The Dudley T. Dougherty Foundation

Increasing access to affordable and effective healthcare for low-income people

Grant Information
Categories Healthcare
Location Texas
Cycle Year 2015
Organization Information
Organization Name (provided by applicant) Lone Star Legal Aid
Organization Name (provided by automatic EIN validation)
Contact Information
Contact Name Lisa Maddux, assistant director of planning
Phone 713.652.0077, ext. 1214
1415 Fannin Street
Additional Information
Used for The Public Benefits Unit (PBU) of Lone Star Legal Aid (LSLA) will study and engage in relationship-building as a means to increase access to affordable and effective healthcare for low-income adults and children. The 6-month capacity-building study will identify the qualifications, requirements, and value of participating in existing external programs and of establishing and formalizing relationships with public agencies and non-profit community service organizations: 1. To identify and assess the benefits and costs of working with specific Federal, state, and local programs and public agencies; health care organizations; and non-profit organizations serving the same target population as PBU: adults and children living in poverty; adults and children who are homeless or criminalized; and people who are at risk of homelessness or criminalization; 2. To inform health care providers about the ease of including evaluations of functional capacity in clinic notes and the benefits of documenting a patient’s ability to function to the individual patient, to the health of the population, and to the health care provider itself; and 3. To build the capacity to access and use electronic medical records (EMR) in representing clients who are seeking Social Security Insurance, Social Security Disability, Medicaid, and other disability-related services; or, who are appealing denials or cessation of those benefits.
Benefits LSLA has limited staff and resources to explore non-legal relationships for the benefit of its client community. Foundation funding will provide LSLA with a unique opportunity to examine external programs and available tools that may help the Public Benefits Unit increase its capacity to serve, provide more in-depth services, and ultimately produce more casework. Increasing client community access to affordable and effective healthcare positively influences all other aspects of clients' lives, including employment, education, housing, and income stability.
Proposal Description LSLA has represented low-income people who qualify for Social Security Insurance, Social Security Disability Insurance, Medicaid, and other disability-related services for more than 65 years. Its staff has a long history of working with external agencies, forums, and individuals who decide whether and for how long adults and children qualify for these government benefits. Due to limited resources and massive client community need, however, the Public Benefits Unit spends the bulk of its time addressing the immediate needs of clients who often are in crisis mode, facing denials and cessations of these and other benefits, with restricted time to respond and act. This leaves little time to research and explore relationships and evidence-gathering tools that may simplify and enrich the Unit’s legal work, as well as expand its capacity to serve. With the help of its Principal Investigator, the PBU has designed a 6-month study that will allow the Unit to engage in informed decision-making. The PBU via its Principal Investigator will examine relationship-building as a means to increase access to affordable and effective healthcare for low-income adults and children. The 6-month study will focus on three areas: Public Agencies and Community Partners Serving PBU’s Target Population; Informing Health Care Providers; and Electronic Medical Records. The study/grant project will focus on LSLA’s client community in Harris County, but study results can later be used throughout LSLA’s 72-county Texas service area.


PBU has numerous potential allies working to increase access to government benefits and health services; but, at this time, PBU does not have the resources required to generate relationships with these potential allies and partners at Federal, state, and local agencies and in the Harris County community. During the study, PBU will initiate communications and relationships with these organizations for the purpose of assessing the benefits and costs of a relationship with a specific program, agency, or organization. PBU will identify not only the commitments required by the organizations from LSLA and PBU, but also the ability of a specific agency, organization or program to enhance the opportunities available to PBU to fulfill its mission and represent its clients successfully. Examples of the agencies and programs PBU will review are:
1. Programs developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) that facilitate and expedite applications for governmental benefits for people with mental illness, SSI/SSDI Outreach, Access and Recovery (SOAR), and for people who are homeless, Projects for Assistance in Transition from Homelessness (PATH),
2. Local public agencies and programs such as the Harris County Departments and programs, the City of Houston’s Departments and Programs, including libraries and community clinics, the Harris Health System, and the Harris Center for Mental Health and IDD, formerly MHMRA of Harris County, and the Houston Independent School District (HISD); and,
3. Non-profit organizations such as the Memorial Hermann Community Benefit Corporation, Federally Qualified Health Centers (FQHCS), other community health clinics, and programs and services for adults and children experiencing food insecurity, are homeless, and impoverished or otherwise disadvantaged and comprise PBU’s target population.


Identifying and expanding community partners and allies will likely support the goal of obtaining reliable evidence of disability for applicants, accessing healthcare or attempting to access public, safety net programs and services. Most health care providers’ medical notes do not include information that is required by the Social Security Act for an evaluation of an applicant’s Residual Functional Capacity (RFC). As noted above, without sufficient information to support a finding of disability, an application for Social Security benefits will be denied. PBU will inform health care providers about building into their clinic notes functional evaluations that satisfy the Social Security Administration’s requirements for measuring disability. Not only does PBU need those medical facts about its clients, but it is also in providers’ interest for qualified applicants to receive government benefits that are a source of reimbursement for health services. Health care insurance coverage is crucial for the well-being of PBU’s clients, the communities where they live, and the health service providers caring for them. By shifting a substantial portion of the risk of poor health onto health care providers, the Patient Protection and Affordable Care Act expands the focus of health care providers from the reimbursed unit of service to the overall health of individuals and communities. As health care providers recognize the benefits to their patients and to themselves of establishing patients’ qualifications for government programs, it is to be hoped that PBU’s commitment to serve the poor will converge with incentives to health care providers created by the Affordable Care Act.


It is essential to present complete and relevant medical records to the Social Security Administration and to Texas’s Health and Human Services Commission. Often, LSLA’s clients who need public benefits the most are the clients least able to collect the medical records they need for a successful application for assistance. Typically, these clients include children and adults with an inadequate education who struggle with severe intellectual, mental and physical disorders that limit the person’s capacity to provide for himself or herself, such as chronic, severe mental and physical disorders, an IQ lower than 80, chronic, severe pain, or physical injuries and diseases, including congenital diseases. Sometimes, these clients, including children, are homeless, have a substance use disorder, or a criminal history. Most of PBU’s clients do not have the medical records they need to apply successfully for benefits when they come to PBU, and many clients do not have the ability to collect their own health records. Thus, the task of collecting health records falls to PBU. It is time-consuming for PBU’s staff to deliver individual record requests to health care providers, and the documents returned may be delayed or incomplete. The request for records may be unsuccessful, or no medical records are returned in response to the request.

The Harris County Medical Society hosts a health information exchange established in 2010, Greater Houston HealthConnect. As of November 13, 2015, HeathConnect enabled health care coordination among twenty-three counties serving 6.8 million people. It currently serves 39% of the region’s physicians and 51% of the hospital market. Many of PBU’s clients are served by participating members of HealthConnect, including the Harris Health System, Legacy Community Health Services, City of Houston Health and Human Services, and the Harris Center for Mental Health and IDD, formerly MHMRA of Harris County.

Having access to the electronic health records available to Greater Houston HealthConnect is likely to improve both the quality and quantity of services available to PBU’s clients because they are a source of critical medical evidence. Nevertheless, it may not be feasible for LSLA and PBU to join HealthConnect because of the costs of membership and of electronic security. LSLA must ensure that its electronic records management system minimizes cyber risks and complies with laws governing personal health information such as HIPPA, the Health Information Technology for Economic and Clinical Health Act (HITECH), and the Texas Identity Theft, Enforcement and Protection Act.


PBU’s investigator will:
1. Research existing programs and the requirements for establishing and formalizing relationships with public agencies and non-profit community service organizations that are most likely to increase the capacity for high-quality legal services to be provided to PBU’s target population.
2. Generate and maintain records of her research, interviews, and observations by program and by organization.
3. Specify all barriers, costs, and burdens that must be accepted or negotiated by PBU in order to participate in the programs and organizations that have been identified in this proposal or that are similar to those programs and organizations and that also serve LSLA’s target population.
4. Describe the anticipated benefits to PBU of participating in or partnering with the program or organization, and
5. To the extent it is feasible, summarize these records to allow PBU to perform a benefit cost analysis for engaging in each program or partnering with each agency and organization included in the review.


Emilie Farenthold, J.D, Ph.D., received a law degree from the University of Texas at Austin and practiced law for more than fifteen years. She obtained a master of laws from the Health Law and Policy Institute at the University of Houston and a master’s and doctorate in Public Health at the School of Public Health, University of Texas Health Science Center, Houston.
Ms. Farenthold’s research focused on the behavioral health needs of criminalized adults and children populations. She is committed to increasing access to community health services for the poor and for those at risk of criminalization, homelessness, and life-long impoverishment because they do not have access to government benefits and community health services.