When illness strikes, middle-class patients and their families can quickly slip
into poverty. As they struggle with the impacts of sickness, such as pain, changing
family roles and changing work situations, they may not know that they are eligible
for support that could prevent further financial decline.
Patients already poor
could become even worse off.
This is why a shadow industry has emerged to let
ill people know what public benefits they are entitled to, to help them fill
out applications, even to
communicate with government caseworkers when things go wrong.
Finding a trained
advocate is often the only thing that keeps a family together in their own
home. However, many agencies serve only a slice of the population
with specific characteristics, so another large part of what they do is “information
and referral,” often between one another.
• Housing Works is one of dozens of agencies serving the HIV+ population. Its case managers,
among their other
to get the city’s HIV/AIDS Service Agency to fulfill its mandate to coordinate
services for their clients.
• People with other specific diseases or
conditions may turn to
specialty organizations, such as Cancer
Care, Inc., which employs
workers trained to help cancer patients deal with the emotional, financial,
and medical effects of their illness.
• Independent living centers help low-income
people with disabilities to apply for social security benefits and similar
income supports, and navigate
and courts concerned with such major life issues as child welfare and housing.
Immigrants, descendants of different ethnic groups, and subgroups of these
populations have their own social service agencies. For example, Blue
Card was founded by Jewish refugees in 1939, and is still helping low-income Jewish
Holocaust survivors to cover the gap between inadequate incomes and the rising
cost of living.
• Supportive housing providers not only house residents with
mental illness or substance abuse histories. They also provide rehabilitative
residents’ public benefits and other social services.
• Many senior
centers have social workers on staff to help members get the benefits they
are entitled to. They sometimes report having a hard time convincing
elderly people to apply for food stamps, due to the stigma attached to “welfare”.
Every hospital employs “discharge planners,” usually social workers,
whose role includes making sure that after a hospital stay, patients have a
place to go home to, and someone to help them with everyday tasks, if necessary.
parents who can manage their own daily lives may need a homemaker for their
children. Poor people may need help applying for Medicaid so that they can
However, once the patient is back home, the hospital discharge
planner is rarely involved in making sure that services work as planned, or
that they change
to meet changing needs.
When a government agency denies an application for benefits or services, or
reduces or ends existing services, legal help can be needed to reverse the
Each government agency has an appeals process that, in theory, does not require
a lawyer’s assistance. However, layers of inadequately trained personnel
separate clients and their advocates from the officials who judge their appeals.
It can be equally difficult to learn the process of appealing a decision that
denies services, to gather documents and successfully present a client’s
case, and to compel an agency to comply with a hearing officer’s decision
in the client’s favor.
The New York Legal Assistance Group launched
the LegalHealth project in September 2001 as a response to the complex needs
of people with serious and chronic illnesses, and low-income patients needing
medical care. Since then, they have directly helped more than 600 patients,
and trained over 1,000 medical professionals and social workers how to identify
deal with the legal problems of low-income, chronically ill patients.
LegalHealth client is a cancer survivor who missed a Medicaid appointment
while she was in the hospital for treatment. The missed appointment triggered
a halt to her welfare benefits, which could have prevented her from paying
rent and resulted in her family becoming homeless, not for the first time.
was required to go to Family Court to be a witness in a child support hearing,
despite her severe illness.
The New York Legal Assistance Group successfully
appealed the cutoff of her welfare checks, accompanied her to Family Court
to ensure that proceedings
went as quickly
as possible, helped her draw up a will providing for legal guardianship
her young son, and assisted her with income tax problems.
Linda Ostreicher, a former budget analyst for the New York City Council, is a freelance writer and consultant to nonprofits.
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