Establishing a Pay-for-Performance Contract Between a Legal Services Organization and a Medicaid Managed Care Organization

Monday, May 12, 2025

By Jean Edwards, PhD, RN (University of Kentucky), Tracy Goodman, JD (Children's Law Center), Kate Marple, MSc (Who Tells the Story?), Katelyn Collins, BS, BA (University of Kentucky), Maria Casoni, MSL, MPH, Bethany Hamilton, JD (NCMLP), Lor Eisele, JD (University of Kentucky), Kimberly Northrip, MD, MPH

Establishing a Pay-for-Performance Contract Between a Legal Services Organization and a Medicaid Managed Care Organization

Social and legal factors profoundly influence health, and medical-legal partnerships (MLPs) are an evidence-based solution that integrates legal expertise into healthcare settings to address these social drivers of health (SDOH). By collaborating to resolve health-harming legal needs and advocate for systemic change, MLPs improve outcomes for patients and communities alike.

Historically funded through philanthropy and healthcare contributions, MLPs are increasingly exploring sustainable financing through Medicaid. This new case study from the University of Kentucky, Children’s Law Center, and NCMLP highlights a groundbreaking step forward: the first-ever pay-for-performance contract between a legal services organization and a Medicaid managed care organization (MCO).

In Washington, D.C., Children’s Law Center partnered with AmeriHealth Caritas DC to establish a reimbursement model for legal services delivered to Medicaid enrollees. This case study explores how the MLP demonstrated its value, the data strategies that supported the partnership, and how the model can be replicated in other states.