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Rural Health Information Hub

Medical-Legal Partnerships

Medical-legal partnerships (MLPs) provide legal services to patients in conjunction with healthcare services. MLPs offer civil legal support, including legal consultation and advice to address housing quality conditions, denial of public benefits, and other social determinants of health (SDOH) that can impact quality of life. As of 2019, 333 healthcare organizations around the country are implementing MLPs in 46 states. The majority of these MLPs are located in urban centers, but they are increasingly used as a model to help address SDOH in rural communities as well.

Programs that use MLPs can connect people to legal services in the same vicinity where they receive healthcare, increasing opportunity for coordination of services. Often, MLP services are free for patients. Some MLPs focus on helping specific patient populations, and some also help address a variety of social needs.

Research shows that MLPs can have a positive impact on addressing SDOH. For example, MLPs have been shown to help improve housing conditions for asthma patients, improve mental health outcomes, and reduce spending on healthcare services. There is some evidence to suggest that MLPs, including those located in rural locations, are likely to improve health outcomes and well-being by decreasing health disparities and improving the overall healthcare system. Medical-legal partnerships have been found to decrease patient stress levels and improve engagement with healthcare and other social support services.

Examples of Rural MLPs Addressing SDOH

  • Medical-Legal Partnership of Southern Illinois (MLPSI) was founded in 2002 to connect patients to legal assistance through referrals from their medical providers. MLPSI helps address SDOH by connecting patients with a variety of health and social services. These services include securing healthcare, educational services, housing subsidies, and protection against eviction and foreclosure, among others. MLPSI has connected thousands of patients to local attorneys and helped relieve millions of dollars of medical debt.
  • The Montana Health Justice Partnership (MHJP) is an example of an MLP that embedded legal staff into healthcare teams to address SDOH. Some of the issues addressed included housing quality complaints, environmental exposures, and domestic issues such as family violence. MHJP operated in several health clinics in rural parts of Montana. The program helped participants save money, address housing concerns, and improve overall health.
  • The Northern Dental Access Center Medical-Legal Partnership helps address SDOH by assisting low-income patients in rural Minnesota with legal and social challenges that affect their oral health. They also provide counseling about insurance, provide care coordination services, and help with transportation needs. This MLP was one of the first to operate in a dental clinic. The MLP employs a full-time attorney and also connects clinic patients with the CHW support.

Implementation Considerations

Many MLPs provide services to patients at no cost. Therefore, in order to implement MLPs, healthcare systems will need to develop partnerships with legal aid services and identify sources of funding. Although there are some rural hospitals and community health centers currently implementing this model, nationally, many MLPs are still located in larger health systems in urban areas. These healthcare systems tend to have bigger overall budgets that can support the implementation and operation of MLPs.

In rural areas, it can be challenging to identify patients with legal and social needs that may impact their health and well-being. Healthcare systems that implement MLPs should provide training to healthcare providers and staff about these services, including best practices for connecting patients with MLP services.

Resources to Learn More

Addressing Social Determinants of Health Through Medical-Legal Partnerships
Article describes how MLPs are being embedded in healthcare centers around the country to address a variety of unmet social needs and describes principles of different models of MLPs.
Author(s): Regenstein, M., Trott, J., Williamson, A. & Theiss, J.
Citation: Health Affairs, 37(3), 378-385
Date: 3/2018

The Social Determinants of Health Academy
HRSA-funded training series that provides health centers with information and examples of different approaches for implementing models, such as MLPs, to address SDOH.
Organization(s): National Center for Medical-Legal Partnership, Milken Institute School of Public Health at George Washington University