Augmenting Advocacy: Giving Voice to the Medical-Legal Partnership Model in Medicaid Proceedings and Beyond
The denial of Medicaid coverage for augmentative communication devices, despite an existing legal framework that mandates the opposite result, raises fundamental questions about what independence means for people with disabilities. This situation, compounded by the barriers in the Medicaid administrative appeal process encountered by such beneficiaries, invites new approaches to the delivery of civil legal services, such as medical-legal partnerships (MLPs). MLPs are formalized arrangements that bring lawyers into a healthcare setting to provide specialist consultations when patients experience legal problems that affect health. While there is an emerging scholarship on MLPs, this Article offers the first in-depth analysis of a particular area of the law-Medicaid advocacy for people with disabilities-in the context of the MLP model. Part I explores legal and public policy justifications for Medicaid coverage of services that promote independence for people with disabilities, such as augmentative communication devices. Part II describes the Medicaid administrative hearing process and the barriers it presents to people with disabilities who appeal the denial of a service, including augmentative communication devices. Part III summarizes existing scholarship about MLPs. Part IV applies the MLP model to the problems typically encountered by Medicaid beneficiaries in the appeals process. The Article concludes by recommending some refinements to increase the acceptance of this new legal services delivery model.