Do Indigent, High Risk Infants Need Legal Advocacy To Receive Health And Welfare Services?

Laura Banickol, JD, MSW
Jocelyn Hirshman, MPH
Janet Fuller, MD
Gopal Srinivasan, MD
Swarupa Nimmagadda, MD
Stephen Wall, MD


  • Low socioeconomic status has been repeatedly demonstrated to have negative effects on the children and families.
  • Children from families of lower socioeconomic status have a higher incidence of mortality and disability, and are more likely to have unmet health needs.
  • Moreover,  the combination of low socioeconomic status and medical complications at birth puts children at an increased risk for long term problems.


  • 1965 - Medicaid

            - enacted to prove health care services for certain low income individuals and families

  • 1972 - Supplemental Security Income

           - created to provide cash assistance to low-income elderly, blind, and the disabled ( including children ).

  • 1997 - State Children's Health Insurance Plan (SCHIP)

            - created to reduce the prevalence of unmet health needs among the most disadvantaged children.

Specific Hypothesis

  • Medically high risk children in families of low socioeconomic status are still encountering barriers in obtaining health insurance, public benefits and other vital services to which they are legally entitled.
  • By providing case management and legal services to fan miles 0n-site at hospital clinics, we can help them obtain these benefits and services.

Study Objective

  • To describe the frequency with which indigent infants, discharged from the NICU, require legal assistance to obtain the health and welfare benefits that they are legally entitled to.

Patient Population

  • Medical Criteria

        -    VLBW Infants (<1500 grams); or

        -    Heavier infants at risk for adverse neurodevelopment outcomes

  • Household Income Criteria

        -  Annual household income < 285% of the federal poverty level

Study Sites

  • Two Urbana
  • Chicago Area Hospitals 

        - University of Chicago Hospital

            * 55 Bed NICU

            * 82% African American and 10% White

        - Mt Sinai Hospital

            * 34 Bed NICU

            * 56% African American and 40% Hispanic

Study Intervention

  • Case Management

            * Provided from the time of the infants NICU discharge through one year of age.

            *  Offered On-Site in the NICU follow-up clinic

The Role of the Case Manager and Attorney

  • Assess each family's eligibility for and access to public benefits like:

            *  Medicare/KidCare

            *  Income Support (TANF/ SSI)

            * Nutrition Programs (Food Stamps/WIC)

            *  Early Intervention Program

  • Screen For Other Issues Like:

            * Child support problems

            *  Domestic Violence

            *  Housing Problems

            *  Immigrant Issues

  • Address any problems that arise through intensive case management and legal services

Description of Legal Services Provided

  • Legal Counseling

            *  Attorney provides legal education, advice and counseling

  • Legal Advocacy

            *  Attorney provides legal counseling and intervenes with outside agencies on behalf of the infant or family through
                one or more of the following::

  1. Written and Verbal; correspondence with state agencies
  2. Assistance filing and resolving appeals 
  3. Representation in administrative hearings or other court proceedings