1.  2010 LegalHealth Bringing Advocacy to Your Practice June 10, 2016

2.  2010 LegalHealth 1 Training Objectives Provide an understanding of LegalHealth’s services and the importance of working as a team. Discuss the forms that advocacy can take and why it is important to you and your development of a systems based practice. Provide case examples to illustrate how advocating with the assistance of LegalHealth helps your patients.

3.  2010 LegalHealth 2 LegalHealth A professional partnership to promote patient well being + =

4.  2010 LegalHealth 3 LegalHealth Since 2001 LegalHealth has partnered with medical professionals to address the nonmedical needs of low- income people with serious health problems. LegalHealth complements health care with legal care – providing free legal services in medical facilities and training healthcare professionals to understand the legal issues their patients face. LegalHealth is part of the New York Legal Assistance Group, a nonprofit law office. LegalHealth is funded through private foundations and its partners.

5.  2010 LegalHealth 4 LegalHealth around New York City HHC All acute care hospitals Coler – Carter Nursing Facility FQHCs Community Health Center of Richmond (Staten Island) Maimonides Medical Center Montefiore Medical Center NYU Cancer Center Mount Sinai Hospital System Mount Sinai Adolescent Health Center Mount Sinai Hospital Beth Israel Hospital St. Lukes Hospital Ralph Lauren Center for Cancer Care & Prevention Veterans Hospitals Bronx Manhattan

6.  2010 LegalHealth 5 Range Of Legal Services Government Benefits –SSI/SSDI –Public Assistance –Food Stamps Insurance Disputes –Medicaid –Medicare –Commercial Housing Immigration Debtor/Creditor Issues Workplace accommodations Advance Planning: e.g., will, health care proxy, power of attorney and permanency planning

7.  2010 LegalHealth 6 LegalHealth at Queens Hospital You will interact with LegalHealth staff through: Weekly legal clinics for patients Date and times to be announced As needed for back-up consultation to you and other health care providers. Training sessions offered throughout the year.

8.  2010 LegalHealth 7 System Complexities Your Patients Navigate Low Income Patient SSA Housing Agency Welfare Office Medicaid Home Services Work Medical Clinic Family court

9.  2010 LegalHealth 8 Overcome barriers due to educational or language issues Voice of authority Special knowledge and trust Why Intervention By Healthcare Providers Is Important

10.  2010 LegalHealth 9 Forms Intervention May Take Assess the need Write letters Complete forms necessary for benefits your patients may be seeking Empower family by educating them about a system they don’t understand Refer family to attorney or other resources

11.  2010 LegalHealth 10 Case: Wilda Wilda is a 59 year old woman suffering from high blood pressure, chronic asthma and depression. She has custody of her 3 grandsons, one who is 6 years old and autistic and another who is 8 and suffers from post- traumatic stress syndrome. She has missed her last two medical appointments because her Medicaid for her and the kids was cut off when she failed to recertify. She also tells you that she’s under a lot of stress with her grandchildren. They both have difficulty at school and her autistic grandson hits her and bites her at home. She was recently denied SSI and her asthma has worsened, which you believe is a result of mice infestation in her apartment. What can you do to help Wilda?

12.  2010 LegalHealth 11 How Can We As A Team Advocate For Wilda? Step One – Assess the Need –What are the non medical issues that confront Wilda? Can she get back on Medicaid? Can she appeal her SSI denial? Can the asthma triggers in her housing be eliminated? Are her grandchildren getting appropriate services at school? Is she getting all the help she needs with her autistic grandson?

13.  2010 LegalHealth 12 Step Two: Intervene Talk to her about the importance of getting to her appointments for Medicaid so she can have continued health insurance and take care of her health and her grandchildren’s health. Each patient brings their own pride, culture, and mental attitude toward their condition. Sometimes they need to hear in straightforward terms that it is okay to receive help to care for their family and receive benefits.

14.  2010 LegalHealth 13 Intervention (cont’d) De-stigmatize the receipt of government benefits (e.g., unemployment, Social Security Disability Benefits, Food Stamps). - A patient’s culture or background may make them too proud to accept government benefits. Sometimes it is important to hear from a trusted voice of authority that these systems exist for their benefit and need to be utilized in times of need. Refer to LegalHealth attorney

15.  2010 LegalHealth 14 Step Three: LegalHealth’s Representation Of Wilda Appealed Medicaid cutoff and requested evidence packet. Worked with doctor to write physician’s letter in support of legal demand to repair housing conditions Worked with doctor to complete SSI disability questionnaire for SSI appeal. Requested CSE for children’s special education needs and additional home based services for child with autism.

16.  2010 LegalHealth 15 Benefits To Wilda Represented at Medicaid Fair Hearing and family are now back on Medicaid, enabling all of them to have regular medical care, including therapy for the child with PTSS Landlord made repairs to home, mice are gone and Wilda’s asthma is improving Children have new IEPs implemented for better school placement Wilda receiving home based training for caring for an autistic child

17.  2010 LegalHealth Case: Jenny Jenny, a 16 year old undocumented immigrant was hospitalized following a cerebral hemorrhage. She was completely incapacitated and in need of a long-term nursing facility, as Elmhurst Hospital did not have the capacity to care for her in her current condition. Her parents visit her regularly, but do not have the ability to care for her at home. What can you do? 16

18.  2010 LegalHealth Assess the Need What are Jenny’s nonmedical issues? –No insurance –Undocumented Next Steps: –Refer to LegalHealth 17

19.  2010 LegalHealth LegalHealth’s representation of Jenny Attorney met with parents of discuss family’s immigration history Whole family was undocumented, but Jenny was brought to the United States when she was five years old. LegalHealth prepared on Jenny’s behalf a deferred action for childhood arrivals application LegalHealth advocated for Jenny’s eligibility for Medicaid after USCIS acknowledged receipt of her DACA application 18

20.  2010 LegalHealth Benefits to Jenny Jenny receives Medicaid Jenny is transferred to a rehabilitation facility where she receives extensive services Jenny returns home with homecare after a year of rehab 19

21.  2010 LegalHealth 20 Changes In How Physicians Practice Training sessions have helped physicians become more aware of their patients as a whole. Physicians have a greater understanding of how and where their patients live and how it may have a direct impact on their health. Focusing part of the medical visit on important factors like resources, housing conditions, insurance problems, and safety will help you to provide better care.

22.  2010 LegalHealth 21 Concluding Remarks Exciting partnership Significant opportunity to form cross-disciplinary teams on behalf of low-income people Legalhealth.org/partnermatters/frequentlyusedforms Password = nylag