Right to Counsel in Housing Court: The Bottom Line

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Susanna BlankleyAndrew Scherer

A new report, which finds that New York City would save hundreds of millions of dollars a year by providing a right to counsel for tenants facing eviction, has added new urgency and optimism to a campaign to pass a bill that would establish such a right.

The bill, introduced in March of 2014 by New York City Council Members Mark Levine and Vanessa Gibson, would require the city to provide attorneys to low-income tenants and homeowners who face eviction and foreclosure. The bill would benefit New Yorkers whose income is 200% of the federal poverty line or below, meaning households earning less than $50,000 a year for a family of four. If signed into law, nearly 130,000 tenants could qualify for the right to counsel.

While 40 of the City Council’s 51 members have signed on to support the bill, it has not yet had a hearing, in large part because of concerns about the high cost of funding a right to counsel. But the report, undertaken for the New York City Bar Association (NYCBA) and conducted pro bono by Stout Risius Ross, Inc., a global financial advisory firm, concludes that, in addition to keeping 5,200 families out of the city’s costly shelter system, a citywide right to counsel would not only offset the cost of counsel, it would save New York City an additional $320 million each year.

The study estimates that providing counsel to eligible New Yorkers would cost $191 million annually. Savings would come from reducing shelters costs ($251 million) and preserving regulated, affordable apartments that would otherwise convert to higher cost, market rate rentals following evictions ($250 million). An additional $9 million would be saved by eliminating city services that are often tapped because of evictions, such as emergency room care and law enforcement.

The report also points to other less quantifiable savings that flow to society when its most vulnerable citizens keep a roof over their heads, including savings in public education, juvenile justice services, public assistance benefits – such as unemployment insurance when the loss of a home results in the loss of a job – and reductions in the public cost of enforcing rent laws and housing codes.

Evictions have decreased significantly in the last year thanks to the unprecedented commitment made by Mayor de Blasio, Speaker Mark-Viverito and the City Council to increase funding for civil legal services to prevent evictions, protect tenants from landlord harassment and help safeguard and secure the rights of the poor and disenfranchised. The progress they have made is extraordinary. But funding can easily be eliminated by a future administration, while a law on the books would be far more difficult to take away. The NYCBA report gives us a compelling new reason to codify the right to counsel and send a bold message that in New York City the lives, the homes and the families of our most vulnerable residents matter.

Guaranteeing a right to counsel for tenants who face eviction would foster equality, prevent homelessness and give a fighting chance to low-income New Yorkers who increasingly face displacement from their homes and communities. The NYCBA report now demonstrates definitively that it would also be cost-effective for the city’s bottom line. New York City has led the nation by significantly increasing funding for legal help for tenants facing eviction. The city should now take the next logical step and pass this trailblazing bill.

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Personal Finances: Facts and Fixes

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Mario Gutierrez blog card2In an effort to encourage Americans to establish and maintain healthy financial habits, the U.S. Senate passed a resolution in 2004 officially recognizing April as National Financial Literacy Month. Over ten years later, those poor fiscal habits are still a challenge for many people, from every economic rung on the ladder. As a financial counselor I see the consequences of these bad habits every day. A lack of knowledge about financial matters is the root cause of many poor decisions about credit, saving money, investing, banking, and many other issues that seriously threaten the financial stability and well-being of individuals and their families.So, in honor of Financial Literacy Month 2016, my colleagues on the Financial Counseling team at NYLAG are pleased to highlight some facts about how well (or not so well) Americans are managing their personal finances these days, as well as suggested “fixes” that can help you overcome these common obstacles to better financial health.

Fact: Only 40% of U.S. households report good or excellent progress in meeting their savings needs.

Most U.S. families are struggling to reach their financial goals. This might mean not saving enough for the family vacation and charging the flight on a credit card. For NYLAG’s clients, it can often mean not having enough for the cheaper monthly metro card and paying for a more expensive weekly unlimited or a pay-per-ride card, or taking out illegal payday loans.

Fix: Whether on your own or with a financial counselor, you can identify obstacles and create a plan (and a budget!) to guide you. In many cases it starts with a look back to where your money is being spent, and then identifying expenses that can be cut, maximizing your income, and taking advantage of income-support benefits. Keeping your goal front and center is crucial.

Fact: 64% of Americans do not have enough cash to handle a $1,000 emergency.

Most people can recall the exact moment when they fell into their debt spiral, and it is very often when an emergency hits. Without savings on hand, you will have to either borrow money from friends and family or use your credit card.

Fix: It’s simple. Start by creating an emergency fund, and stick to it. One of the major determinants of financial security is the ability to consistently save a portion of your income. Start with whatever amount you can afford – $50 or $5 a month – and increase the contributions as you grow your income and optimize your budget.

Fact: One in four student loan borrowers are either in delinquency or default on their student loans.

Student loan debt passed the $1 trillion mark in 2012 – exceeding both credit card and auto loan debt. If you are not in default, but still struggling to keep up, you have a few options. You might be able to resolve a delinquency with a deferment or forbearance if you qualify, which are ways to temporarily pause monthly payments. You might even qualify for an income-driven repayment plan where your payment will be determined by your discretionary income. For tools and resources, go to www.studentloans.gov and https://studentaid.ed.gov/sa/.

Fix: Once your federal student loan is in default, your options are limited. You must either rehabilitate the loan or consolidate it out of default with a new loan. Though servicers are supposed to thoroughly explain your options, you can also speak with an impartial financial counselor or professional. In addition, access the U.S. Department of Education’s special portal developed for students in default atwww.myeddebt.ed.gov.

Fact: Medical bankruptcy is the number-one cause of personal bankruptcy in the U.S.

Unfortunately, the threat of medical debt doesn’t seem to be subsiding. Americans pay three times more for medical debt than they do for bank and credit-card debt combined. Even with more people covered by some form of insurance, medical debt is still stymieing progress toward achieving financial goals.

Fix: Ensure that any upcoming procedures are covered under your insurance plan (See this blog by NYLAG colleague Debra Wolf for helpful tips on dealing with insurance providers.) If you have a high-deductible insurance plan, make sure that you have at least the amount of the deductible saved in your emergency fund. You might want to consider low-deductible insurance plans, but be ready to pay more in monthly premiums.

We advise many of our clients to ask for a discount before securing services. In fact, many local, government-funded hospitals offer a sliding scale for services and procedures. For the uninsured, utilize community health centers and other free or low-cost programs and services.

Fact: An estimated 825,000 adults in New York City lack even a basic checking account.

Banking is a crucial pathway to financial inclusion and security. It provides a platform for effectively managing your money. Without access to affordable banking products you are robbed of the benefits of the formal banking system and are often forced into more expensive and less secure alternatives.

Fix: There has been a lot of progress in making bank accounts accessible for low-income Americans. You still need to watch out for the fees, but banks are now offering more options and there’s a proliferation of free online bank accounts. New Yorkers can take advantage of the Take It To The Bank search tool, created by New York City Comptroller Scott Stringer and endorsed by NYLAG. With it, consumers can enter certain parameters and receive a list of banks that offer accounts that match those features, such as no minimum balance requirements, unlimited free transactions, and acceptance of IDNYC, the municipal ID card.

April isn’t over quite yet, so we still have a little time to mark the occasion by making ourselves a promise to become more educated about our financial lives. Personal finances can be tricky and intimidating, but with the right resources and support, everyone can move closer to financial stability and achieve the goals they set for many seasons to come.

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When Your Medical Claim Is Denied

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Photo of Debra WolfI work with low-income patients living with cancer, vulnerable people whose life circumstances make it particularly challenging to deal with health insurance issues. The truth is, though, that this complex world is difficult for most of us to navigate — and never more so than when a medical claim is denied. But before I describe how understanding the system can make all the difference – a little background will help.

Whether you are insured through an employer or union group policy, a privately purchased policy or one of the policies available through the Affordable Care Act, you will have a written plan outlining your benefits, coverage limits and the appeals process – and you need to read it. You must also know whether your policy is an HMO, which allows only in-network doctors, or one that allows for out-of-network doctors which may be at a much reduced reimbursement rate. With an HMO, you generally have a co-payment and sometimes a deductible or coinsurance and that is the extent of your financial responsibility if your doctor is in network; with other policies, your out of network doctor can usually bill you directly for any amount not paid for by your insurance.

Whatever plan you have, all policies can still limit certain coverage. This might include the number of physical therapy visits or home nursing visits allowed per year. If your policy requires pre-authorization, and most do for major medical procedures and radiology such as CT Scans and MRIs, make sure either you or your doctor’s office check with your insurance company to confirm that the procedure is approved. If you have an HMO, make sure all your doctors are in network and if you are having surgery, make sure all doctors involved, such as your anesthesiologist, are in network.

Even when you understand in advance the limits of your coverage, claims are sometimes denied. Your insurance company is required to provide an Explanation of Benefit, called an EOB, for each claim reviewed. The EOB outlines the amount paid by your insurance, your required contribution and, if not paying, the reasons for denial. It’s important to read every EOB to make sure your claim has been properly paid and if not, the reasons for the denial.

When a claim is denied, your first step should be to call the insurance company to discuss.  There are many reasons a claim may be denied  ̶  often the insurance company  just needs more documentation from your doctor’s office to approve.  Sometimes claims are denied for administrative reasons that are easy to fix. Make sure to keep track of every call or letter, writing down the date and who you spoke with at your insurance company.

Know Your Rights

If you do owe for a claim that was denied, or you feel your insurance company paid an improper amount, you have the right to appeal. You will receive written notice about how to appeal. Be sure to read them and note what the deadlines are, as they are very strict.

paper workHealth plans and insurance companies have to tell you very specifically why they’ve decided to deny a claim. You also have the right to request a full copy of your insurance file prior to the appeal to see how they reached their decision. This includes the claim reviewer’s notes, reports of doctors who reviewed your claim and all other relevant documents.

Often the first appeal is submitted through your doctor’s office so be sure to talk to your medical team. In your written appeal, document the reasons you disagree with the insurance company and always include medical records and a letter from your treating doctor. Your insurance company must conduct a full and fair review of its decision and, if urgent, they must expedite this process.

If your insurance company denies the appeal, you can request an external review. This means that independent medical professionals with no financial stake in the claim make the decision. If the external reviewer overturns your insurer’s denial, your insurer must give you the payments or services you requested in your claim. If you believe your insurance company is acting improperly or in violation of the policy terms, you may also file a complaint with the New York Department of Financial Services or, if not in New York, with your state insurance department.

The good news is that many denied claims that are appealed or sent for an external review are finally allowed coverage. If you draw on all the resources available to you, and have adequate medical support for your claim, you stand a good chance of having your claim paid.

Here are some resources in New York State to assist you with health insurance disputes or questions:

The NY Health Plan Marketplace Consumer Assistance Line:  1.855.355.5777 or nationally, https://www.healthcare.gov/

New York Department of Financial Services
www.dfs.ny.gov
Consumer Hotline: (800) 342-3736 (Monday through Friday, 8:30 AM to 4:30 PM).
Local calls can be made to (212) 480-6400.
(The website has a link to file a complaint and they are often very helpful in resolving issues with your insurer.)

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Guest Blog: The Eviction Epidemic in our Midst

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Guest Matt Desmond blog cardEven in the most desolate areas of American cities, evictions used to be rare. They used to draw crowds. Eviction riots erupted during the Depression, even though the number of poor families who faced eviction each year was a fraction of what it is today. A New York Times account of community resistance to the eviction of three Bronx families in February 1932 observed, “Probably because of the cold, the crowd numbered only 1,000.” Sometimes neighbors confronted the marshals directly, sitting on the evicted family’s furniture to prevent its removal or moving the family back in despite the judge’s orders. The marshals themselves were ambivalent about carrying out evictions. It wasn’t why they carried a badge and a gun.

These days, there are sheriff squads whose full-time job is to carry out eviction and foreclosure orders. There are moving companies specializing in evictions, their crews working all day, every weekday. There are hundreds of data-mining companies that sell landlords tenant screening reports listing past evictions and court filings. These days, housing courts swell, forcing commissioners to settle cases in hallways or makeshift offices crammed with old desks and broken file cabinets—and most tenants don’t even show up. Low-income families have grown used to the rumble of moving trucks, the early-morning knocks at the door, the belongings lining the curb.

Families have watched their incomes stagnate, or even fall, while their housing costs have soared. Today, the majority of poor renting families in America spend over half of their income on housing, and at least one in four dedicates over 70 percent to paying the rent and keeping the lights on. Millions of Americans are evicted every year because they can’t make rent. In Milwaukee, a city of fewer than 105,000 renter households, landlords evict roughly 16,000 adults and children each year. That’s sixteen families evicted through the court system daily. But there are other ways, cheaper and quicker ways, for landlords to remove a family than through court order. Some landlords pay tenants a couple hundred dollars to leave by the end of the week. Some take off the front door. Nearly half of all forced moves experienced by renting families in Milwaukee are “informal evictions” that take place in the shadow of the law. If you count all forms of involuntary displacement—formal and informal evictions, landlord foreclosures, building condemnations—you discover that between 2009 and 2011 more than 1 in 8 Milwaukee renters experienced a forced move.

There is nothing special about Milwaukee when it comes to eviction. The numbers are similar in Kansas City, Cleveland, Chicago, and other cities. In 2013, 1 in 8 poor renting families nationwide were unable to pay all of their rent, and a similar number thought it was likely they would be evicted soon.

Eviction’s fallout is severe. Losing a home sends families to shelters, abandoned houses, and the street. It invites depression and illness, compels families to move into degrading housing in dangerous neighborhoods, uproots communities, and harms children. Eviction reveals people’s vulnerability and desperation, as well as their ingenuity and guts.

Fewer and fewer families can afford a roof over their head. This is among the most urgent and pressing issues facing America today, and acknowledging the breadth and depth of the problem changes the way we look at poverty. For decades, we’ve focused mainly on jobs, public assistance, parenting, and mass incarceration. No one can deny the importance of these issues, but something fundamental is missing. We have failed to fully appreciate how deeply housing is implicated in the creation of poverty. Not everyone living in a distressed neighborhood is associated with gang members, parole officers, employers, social workers, or pastors. But nearly all of them have a landlord.

This blog is an excerpt adapted from EVICTED: Poverty and Profit in the American City Copyright © 2016 by Matthew Desmond. Published by Crown Publishers, an imprint of Penguin Random House LLC. Mr Desmond will appear at a book launch in New York City on Wednesday, March 9, 6:30 PM, hosted by the Right to Council NYC Coalition, of which NYLAG is a member, and The Institute for Public Knowledge at New York University.

Author photo by Michael Kienitz.

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New York City Is Ready for Favorable SCOTUS Ruling

Irina Matiychenko Blog CardI remember the joy I felt on November 20, 2014, when President Obama used his legal authority to introduce his Immigration Accountability Executive Action (Executive Action) – a series of reasonable reforms to our nation’s immigration policy that would provide temporary relief from the threat of deportation to as many as 5 million people. Executive Action was welcome news for those of us who, in the face of continuing inaction on the part of Congress, have been calling on the President to exercise his inherent executive power to overhaul our broken immigration system. A Texas judge’s temporary injunction cut short that joy a few months later, but my belief in the rightness of the President’s action, and the commitment NYLAG shares with so many others to fight for the interests of immigrants, has only strengthened.

Now, as the battle over the President’s reforms comes to the Supreme Court, NYLAG is honored to support New York City Council Resolution (No. 928-A), spearheaded by Councilmember Carlos Menchaca, Chair of the New York City Council Committee on Immigration, which urges the Supreme Court to overturn the Fifth Circuit’s ruling in United States v. Texas and uphold President Obama’s Executive Action.

Despite the injunction, New York City officials, agencies and advocates have been united in their support of the President’s plan, and in working to ensure that immigrants get the real facts about our nation’s immigration policies and to show them that their city values and supports them. Mayor de Blasio joined cities and counties across the U.S. in filing an amicus brief arguing to the Supreme Court that the President’s program is in the best interests of the nation. Meanwhile, the City Council, under the leadership of Speaker Melissa Mark-Viverito, and the Mayor’s Office of Immigrant Affairs, led by Commissioner Nisha Agarwal, have made it a priority to provide immigrants with accurate information and legal and other services to help them prepare for the day when the President’s vision becomes a reality.

The City Council’s Key to the City Initiative, coordinated by the New York Immigration Coalition in collaboration with many partners, has been enormously successful in reaching immigrant populations by creating comprehensive, one-stop-shop events where they can be screened for all potential avenues for status relief. Similarly, immigration clinics and events held by the Mayor’s Office of Immigrant Affairs have brought organizations together to assist New York City’s immigrant communities.  Thanks to the city’s support, legal services agencies such as NYLAG have been able to help more immigrants than ever address a range of legal matters that stand between them and a better quality of life. This has been particularly important in recent months when inflammatory presidential campaign rhetoric has created a heightened level of fear in immigrant communities.

Building on a Good Idea

NYLAG UAM Clinic Bronx

NYLAG staff at a large-scale clinic in Bronx, NY this past summer.

Executive Action expands Deferred Action for Childhood Arrivals (DACA), a policy introduced in 2012 that provides temporary relief to immigrants who were brought to the U.S. as young children, allowing them to apply for temporary work authorization and to obtain a social security number, driver’s license, and credit card. Since its creation, NYLAG has helped 2,407 people apply for DACA, and the need continues, especially for those with more complicated cases. We have seen firsthand the economic and moral benefits of DACA and wholeheartedly support expanding the program.

In addition to expanding DACA to a larger cohort of young people, Executive Action also introduces Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA) for the parents of U.S. citizens and lawful permanent residents who meet certain criteria. While not a pathway to citizenship or a green card, those who qualify for expanded DACA or DAPA will no longer live under the threat of deportation, removing a barrier for many hardworking immigrants who have been forced to work under the table, often for appallingly low wages and in substandard conditions. Most importantly, thousands of families who have lived in fear of being separated can now for the first time be assured that parents and children will not be torn apart. The plan includes a number of other welcome steps that will shift enforcement emphasis away from deporting immigrants with strong community ties and no criminal records, including eliminating a controversial Homeland Security Program that rapidly pushes immigrants into detention and deportation, strengthening policy guidance for immigration authorities, and implementing immigration court reforms.

The Justices will hear the case this spring and, we hope, issue a decision before the term ends in June. I believe that our highest court will uphold the President’s authority to take action on immigration relief – as Presidents have done time and time again over the past several decades. The timeline for the implementation, however, will present a serious challenge. Because the next Administration could reverse Executive Action, it is imperative that the programs be implemented before President Obama leaves office and that all potentially eligible immigrants apply for expanded DACA and DAPA as soon possible.

New York has the infrastructure in place to mobilize quickly and roll out a citywide campaign to conduct large-scale screening clinics to determine individual eligibility for DACA and DAPA benefits. In fact, thanks to the many events the city has sponsored, thousands of immigrants have already been screened; NYLAG alone has identified 1,950 individuals who may potentially benefit from a favorable Supreme Court decision. In the meantime, it is important that immigrants who may be eligible for relief are encouraged to collect the necessary documentation in anticipation of a successful appeal, and to be aware of and avoid fraudulent providers offering to take money to help apply for these programs that do not yet exist.

We will have limited time to act, but luckily, in New York City, we are well-positioned to make it happen.

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The New Year Brings Good News

Paula Arboleda Blog Card2We got some good news recently in New York State when Governor Andrew Cuomo maintained funding in his 2016-2017 Executive Budget for the State’s Managed Care Consumer Assistance Program. MCCAP is a network of six community-based organizations across New York State that work together to serve seniors and people with disabilities and their families by helping them access needed health services and reduce their Medicare costs.

NYLAG has proudly been a part of the MCCAP network since 2006. Along with our fellow agencies – Community Service Society, Empire Justice Center, Medicare Rights Center, New York Statewide Senior Action Council, and Legal Aid Society – we provide hands-on assistance to beneficiaries who are unable to access or afford health care; we also operate consumer hotlines, conduct live and web-based training programs and educational workshops.

As a senior legal advocate with NYLAG’s Evelyn Frank Legal Resources Program, I know firsthand what a difference MCCAP has made. MCCAP agencies last year served more than 3 million of New York’s most vulnerable and hard-to-reach residents: Medicare eligible individuals who are uninsured, dually eligible for Medicare and Medicaid, seniors, immigrants, and people with disabilities. MCCAP agencies collaborate with the New York State Office for the Aging (NYSOFA) to accept referrals of the most complicated cases and resolve complex Medicare issues. We also operate as technical assistance support for the State’s Health Insurance Information, Counseling and Assistance Program, and report to NYSOFA regularly on client outcomes.

I will share just one story of a client whose situation would have been very different without the resources we were able to tap on her behalf.

Ms. T, a 67-year-old New York City resident, is a cancer survivor who applied for Medicaid in 2014. As an income-eligible Medicare beneficiary, she should have been automatically enrolled in a Medicare Savings Program (MSP). Through a processing error, she was initially denied Medicaid. A Fair Hearing later reversed this denial and provided retroactive Medicaid coverage, but failed to retroactively enroll her in an MSP. This put her crucial Part D prescription drug subsidy for expensive cancer drugs at risk. Ms. T also had outstanding paid medical bills that should have been eligible for reimbursement. An MCCAP counselor was able to successfully advocate for Ms. T to be retroactively enrolled in an MSP back to the earliest date of her eligibility, to be reimbursed for seven months of expenses she had paid out of pocket, and to continue her vital Part D subsidy, without which she could not afford the cancer drugs.

MCCAP has allowed NYLAG and our partner agencies to help millions of struggling New Yorkers like Ms. T. By leveraging the strengths of different organizations we have been able to provide technical support to state agencies, meet unique community needs – such as providing assistance in any language our clients speak – and maintain the direct-to-consumer assistance that Medicare beneficiaries and their families depend upon.

Now more than ever, funding for this vital lifeline needs to be maintained – indeed increased – as the state continues to implement major system reforms, and many more people transition into Medicare who are unable to afford the high out-of-pocket costs. By maintaining MCCAP’s funding, Governor Cuomo is sustaining a trusted on-the-ground resource for vulnerable New Yorkers.

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Chief Judge Jonathan Lippman’s Enduring Legacy

Beth Goldman NYLAGAs the year draws to a close, so too does the tenure of New York State Chief Judge Jonathan Lippman. Since his appointment in 2009, the Chief Judge has inspired us with his pursuit of justice for every New Yorker. He has relentlessly attacked the justice gap through reforms that are both cutting edge and highly effective. Under his leadership we have seen a drumroll of initiatives that are making the State’s court system more equitable and accessible:

Judge Jonathan Lippman NYLAG

Chief Judge Lippman received NYLAG’s Visionary of Justice Award at its third annual Gala on May 22, 2013.

We not only have a chief judge who has made expanding access to justice a central tenet and top priority, but we also have a city leadership that has made an unprecedented commitment to increasing funding for legal services to help safeguard and secure the rights of the poor and disenfranchised. This includes initiatives to prevent evictions, protect tenants from landlord harassment, and provide increased access to legal assistance for immigrants, victims of domestic violence, veterans, the working poor, and the elderly.

Further evidence of the administration’s vision is the creation of an Office of Civil Justice earlier this year, which will monitor and improve access to representation across the city. I believe that the work of this office will demonstrate conclusively the benefits of civil legal service programs to the City, to taxpayers – who save money in areas such as shelter costs, healthcare costs, and public benefits – and to poor and near-poor New Yorkers whose lives are greatly improved.

Chief Judge Lippman leaves us with an enduring legacy. Thanks to his vision, NYLAG and other organizations have been able to expand the breadth of our services and increase the number of New Yorkers we are able to serve each year. We have not closed the justice gap, but we are making progress toward the day when, in the words of the Chief Judge, “… as a matter of public policy and values, every person who is faced with legal issues affecting the necessities of life will get legal representation or effective legal assistance to deal with those issues.”

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Guest Blog: Out of the Hospital and Into Reality

Kenneth DavisBeth Breslin

As administrators of two of the largest health systems in the nation, we have long known that the best patient care cannot be delivered exclusively inside the walls of our facilities. No matter how high the standards of care, how cutting edge the technology, how sophisticated the systems – not even how talented and dedicated the staff – we cannot do our jobs unless we look outside the hospital and into the reality of our patients’ lives. And for the poor and low-income New Yorkers we serve, that reality can be bleak. Many are homeless or precariously housed, unemployed or underemployed, struggling to pay for nutritious food, and have limited education.

If you are poor, you face substantial barriers to good health. An estimated 40 percent of health outcomes are shaped not by genetics or bad habits, but by powerful social and economic factors – most notably income, education, and employment. If you are poor you are more likely to develop cancer or cardiovascular disease, or to become disabled. You are less able to access or afford healthy food, which often leads to obesity, hypertension and diabetes. You often do not have private insurance, may not know about the healthcare benefits you are entitled to, or have the resources to navigate a complicated insurance system.

Both of our hospital systems – one public and one private – recognize the importance of understanding the circumstances in which our most vulnerable patients live. Out of that understanding have come a number of initiatives designed to address the social determinants that lead to and exacerbate poor health – particularly for Medicaid and Medicare beneficiaries, who are among the highest users of the healthcare system, and most likely to face societal and economic barriers to effective care.

Addressing the multiple factors that determine health requires changing the way we think about it. Health is not the sole domain of medical practitioners, but a responsibility we share with myriad community partners, advocates, and social service organizations. Coordinating with these partners, we work to break down impediments to improved health, helping patients understand their health conditions, adhere to their care protocol, and access nonmedical services, such as financial and housing assistance, transportation, food and nutrition support, and employment services.

Among the social services initiatives that have been most successful in removing nonmedical barriers to better health outcomes are the partnerships we and other hospitals have forged with legal service providers, known as medical-legal partnerships. Across the country, attorneys are training healthcare professionals to understand the legal issues their patients face, and being integrated into low-income patients’ health care teams to address legal problems that impede treatment or recovery.

In New York, we are fortunate to have been working for many years with a division of the New York Legal Assistance Group (NYLAG), LegalHealth, which is the country’s largest medical-legal partnership. Their attorneys assist patients at locations within the hospital on a range of issues, including identifying healthcare coverage options, securing coverage, and helping patients negotiate with insurance providers when disputes arise. They also help patients deal with the threat of eviction, other landlord tenant issues, foreclosure or unemployment, and secure Social Security Disability and other benefits, among other matters.

Here is an example of how the partnership works: a woman suffering from Stage 3 breast cancer began missing chemotherapy appointments at the hospital. Because her healthcare team was trained to identify the health-harming legal needs of patients, when she next came in, they probed and discovered that due to her illness she had lost her job, fallen behind in rent, and was facing eviction. The stress of her legal problems was causing her to forego her treatment. The hospital staff referred the patient to an onsite LegalHealth attorney who represented her in housing court and successfully prevented the eviction, enabling the patient to focus once more on her health.

Patients are not the only ones these attorneys help – healthcare systems benefit as well. When a lawyer acts as a part of the healthcare team, doctors are not burdened with issues outside of their expertise, and can focus on their patients’ health. Healthcare institutions and practices benefit financially when their patients are not struggling with complicated legal issues that cause them to miss medical appointments and treatment, decreasing efficiency and productivity, and compromising care. And by assisting clients in obtaining health coverage, legal services help to move uncompensated care paid for by the hospital to compensated care paid for by third-party payors. From the hospital perspective, the return on investment can be substantial. According to a recent study commissioned by NYLAG, for every one dollar spent on their services, LegalHealth generates about two dollars in direct financial benefit for hospitals, and even more in indirect financial benefits.

Medical-legal partnerships and other social services are receiving increasing attention since the implementation of the Affordable Care Act (ACA) in 2013, which expanded federal Medicaid coverage to approximately 32 million more lower-income individuals with a host of unmet social needs that affect their health. In addition, various Medicaid reform programs underway across the country, such as New York State’s delivery system reform incentive payment (DSRIP) program, have the primary goal of reducing avoidable hospital use by 25% over five years. DSRIP puts particular emphasis on initiatives that bring together medical and social service organizations to move care out of hospitals and into the community.

The primary goal of every health care institution is to improve the health of the patients who walk through its doors. Doing so in today’s dramatically changing healthcare landscape demands that we leverage every opportunity to innovate and collaborate. By addressing the link between poverty and health, medical-legal partnerships have improved lives and lowered costs. There are now 273 hospitals and health centers in 36 states working in similar partnerships. Based on our own success, we urge every hospital executive to consider joining us.

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Helping Veterans Face a Web of Legal Crises

Keith Hoffman A version of this blog post was published by Huffington Post.

VA medical centers are places where many veterans receive health care, socialize, and engage with other veterans in support groups and therapy sessions. The VAs are also epicenters of veterans in crisis. As an attorney working in a medical-legal partnership at VA hospitals in New York City, I have seen firsthand how veterans, in particular those who are chronically ill, can be overwhelmed by multiple, interconnected crises.

One of my clients, an Iraq War veteran who has severe post-traumatic stress and a brain injury from a roadside bomb, has been unable to work since he left the military a year ago. The veteran’s wife is now his full-time caretaker, but his VA compensation claim took nearly a year to process, so the couple cannot afford an apartment of their own. They joke that they are on the “couch tour,” bouncing between family and friends’ houses, but the veteran’s memory problems, panic attacks, and homelessness strain their marriage. Another client sought legal advice after meeting with her support group for survivors of military sexual trauma.  She is fighting to keep her children in her life even as she struggles to maintain stable housing, secure VA benefits for a disability caused by her service, and battle an alcohol addiction that has led to a criminal conviction.  She considers violating parole to visit her children.

I wish these stories were unique, but they are not. Many veterans that I represent are living on the street, victims of domestic violence, overwhelmed with debt that accumulates while they wait for benefits to be processed, and involved in the criminal justice system. In order to attack layers of problems like these, advocates must address many civil legal needs, including housing, employment and family matters, and representation in VA benefits cases. This requires more than just the commitment and passion of dedicated civil legal services attorneys. We need to recognize the limitations of our economic and human resources, and find creative ways to empower veterans facing social challenges and in the process multiply the impact we can have. In the last several months, I have had the good fortune to be involved in developing initiatives that are doing just that.

Leveraging Resources to Untangle the Web

veterans legal stand down

69 veterans attended NYLAG’s July 27 legal stand down at the Manhattan VA Hospital.

Working with the New York Legal Assistance Group’s LegalHealth division, which partners with medical professionals to address the legal needs of low-income individuals with serious health problems, and Latham & Watkins LLP, my Equal Justice Works fellowship sponsor, I have created two new educational and outreach initiatives targeting veterans. The first is a series of “Legal Stand Downs,” events where veterans can learn about their legal rights and have the opportunity to ask legal experts questions about their individual situations. The series, which is modeled after the stand down concept used during the Vietnam War to provide a safe retreat for units returning from combat, has thus far provided information to over 200 veterans in the areas of family and housing law. In the months ahead we will conduct additional Legal Stand Downs covering VA benefits, consumer debt and bankruptcy.

The second effort is The New York City Veteran’s Legal Guide, published with generous support from Latham & Watkins and input from more than 20 NYLAG and Latham attorneys and paralegals. The guide contains information on 50 of the most common legal issues facing veterans, including: how to deal with housing problems like evictions and requesting repairs; information about various VA benefits; the basics of the Family and Medical Leave Act; and how to get an order of protection – always with clear direction on when to consult an attorney. More than 300 guides have been distributed to veterans, VA hospital staff, social workers, and veterans’ organizations across New York City.  A second edition of the guide will be printed in 2016.

These new programs empower veterans by demystifying complex government and social programs, and helping them know their rights. They also provide a basic understanding of the law that can help people to catch legal problems before they reach crisis-level, or prevent legal problems from arising in the first place.  They teach veterans about when to seek legal counsel, so that when they face enormous legal challenges, they do not have to fight alone.

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Gender-Based Violence and Male Privilege

Kim Susser A version of this blog post was published by Huffington Post.

Anyone can be the victim of violence. Women are sometimes violent towards their male intimate partners. Same sex couples can be violent toward one another. But the majority of domestic violence crimes and sexual assaults involve men abusing women. According to the National Intimate Partner and Sexual Violence Survey, while one in four women has experienced severe physical violence by an intimate partner, only one in seven men has experienced it. Similarly, while one in five women has experienced sexual violence in her lifetime, only one in 59 men has experienced it.

DVAM NYLAGOur society gives men more power than people of other genders. On average, men make more money than women and transgender or gender non-conforming people; there are more men than women in elected office; and gender-based violence is overwhelmingly perpetrated by men against women. We live in a world where men learn that they are entitled to power, which is why domestic violence, sex trafficking and sexual assault share the dynamic of power and control.

Many recent examples covered by the media demonstrate how social norms, sometimes referred to as “male privilege,” underlie gender-based violent crimes.

Male privilege pervades college and professional athletics. Athletes at all levels are provided unparalleled entitlements and taught that they will be shielded from repercussions for wrong-doing. As a result, studies on college campuses show that athletes disproportionately perpetrate sexual assaults and are frequently not brought to justice. Over 100 colleges and universities have been investigated for their response to reports of sexual violence. Professional athletes are also consistently in the news for violence perpetrated against intimate partners, while the profit-driven athletic programs that value their athletic skills above the safety of women turn a blind eye.

Violence is a learned behavior. Just as children who are raised in violent homes learn violence as a means of resolving conflict, student athletes learn early on that they can get away with violent behavior from the preferential treatment they are given, and from observing their role models in professional sports. In 2009, University of Michigan football freshman kicker Brendan Gibbons allegedly raped a female student at a fraternity party. That same night, a police report was made. But not until 2014, just after his final season as a starter on the nationally ranked football team, was Gibbons “permanently separated” from the school for violating the university’s Student Sexual Misconduct Policy.

DVAM stat2The perpetuation of male privilege in athletics only worsens when young athletes become professionals in a billion-dollar industry that will do anything to protect its stars. Greg Hardy returned from a four-game suspension from the NFL (reduced from ten) after allegedly throwing his girlfriend, Nicole Holder, on a futon full of firearms and strangling her, with “guns blazing.” Milton Bradley, a baseball player in the MLB, was allegedly emotionally and physically abusive to his wife, Monique Bradley, for ten years. The MLB continued to support Bradley until this past April when he was sentenced to 32 months in jail — a sentence that may now be reduced by 27 months. Likewise, Floyd Mayweather, widely agreed to be the best boxer alive, has seven assaults against five women that have resulted in citations and arrests. And last year, NFL player Ray Rice was caught on video knocking his partner, Janay Palmer, unconscious. One month later, Rice and Palmer were married. People wondered why she stayed, but many women knew the answer — they recognized the power and control dynamic at work. The hashtags #WhyIStayed and #WhyILeft quickly went viral, with domestic violence survivors sharing their stories of the shame, guilt, and fear that come with being abused by someone they love and knowing things may only get worse if they report it or try to leave.

According to the Everytown for Gun Safety 2015 Report, there is a noteworthy connection between mass shooting incidents and domestic or family violence. In at least 76 of the cases (57%), the shooter killed a current or former spouse or intimate partner or other family member, and in at least 21 incidents the shooter had a prior domestic violence charge.

DVAM stat3Typically, when a woman is abused, her abuser tells her it’s her fault that this is happening to her. He might tell her that she has been disrespectful, or that the abuse is deserved. Male privilege gives him permission to shift responsibility to his female victim for the acts he has committed. The shooters in Oregon, and last year at UC Santa Barbara, each cited the belief that because they did not have girlfriends they were being denied something they were entitled to. The latter used this to justify mass murder.

NYLAG offers free legal services to survivors to help them shift the power dynamic. By obtaining tangible relief including orders of protection, child support, divorce, immigration status and safe custody and visitation arrangements, we help our clients to break the cycle of violence that allows their abusers to maintain control. During October, Domestic Violence Awareness Month — and the rest of the year — it is important that we recognize why violence against women happens in the first place and work together at all levels to confront it.

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