MRT Innovations in Social Determinants of Health Initiative

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NYC Department of Health and Mental Hygiene

Q1 Please provide your contact information below.

Name

Title and Organization


Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Graham Harriman

Director of Care and Treatment Program, NYC Department of Health and Mental Hygiene

42–09 28th Street

Queens

NY

11101–4132

gharriman@health.nyc.gov

347–396–7418

Q2 Please describe your company or organizations overall goals and mission.

With an annual budget of $1.6 billion and more than 6,000 employees throughout the five boroughs, we´re one of the largest public health agencies in the world. We´re also one of the nation´s oldest public health agencies, with more than 200 years of leadership in the field.

Every day, we protect and promote the health of 8 million diverse New Yorkers. Our work is broad–ranging. You see us in the inspection grades of dining establishments, the licenses dogs wear, the low– to no–cost health clinics in your neighborhood, and the birth certificates for our littlest New Yorkers.

We´re also behind the scenes with our disease detectives, investigating suspicious clusters of illness. Our epidemiologists study the patterns, causes and effects of health and disease conditions in New York City neighborhoods. These studies shape policy decisions and the City´s health agenda.

The challenges we face are many. They range from obesity, diabetes and heart disease to HIV/AIDS, tobacco addiction, substance abuse and the threat of bioterrorism. We´re also working to address enduring gaps in health between white New Yorkers and communities of color. Structural racism is at the root of these health inequities, which is why the Department has made racial justice a priority.

The New York City Health Department is tackling these issues with innovative policies and programs and getting exceptional results.

Within the Department of Health, the mission of the Quality Management and Technical Assistance (QMTA) Unit is to support Ryan White Part A programs and staff to promote the health of people living with HIV, while actively working to reduce health disparities with the goal of achieving health equity. The QMTA Unit works with community stakeholders to improve service quality and build capacity through the provision of technical assistance in the field of quality management.

Q3 Please indicate which category your organization falls under.

Other (please describe below: 150 character maximum):
City government health department.

Q4 Innovation Executive Summary. Please describe the innovation, and how it addresses the social determinants of health. Please identify how the innovation addresses the 6 innovation criteria (i.e. ROI, scalability, feasibility, evidence–based support for innovation, relevance to the Medicaid population and speed to market).

Medicaid–reimbursable legal and financial education services, a Medical–Legal Partnership (MLP), can mediate the effects of homelessness and poverty, thereby serving to improve health outcomes and reduce preventable emergency department visits. Comprehensive, culturally and linguistically appropriate legal advocacy services, offered by skilled attorneys and paralegals working in conjunction with medical providers, can assist Medicaid recipients with housing, family, government benefit, financial, and other civil issues.

Since 2012, comprehensive legal services have been available to Ryan White Part A (RWPA)–eligible New Yorkers with HIV as a reimbursable RWPA service. Many of the 11 funded legal service providers work closely with HIV medical providers to ensure that the legal needs of clients, particularly those pertaining to housing, family, and government benefits, are addressed. Because the model works with non–profit law offices with full–time staff attorneys and paralegals, the intervention became fully operational within six months of initial award. Clients receiving services under RWPA are not charged legal fees, as these fees are paid by RWPA funds. In 2016, the annual average program cost per client receiving these services under RWPA was $1,391, as compared to the hourly rate of a private attorney in New York City, which ranges on average from $200 to $500 per hour. Additionally, a client receiving RWPA–funded representation in Social Security Disability (SSD) back pay claims may keep 100% of their award, while a private attorney may collect up to 25% of the settlement in these claims.

The proposed Medicaid–reimbursable model expands upon the already successful RWPA legal services program by implementing a medical–legal partnership (MLP) model, ensuring a more holistic treatment of Medicaid recipients that addresses not only their health needs, but also economic social determinants of health. In an MLP, both physicians and attorneys are cross–trained to effectively identify legal problems and the impact they may have on an individual´s health. Medicaid recipients treated through an MLP would benefit from a team approach, thereby improving health outcomes and preventing a decline in health due to factors such as poverty and housing status.

Q5 Was your innovation implemented? If so, please explain when, the number of people impacted, and the results.

Yes (please specify when and the estimated number of people impacted):

Yes, since 2012 NYC DOHMH has successfully administered this model using RWPA funding. In 2016, 2,797 unique individuals were served, the majority of whom represent Black and Latinx clients and older people with HIV (age of 50+), a population with specific health needs related to both HIV and aging. This innovation could be applicable to other vulnerable Medicaid–eligible populations. According to interviews with staff attorneys, many of these cases represent SSD back payment claims and eviction prevention cases, with successful outcomes leading to significant monetary gains for clients and the maintenance of safe, stable housing.

Q6 Please identify the SDH Domain that your innovation addresses. (Select all that apply.)

Health and Health Care

Economic Stability

Q7 I give the Department of Health the right to share the information submitted in this application publicly (for example: on the DOH website). I understand that there is no monetary reward/reimbursement for my submission or for attending the summit should my innovation be selected.

I consent to have my innovation shared