Data Note
July 2025
Marsha Regenstein
In 1993, a team of doctors and nurses at Boston Medical Center attempted to figure out why so many of their pediatric patients with asthma were coming back to the hospital again and again, apparently not responding to state-of-the-art medical treatments. They learned that the culprit was mold: these children lived in moldy apartments in buildings where landlords refused to comply with sanitation codes. What they did next set the stage for an innovation that has been replicated in hundreds of care sites across the country, including community health centers. They brought in a lawyer. In this case, they sought the assistance of Greater Boston Legal Services, where attorneys and paralegals provide free civil legal assistance to low-income individuals and families. This innovative collaboration – between health care and civil legal services organizations – became the first medical-legal partnership.
Though the modern Medical-Legal Partnership (MLP) model was born in a hospital setting, it has since grown rapidly in health centers, with community health centers (CHCs) now making up about a third of the estimated 450 MPLs nationwide. The MLP model, which embeds legal services in health care settings, is well aligned with the comprehensive health center approach to primary care and prevention, which provides a wide range of critically important services that enable patients to fully engage in their health care and promote overall health improvement.
This overview explains the MLP model, describes its adaptability to a variety of health care settings, and highlights the ways that MLPs advance the health and well-being of CHC patients. It also summarizes the extraordinary impact MLPs can have on children and families, older CHC patients, persons with disabilities and chronic conditions, veterans, and other high-risk populations.
What is a Medical-Legal Partnership?
MLPs always involve a partnership between the health care setting and a legal professional – most commonly a civil lawyer or paralegal. MLP professionals become part of the care team, alongside clinicians and other team members, to help address health-related social needs that affect patients’ overall wellbeing. This is particularly suited to and important in health centers, which use a team-based approach to care and often incorporate community health workers and patient educators as well as other professionals in the care teams.
These legal professionals serve as problem-solvers, bringing their knowledge of laws and policies, and their expertise in navigating complex systems, to address issues at both the individual or family level, as in the case of the asthmatic child in the very first MLP, and at the system and community level. At the system level, lawyers identify legal impediments or systemic barriers that affect groups of individuals. For example, a lawyer at an Arkansas MLP worked with a few patients who were repeatedly being denied Medicaid coverage despite meeting the state’s eligibility criteria. The lawyer identified a glitch in the determination software, and met with state Medicaid eligibility staff who recognized and corrected the problem, resulting in dozens of families gaining access to coverage for which they were eligible.
MLPs have common characteristics but are highly flexible
More than 450 MLPs are actively operating in health care settings across the country. Most include eight key elements:
A formal agreement between a health care organization and a legal services provider outlining the details and contours of the partnership.
A defined population for the work. For health centers, this can be the entire health center population; children with chronic conditions or learning needs; patients with guardianship needs; or other groups that could benefit from the MLP’s expertise.
A screening process and tool to identify patients with legal needs that cannot be addressed by social workers or case managers. Health centers often use the PRAPARE screening tool or other social risk tools to screen for a broad group of social risks that could have potential civil legal remedies, including housing, employment, insurance status, income supports, utilities, and interpersonal safety.
Legal staffing, generally from a local civil legal aid organization, or from a partnering law school or law firm that provides pro bono legal services. Health center staff participate in MLP work through screening and follow-up, but the bulk of the work happens through the interaction between the patient (or family members) and lawyers.
The “lawyer in residence” – the availability of the lawyer at the health center site one or more days a week, enhancing integration between clinical and legal concerns.
Bidirectional training, where lawyers educate clinicians about what types of interventions can help their patients lead healthier lives, and clinicians can educate lawyers about the clinical consequences of social circumstances.
Information sharing, beginning with screening for legal needs, referrals to lawyers with the consent of patients, and in some cases, clinical information to support the patient’s civil case due to health consequences.
Designated resources, in the form of grant funding, core support from health center grant funds, enhanced managed care payments, or donated time from civil legal aid groups.
MLPs are particularly well-suited to addressing many of the practical challenges faced by community health center patients. Nearly 90% of the 31.5 million people served by CHCs live in households under 200% of the federal poverty level, and many have complex social as well as health care needs. They depend on CHCs for high-quality, accessible and affordable care, as well as assistance in navigating difficult roadblocks to securing necessities for their families, children and aging relatives: housing that is safe, secure, and mold- and pest-free; food that is healthy and sufficient; education that is adequately adapted for children with diverse learning needs and disabilities.
MLPs tackle problems in people’s lives that are actually quite solvable, in the areas of housing, education, and family law, as well as issues related to public benefits, immigration status, veterans’ benefits and other areas of civil law. Once CHC staff determine that a given problem might best be addressed through legal expertise, patients are offered help from the MLP and, if they are interested, are contacted by a lawyer. While the process of approaching a civil legal aid attorney outside of the health center setting can sometimes be cumbersome, accessing MLP civil legal services at a health center site can be seamless, with a warm hand-off from a member of the clinical team to the lawyer in residence at the clinic site.
The typical MLP is small, providing a lean and highly cost-effective intervention from both a health care and civil legal services perspective. While some MLPs have full-time lawyers working at the health care organization through contractual arrangements, most health center MLPs have a share of one or more lawyers’ time, plus some portion of health center staff time.
The number of MLPs in health centers has been growing steadily
Supported by federal grants, Medicaid reimbursement and other sources of revenue, CHCs provide a wide range of non-clinical “enabling services” such as case management, health education, interpretation, eligibility assistance and transportation to improve access to care and overall health outcomes. Consistent with this orientation and mission, health centers have long embraced the MLP model, and MLPs have operated successfully in health centers for decades.
The field grew rapidly following a 2014 decision by the Health Resources and Services Administration that recognized civil legal aid as an enabling service and therefore an allowable federal Section 330 grant expense. The change allowed health centers to contract with civil legal aid organizations to customize legal support to precisely the needs of their patient populations. In practice, health centers tend to spend modestly on MLP services, with the bulk of legal hours funded through private grants or Legal Services Corporation support. With the generosity and commitment of health center staff, civil legal services experts, local and national foundations, and health center grants, MLPs have grown in size, scope and number in the last decade. An environmental scan conducted in 2023 estimated that approximately 175 health centers were providing legal services to patients, and an additional 100-plus health centers had plans to start an MLP at one or more of their care sites.
Some health centers share MLP services, either through customized CHC-to-CHC arrangements, or through a coordinating body like the Montana Primary Care Association, which helped to develop a statewide model for MLPs that health centers can join to access legal services. The Wisconsin Primary Health Care Association also takes this statewide approach. Currently in a two-year pilot stage (2024-2026), the project is funded through a community impact grant from the Wisconsin Partnership Program. Wisconsin Primary Health Care Association has partnered with two legal organizations, Legal Action Wisconsin and Judicare Legal Aid, as well as the University of Wisconsin-Madison School of Human Ecology as an academic partner. The pilot includes three health centers -- Lakeshore Community Health Care, Noble Community Clinics, and NorthLakes Community Clinic -- that together see more than 50,000 patients annually. A goal of the pilot is to expand the partnership more broadly through evidence-based program development.
Health centers interested in forming MLPs or strengthening their partnerships through cross-learning with their peers can tap into technical assistance and training opportunities offered by the National Center for Medical-Legal Partnership through a national cooperative agreement that cultivates and supports MLPs across the country. Health centers receive technical assistance to support initial MLP planning and start-up, overcome challenges associated with identifying the right mix of staffing, address data sharing questions, evaluate expansion to multiple sites and additional legal partners, and design evaluations and measure outcomes.
Evaluating the Impact of MLPs
Many positive outcomes have been associated with MLPs, including a reduction of emergency department visits and total hospital days for children with asthma; lower rates of stress and improved mental health for adults in a primary care setting; better mental health and housing access for veterans; helping patients with cancer address legal needs associated with living wills and advanced directives, as well as employment and financial legal matters; providing greater financial relief for families, including those with sickle cell disease; greater likelihood of having a medical home; and better access to necessary education supports and interventions for school-age children with disabilities
One of the largest studies of MLPs examined the effect of being referred to an MLP on hospitalization rates for low-income children in Greater Cincinnati. Children who had MLP legal advocates – who were able to confront the root causes of the children’s poor health – had hospitalization rates that were 37% lower than a similar group of children who had not been referred to a MLP.
Because most health center MLPs are relatively small, evaluation is somewhat challenging, and most robust evaluations of the impact of MLPs have been with larger groups of patients across multiple types of health care settings. While an academic medical center or other hospital setting can often tap in-house research expertise to track MLP outcomes, most health centers do not have these resources readily available; as a consequence, the majority of peer-reviewed studies that include empirical evaluation data reflect hospital-based MLPs.
However, evidence supports the value of MLP interventions for health center patients. For example, when clinicians at Chicago’s Erie Family Health Center (EFHC) found high lead levels in one of its patients, its legal partner – the Loyola University Chicago School of Law and Legal Assistance Foundation of Metropolitan Chicago – sprang into action. Inconsistent definitions of lead poisoning across government agencies meant that the family’s landlord, under contract with the Chicago Housing Authority, was not legally required to remove the lead. The Erie Family Health Center’s MLP successfully obtained a reasonable accommodation under the Americans with Disabilities Act, and the family was able to move to a new residence that had already gone through lead abatement. The MLP attorneys helped the family receive special education services, public benefits to which they were entitled, and a connection to a personal injury attorney to pursue an action for negligence caused to the family. MLP also worked with a broad coalition of partners to implement changes to data reporting requirements associated with lead screening, which were particularly relevant to children living in federally assisted housing units.
Health Center MLPs at Work
In Austin, Texas, the People’s Community Clinic MLP was integral to a patient’s successful recovery following a debilitating stroke that left him paralyzed, unable to speak, and in need of a host of therapy. However, he had lost his job due to his inability to work and was uninsured. The health center provided primary care and supportive services, but it was the lawyer’s special expertise that saved the day. They helped him secure health insurance, which was his link to speech, occupational and physical therapy. On his behalf, the MLP lawyer successfully appealed public benefit denials, thereby providing much-needed income while he recovered from the stroke. Two years later, the patient had fully recovered. As in Chicago, the legal help from the MLP lawyer mitigated or fully resolved a complex issue.
Some MLPs designate a particular population for outreach and support. For example, Northern Nevada HOPES started its MLP in 2017 and quickly narrowed its focus to patients with substance use disorders, who were deemed eligible for MLP services through a referral from their behavioral health provider without the need for additional screening. At Northern Nevada HOPES, the most common legal issues have been criminal record expungement and associated housing and employment issues. Even for individuals who have successfully engaged in SUD treatment programs, SUD-related criminal records can create enormous barriers to housing and employment opportunities, The MLP lawyer educates patients about legal issues related to their recovery, eligibility for public benefits, family law and other legal issues.
Eskenazi Health, a large public health and hospital system providing care to people in Marion County and Central Indiana, operates 13 health centers that serve more than 105,000 health center patients annually . Eskenazi launched its first MLP in 2008 and has grown the service since, expanding to several locations and broadening the scope of legal services offered. Since its early days, it has helped thousands of patients. Currently, the MLP offers assistance with a variety of legal needs most commonly related to housing, consumer rights, immigration, family stability, government benefits, and education law. Eskenazi Health works closely with legal partners at Indiana Legal Services, private law firms and foundations to provide and support legal services. The MLP has also added kiosks throughout other parts of the health system to facilitate easy access to legal resources and services. The kiosk at the Eskenazi Health downtown location is ADA-accessible, includes a printer, and helps users access legal forms and instructions that can be completed at home.
KKV, originally known as Kōkua Kalihi Valley Comprehensive Family Services, is one of Hawaii’s oldest and most beloved health providers. Located in Honolulu, KKV is committed to community health and prevention, primary care and supportive services, and has paid particular attention to wellness and healthy development for children and adolescents. In 2009, it partnered with the University of Hawaii Richardson School of Law to establish a medical-legal partnership for children (MLPC). Practice and training are both stressed through activities geared toward providers (physicians and medical residents) and trainees (medical and law students). Each week, the MLP runs free legal advocacy clinics for low-income families who come to the KKV Health Center for their care. The advocacy clinics take place at the same time as pediatrics clinics, to make access convenient for parents who may be bringing their children in for routine visits. Common legal issues include housing, employment, benefits terminations, and other pressing legal concerns. Patients with specific legal questions arising from the advocacy clinics, or flagged in provider visits, may follow up in one-on-one meetings with the legal team, with coordination across legal and clinical providers.
McKinney Medical Center, a health center located in Southeast Georgia’s Ware County, operates a MLP in partnership with Georgia Legal Services to address legal issues plaguing its rural residents, who have high rates of unemployment and poverty. The MLP helps patients with Medicaid applications; helps veterans access benefits; serves as legal support for personal and family stability issues; steps in to resolve landlord/tenant issues; assists persons with disabilities in maneuvering the complex legal system; and helps with guardianship, power of attorney, wills, and other legal documents. Originally started with discretionary health center funding, the MLP now operates with a dedicated budget line, reflecting the importance of the MLP to overall patient care. In Michigan, Cherry Health, the state’s largest federally qualified health center, serves a large patient population in and around Grand Rapids. Cherry Health partners with Legal Aid of Western Michigan and operates a MLP that offers s help with evictions and other housing concerns, foreclosures, benefit appeals, domestic violence, divorce cases, and many other areas.
MLPs Need a Stable Source of Support to Continue Serving Health Center Patients
The growth of MLPs in health centers is perhaps best described as a passion project. Leaders, clinicians, enabling services staff and others at health centers see first-hand how important civil legal services can be for their patients, and then partner with local legal aid organizations to secure necessary resources to seed the venture. Many MLPs are thriving in health centers, but others have struggled to stay afloat. While CHCs can tap grant funds to support MLPs, they are typically juggling multiple patient-related needs for these limited resources. And while CHCs can refer to legal aid resources in their communities even without a formal partnership, established MLP arrangements create a priority pathway for their patients, with remarkable outcomes in so many cases. Health center MLPs are low-risk, low-cost, high-reward activities, but they need more than in-kind support to function adequately.
The Health Resources and Services Administration has been a steadfast champion for health center MLPs, providing technical assistance and training to both start-up initiatives and established entities. Threats to health center revenue, including drastic Medicaid cuts, would be devastating to health center operations. So too could changes in agency priorities that decrease their commitment to nonclinical interventions such as transportation, nutrition programs, interpreter services, and medical-legal partnerships that enable patients to engage in their health care and lead healthier lives.
At a time when health center funding and Medicaid cuts loom large on the policy horizon – with potentially devastating consequences for patients, the health center workforce, and communities all across the country – the need for health center MLPs will be greater than ever. It is critical that health centers remain vibrant health hubs for children, adults and older individuals, and that they retain their ability to address the social, supportive, and legal needs of their patients that are essential to good health.