced landlords to provide better living conditions for adult patients with asthma. It found that the number of Emergency Department visits and hospital admissions declined post-MLP intervention, and that all patients had reduction in medication due to increased wellbeing. The findings, published in the Journal of Asthma, indicate that legal care is effective in bringing about substantial symptomatic and objective improvements in adult asthma patients.
This article in the Journal of Healthcare Management examines the role the medical-legal partnership at Children’s Healthcare of Atlanta played in increasing reimbursements, reducing costs, and improving access to care for patients with low socioeconomic status. Over a four-year period, the MLP secured Medicaid payments for services that would otherwise be unreimbursed. MLP services also led to an increase in physician satisfaction and saved hospital employers $10,000 annually in continuing education costs.
A three-year study of a rural medical-legal partnership at Southern Illinois Healthcare showed that the hospital made a 319% return on its investment in MLP services by recovering dollars for clinical services. An article in the Journal of Health Care for the Poor and Underserved shares that patients also experienced a range of social benefits from MLP services.
In a three-year period, 297 referrals were made to a palliative care-based medical-legal partnership for legal assistance with custody planning and guardianships, advance care planning, benefits advocacy, estate planning, and housing. An article in the Journal of Palliative Medicine details how the medical-legal partnership was able to solve many of patients’ legal problems and help them access critical public benefits, while also providing financial benefit to the hospital. Through 17 cases where the MLP helped patients enroll in previously denied health care coverage, the hospital was able to recover $923,188 in unreimbursed clinical services.
Benefits for the Healthcare Workforce
A 16-question survey was emailed to 532 providers in a health system in South Carolina. The survey assessed clinicians’ perception of their role in addressing SDOH needs, the MLP’s impact on their clinical capacity, and the MLP’s ability to remedy patient SDOH needs. Providers who had referred to the MLP indicated higher levels of agreement that SDOH screenings were part of their clinical responsibility and had higher levels of agreement regarding comfort levels for completing SDOH screenings. Geriatric providers reported higher levels of agreement that the MLP reduced clinician stress than pediatric providers. Findings were published in the Journal of Epidemiology & Community Health.
Authors conducted semi-structured interviews with 20 pediatric providers and 20 parents/guardians who had engaged with medical-legal partnership services at an academic medical center in New Haven, Connecticut. They found that the MLP improved provider knowledge of and ability to address social determinants of health and health-harming legal needs, improved provider-family relationships, and encouraged providers to engage in systemic and institutional advocacy. Findings were published in Academic Pediatrics.
The authors conducted a systematic review to better define the impact that educational programs centered on medical-legal partnerships have on trainees’ knowledge, attitudes and future practice with regards to the social determinants of health. Benefits to trainees were wide in scope but all programs showed improvements in participants’ understanding, comfort, confidence, and/or abilities in identifying and intervening on the social determinants of health in their patients. This article was published in the BMC Medical Education.
From 2016 - 2017, a medical-legal partnership in Washington, D.C. piloted a legislative advocacy training program for preclinical medical students designed to prepare them to meet with Capitol Hill representatives about a health justice issue. The pilot assessed the impact of adding an interprofessional education dimension to the program, which in this case involved engaging law faculty and students to help the medical students understand and navigate the federal legislative process and prepare for their meetings. Results from the pilot suggest that adding law and policy experts to advocacy-focused training programs can improve medical students’ advocacy knowledge and skills and increase their professional identity as advocates. The findings were published in the Journal of Legal Medicine.
In 2011, the authors implemented a four-session didactic interprofessional curriculum on medical–legal practice for third-year medical students at Morehouse School of Medicine. From 2011–2014, medical students participated in pre- and post-intervention surveys designed to determine their awareness of SDOH’s impact on health as well as their attitudes toward screening for SD0H issues and incorporating resources, including a legal resource, to address them. Post-intervention survey results indicated that students self-reported an increased likelihood to screen patients for SDOH issues and an increased likelihood to refer patients to a legal resource.
Medical-legal partnership training helps residents develop structural competency and build the skills necessary to address barriers to health at the patient, institutional, and population levels. Through a case study, this Perspective in Academic Medicine explores how residents can address health-harming legal needs working in partnership with interprofessional health care teams that include lawyers, and illustrates how such MLP experiences can relate to competency-based Milestones that are applicable to training residents in all specialties.
This article in the Journal of Legal Medicine details a pilot that integrated legal services into a federally-funded Healthy Start program intensive home visiting model. MLPs in the pilot delivered legal assistance to patients, provided training to increase healthcare workforce capacity, and tackled systemic problems at a policy level. Through case consultations and trainings, case managers and staff reported an increase in both knowledge and ability to advocate on behalf of their patient-clients.
This article in the Journal of Healthcare Management examines the role the medical-legal partnership at Children’s Healthcare of Atlanta played in increasing reimbursements, reducing costs, and improving access to care for patients with low socioeconomic status. Over a four-year period, the MLP secured Medicaid payments for services that would otherwise be unreimbursed. MLP services also led to an increase in physician satisfaction and saved hospital employers $10,000 annually in continuing education costs.