Medical Debt Legal Advocate Initiatives

May 10, 2020- The Utah Supreme Court’s Office of Legal Services Innovation has approved two new non-profit pilot projects for the Utah legal regulatory Sandbox. Both pilots will connect people experiencing medical debt with non-lawyer advocates in the non-profit sector. The pilots are the second and third non-profit projects to be approved by the Sandbox, and the first in the nation to empower non-lawyers to give limited-scope legal advice about medical debt.

The Community Health Worker pilot will train two community health workers (“CHWs") at Holy Cross Ministries, a 501(c)(3) in Salt Lake City, UT. These CHWs will be trained to serve as bilingual non-lawyer Medical Debt Legal Advocates (MDLAs). The CHWs at Holy Cross Ministries trained in this pilot program will continue to provide the holistic, continuum-of-care services that they already provide in the community; the pilot will enable them to enhance their services by also offering limited scope legal advice about medical debt and its collateral issues. This pilot is designed to enhance CHWs’ ability to provide more complete services by delivering legal assistance to clients immediately after the clients disclose medical debt.

The Medical Debt Diversion pilot will train one MDLA from AAA Fair Credit Foundation and one MDLA from People’s Legal Aid, both 501(c)(3) non-profit organizations located in Salt Lake City, UT. In this pilot, defendants in medical debt collection actions will be notified of the availability of a free MDLA at the time they receive a 10-day summons (a document that is personally delivered to the defendant that explains that a complaint will be filed against them in 10 days) from the Utah District Court, Third District. The MDLAs will provide services such as debt negotiation and settlement agreements with creditor attorneys on behalf of a consumer, assistance creating and filing answers and counterclaims, and pre-litigation support.

Both pilots were designed in partnership with Innovation for Justice (i4J) at the University of Arizona James E. Rogers College of Law. i4J is a social justice innovation lab that designs, builds and tests disruptive solutions to the justice gap. The approved pilots are the result of a nine‐month, iterative, community‐engaged research effort lead by i4J: 70 community participants (including community members who have experienced medical debt, healthcare providers, subject-matter experts from the legal profession and the health law and policy fields, and over 30 individuals and organizations working in the non-profit sector) worked collaboratively to design, build, and test the proposed pilots. The MDLA training will be hosted by i4J as an online, modular, bilingual curriculum.

Medical debt impacts a staggering number of people throughout the United States every year, with one in four Americans reporting that they struggle to pay for medical care.1 In Utah, nearly 22,000 lawsuits—one third of all debt-collection cases filed in the state—are filed against people experiencing medical debt each year. By the time a medical debt reaches the court system, devastating consequences for the debtor are almost inevitable: in 72% of Utah medical debt cases, defendants do not appear for their hearing and the court enters a default judgment in favor of the medical debt collector. And Utahns experiencing medical debt do not perceive the civil legal system as an opportunity to resolve those issues. In fact, a majority of low-income Utahns indicated that if they needed a lawyer, they would still try to solve the problem themselves.

Traditional legal services cannot meet the civil legal needs of Utahns experiencing medical debt. Nationally, 86% of civil legal needs in the low-income community receive little or no legal assistance. Utah is no exception: dealing with debt collection and medical bills are two of the top three legal needs identified by Utah low-income community members, but Utah legal services offer almost no legal aid assistance for financial issues such as medical debt.

The Utah Regulatory Sandbox offers an opportunity to reimagine a better legal system that delivers justice to Utah’s underserved and underrepresented populations. In nearly every state in the United States, only lawyers can give legal advice. But Utah is unique; the regulatory Sandbox provides a pathway for new and innovative legal business models and services, permitting nonlawyer legal services to operate with regulatory oversight. As the legal profession struggles to expand access for populations that cannot afford legal services under traditional models, whether a professional with legal training but not a J.D. should be permitted to give legal advice is an issue at the forefront of access to justice decision-making across the country. These pilots are positioned to be a critical, groundbreaking step in the effort to significantly restructure legal regulation and innovate the delivery of legal services to improve access to justice. The research findings generated by these pilots have the potential to change the delivery of civil legal services for low‐income populations nationwide, by creating a new and sustainable tier of civil legal service providers for the non‐profit, civil legal aid, and social service communities.

More information about i4J’s work in the medical debt space is available in the interim report (see above).