2011 March - April

The federal government and many states are promoting medical-legal partnerships as a cost-effective way to improve patients’ health. MFY Legal Services’ mental health-legal partnership with new York City mental health care providers is a pioneer: the collaboration since the mid-1980s benefits both patients and the institutions that serve them. By studying the MFY mental health-legal partnership, advocates can learn about the successes and challenges that MFY has faced in implementing its program and determine whether a medical-legal partnership would be appropriate for their clients.

A large proportion of low-income college students can legitimately qualify for the Supplemental Nutrition Assistance Program (SNAP). In many instances low-income students’ obtaining SNAP depends on the willingness of either SNAP agencies or the students’ schools to take steps to help the students qualify for one of the exceptions to the disqualification rule. SNAP administrators, financial aid officers in schools serving large numbers of low-income students, and others will benefit from reviewing the exemptions from the student rule to ensure that eligible low-income students receive the food assistance they need.

Critics of the child welfare financing system, which incorporates an entitlement to services, contend that the system harms children by stifling innovation and limiting states’ flexibility in responding to children’s needs. The critics argue instead for a capped allocation of child welfare funding, a system akin to block grants. But experience with ending entitlements in other programs and substituting block grants teaches that the result is likely to be reduced funding in the face of greater need for services, particularly as states struggle with budget crises.

The Fair Housing Amendments Act prohibits disability discrimination in housing settings, such as seniors’ assisted living facilities, designed to serve people with disabilities. State licensing schemes can make it very difficult for seniors to request the reasonable accommodations that they often need to remain in their homes. By studying the California licensing scheme and two poignant examples of seniors determined to age in place, advocates can learn new strategies for helping their clients preserve fair housing rights.

Public interest lawyers often find that traditional notice-and-comment rulemaking is not conducive to innovative advocacy. Negotiated rulemaking, endorsed by Congress in the Negotiated Rulemaking Act of 1990, can help parties reach common ground more quickly and efficiently. Three examples from state and federal regulatory and statutory reform efforts show how the principles of negotiated rulemaking can help advocates effect meaningful social change.

The income insecurity of low-income lesbian, gay, bisexual, and transgender (LGBT) seniors and its effects on accessing health and long-term care services, pensions, and other retirement income are difficult obstacles. Medicare, Medicaid, and social security rules apply to all seniors, but limited income, disability, and lack of caregiver support or recognition of that support exacerbate difficulties for LGBT seniors. The treatment of couples in the Supplemental Security Income program, however, results in preferential treatment of LGBT elders compared to their heterosexual counterparts. Undue hardship waivers in the Medicaid transfer-of-assets and estate-recovery contexts may be helpful as well.

Privatization of the operation of public benefit programs in the wake of welfare reform diminished the effectiveness of traditional approaches to advocacy. A case study from New York City of how private contractors succeeded in reducing welfare roles while imposing punitive policies on poor families offers a glimpse of possible new advocacy tools. Requiring contract-monitoring bodies that involve community members and advocates could help facilitate transparent contracting processes and reshape social welfare programs to serve clients.