Medical-legal alliances help low-income patients

It took Sheena Sheard two hours on two buses, towing two children and a three-wheeled stroller, to get to St. Christopher's Hospital for Children.

It would have been three buses but the trio legged out the final stretch to ensure Sheard could see her lawyer.

That's right, her lawyer. Sheard was going to see Eileen Carroll at St. Christopher's to determine whether she qualified for a hardship exemption that would allow her to buy health insurance on the now-closed Affordable Care Act marketplace.

"I am concerned," Sheard, 32, of West Oak Lane, said as her son Ziahil, 13, kept a sharp eye on 7-month-old Shania in the stroller. "I have tried everything in my power to get insurance."

Carroll has been dealing with the concerns of parents of St. Christopher's patients since the PhilaKids Medical-Legal Partnership between the Legal Clinic for the Disabled and the hospital opened in 2011. She and her colleagues have provided free legal assistance and even appeared in court with some clients.

To date, the partnership has surveyed 5,041 St. Christopher families and found half reported having at least one unmet legal need. Its attorneys have helped more than 1,133 families with everything from food insecurity to eviction.

Such partnerships aren't new; there are three others in Philadelphia and scores more scattered across the country. But PhilaKids is the region's only one in a children's hospital. And thanks for that goes to Lee M. Pachter.

In 2010, Pachter became St. Christopher's chief of pediatrics. Coming from a Connecticut hospital that had a medical-legal partnership, he understood the benefits of lawyers and doctors' working together to help low-income families. His goal at St. Christopher's is to train young doctors to see patient advocacy "as part of their everyday job."

That message is reinforced daily to medical students and residents by Daniel Taylor, St. Christopher's director of community pediatrics and child advocacy.

Taylor says 80 percent of American health issues have "more to do with zip code than genetic code." So before he begins examining a child, he asks what is going on with the parent.

"We work a lot on moms' issues," he said. "You just can't separate the two."

When families arrive in the clinic, parents receive a form with several yes-or-no questions. One yes answer triggers a consultation between the physician and an attorney from the partnership.

But getting people to accept help can be difficult. Knowing from experience that only two out of 10 people referred to legal aid outside the hospital followed up, Pachter decided to take the lawyers to the patients.

Carroll and her team are nestled in a converted exam room in the heart of the hospital's Center for Child and Adolescent Health, where they average eight to 10 referrals a day. The top problem for families: health insurance.

Carroll says that before the ACA, the only alternative for many people who could not afford insurance or get on Medicaid was a city health clinic. Since the ACA, some people have qualified for subsidies and bought insurance on the marketplace. For most, things haven't changed. "Largely, they fall into the gap" caused by Pennsylvania's not expanding Medicaid, Carroll says. People who don't make enough to qualify for tax-credit subsidies or cost-sharing reductions and who aren't eligible for Medicaid remain uninsured.

"It is really hard to go into a room and open up hope to something and then say, 'You don't make enough money to qualify for anything,' " Carroll said.

Sheard tumbled into the gap after losing her job in February. She met Carroll in May after a pediatrician seeing her children asked about her household situation. Sheard told the doctor she was being evicted.

"They introduced me to Eileen," Sheard said. "I felt relieved that I could get some help."

Since then, Sheard has escaped eviction and found part-time work. She's making enough to afford a low-cost plan. With Carroll's help, she filled out an application Tuesday and qualified for a subsidy. The question now is, can she get a hardship exemption? Still, she was happy and relieved. The partnership at St. Christopher's "has been great," she said.

Looking for legal help? Locally, six sites specialize in helping patients with legal problems.

St. Christopher's Hospital for Children

160 E. Erie Ave.

215-587-3461

11th Street Family Health Services, run by Drexel University School of Medicine

850 N. 11th St.

215-769-1100

The Family Practice and Counseling Network

4700 Wissahickon Ave.

215-843-9720

Hahnemann University Hospital

1513 Race St.

215-587-3350 - call Wednesdays 9:30 a.m. to 3:30 p.m.

The Health Annex

6120 B Woodland Ave., 2d Floor

215-727-4721

Magee Rehabilitation Hospital

1513 Race St.

215-587-3000

Did you buy insurance under the Affordable Care Act through Healthcare.gov? How is it going? We would like to hear about your personal experiences with the ACA, including the expanded Medicaid program in New Jersey. E-mail us at fieldclinic@philly.com.EndText