What Should Clinicians in Organizations Without Established MLP Programs Do When Their Patients Need Lawyers to Meet Their Health Needs?

Undocumented people in the United States face innumerable legal and structural barriers to health and health care services, including for kidney failure.Their experiences vary across states and regions due to wide variation in insurance coverage and unreliable access to healthpromoting resources, including medical-legal partnerships.This commentary on a case canvasses key policy about structural and legal determinants of health for undocumented persons. CaseIn the emergency department (ED) of a large, urban academic health center near the US-Mexico border, Dr B encounters GG, who presents with severe fatigue, headache, dysuria (painful urination), and aching joints.After GG is stabilized, metabolic tests reveal that GG has kidney failure.Dr B refers GG immediately for emergency dialysis and then routine dialysis follow-up.However, due to GG's immigration status, the state's Medicaid program does not reimburse for routine dialysis, only for emergency dialysis.Three weeks later, Dr B gets called back to the ED because GG is back with severe lifethreatening symptoms (hyperkalemia, confusion, and hypoxia from pulmonary edema) due to lack of routine dialysis.Dr B is morally distressed and outraged that he has had to witness GG's symptoms become life-threatening due to the state Medicaid program's lack of coverage for optimal kidney care (eg, routine dialysis).Dr B thinks, "My patient needs a lawyer," and wonders what to do. CommentaryClinicians' moral distress stemming from their inability to provide optimal care for individuals like GG and questions regarding how to improve care for undocumented individuals have generated critical national discourse, investigation, and equityenhancing policy reform related to caring for undocumented people with kidney disease.Over 2 decades of studies have documented the extensive, multilevel harm and financial cost associated with emergency-only dialysis for individuals with kidney