Conor's Story: Finding the Right Educational Support | | MHAP for Kids Attorney Carolina Berger (pictured above) connects with clients to help them access mental health and educational resources for their children. | Since Conor* was about two years old, his mom Marie* knew that he was different from most kids. As a toddler, he could never sit still and struggled to verbalize his needs, even with the support of speech therapy. Marie knew from an early age that Conor had attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). When Conor had those moments when couldn’t put what he wanted into words, he would “only see red,” as Marie describes. To help channel his energy in a fun and productive way, Marie put Conor in martial arts classes as a child. Conor loved it. | | In school, however, when Conor had those “only see red” moments, he exhibited some aggressive and destructive behaviors. He would bite others or destroy classroom materials when he became agitated. By second grade, his school recommended transferring him to a program better equipped to support his needs. But finding the right fit proved to be very challenging. Conor cycled through several day schools, none of which could provide the combination of behavioral and educational support he required. | |
Marie would receive calls almost every day from Conor's school asking her to come pick him up. Marie took him to different hospitals to try to get him help, which resulted in him missing a lot of school. Between working full time and taking care of Conor and his two siblings, Marie was struggling.
“I was exhausted,” Marie admits, “It was mentally and physically draining.”
Eventually, Marie was introduced to a Department of Mental Health (DMH) caseworker. In 2023, when Conor was thirteen, he was referred to a residential treatment program. The residential program focuses on helping youth with mental health or intellectual disabilities learn coping and self-regulation skills. The program is designed for stays of around 60 to 180 days to help youth transition to longer term settings.
“[The residential program] was nothing but a godsend for him,” Marie describes, “Help finally came for him.”
Conor was finally in a place where he felt comfortable and motivated to participate in school. He learned safer ways to cope and manage his behaviors. He connected with staff who could understand his behaviors and needs. He ended up staying at this facility for more than a year.
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When it came time for Conor to be discharged, his school district tried to place him in a therapeutic day school again, despite his clinicians’ recommendations for a residential school. Worried that Conor may lose a lot of the progress he made at the residential treatment program, Marie looked for other options. Her DMH caseworker introduced her to HLA’s Mental Health Advocacy Program for Kids and connected her with Staff Attorney Carolina Berger. When Carolina became involved in discharge conversations in April 2025, she knew immediately that a residential program was the right option for Conor’s well-being.
“It was very clear that this child would not succeed in a therapeutic day school,” Carolina remembers.
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Carolina worked quickly to coordinate numerous meetings with the residential program, the school district, and the DMH caseworker. She filed an appeal at the Bureau of Special Education Appeals on Marie's behalf and negotiated with the school district to advocate for a residential placement. Through her dedicated advocacy, Carolina helped ensure Conor ended up in a placement that kept him safe while allowing him to continue learning and growing.
Marie feels hopeful about Conor's placement. While Conor is nervous about making new friends--a normal fear for teenagers entering a new environment--he and his mom are confident about the next step in his academic journey.
*Names changed for privacy
| | Tricia's Story: How Administrative Challenges Led to Loss in Coverage | | |
When Tricia heard that she no longer had to fill out and submit a form about her disability to continue her MassHealth coverage, she thought it was the best news. After years of filling out forms to prove her disability status, she was relieved that she no longer had to go through the strenuous process. Unfortunately, this relief was short-lived.
Tricia qualifies for MassHealth's CommonHealth insurance program due to her lifelong post-traumatic stress disorder (PTSD). She works in housekeeping for a psychiatric hospital and also receives MassHealth Premium Assistance to help cover the cost of her employer-sponsored insurance.
Every five years, Tricia is required to fill out a disability supplement form for her disability determination to renew her MassHealth CommonHealth. This disability determination also keeps her in the Premium Assistance program, which is contingent upon staying enrolled in MassHealth. When she received the form in the mail this year, she called MassHealth’s customer service line for advice on filling out the form. The representative she spoke with told her that because she is not on Social Security, there is no need to submit the disability supplement form in order to keep her benefits.
“I thought this was such great news,” Tricia remembers.
Shortly after her call with MassHealth, Tricia received a letter in the mail stating that her MassHealth CommonHealth was terminated. Tricia was suddenly left without MassHealth coverage and thought she would owe an unaffordable premium for the employer-sponsored insurance that MassHealth had required her to enroll in. Panicked and confused, she emailed HLA Senior Supervising Attorney Kate Purrington, whom she had worked with in the past. Kate immediately began requesting documents to build the case and helped Tricia file an appeal with the MassHealth Board of Hearings. To avoid a gap in coverage, Kate ensured that Tricia's MassHealth coverage be reinstated during the appeal, which is her right
As she started working with Kate, Tricia could “see some sort of light at the end of the tunnel.”
When the day finally came to speak at the Board of Hearings meeting, Tricia felt nervous that she would not effectively communicate during the hearing. To minimize the extent that Tricia would have to testify at the hearing, Kate drafted an affidavit for Tricia to sign that explained why she had not submitted the disability supplement.
Kate argued to the Board of Hearings that MassHealth should retroactively reinstate Tricia’s benefits because the agency failed in its obligation under federal law to provide adequate application assistance when Tricia called customer service. The hearing officer agreed with Kate's argument and MassHealth agreed to settle the appeal by retroactively reinstating Tricia’s benefits.
“She was my voice when I didn’t have it,” said Tricia.
After the hearing, Kate explained the result to Tricia, and she was elated. Tricia’s MassHealth benefits have been fully reinstated without any gaps in her coverage.
“Kate has been wonderful from the beginning,” Tricia said, “Without her I would not have MassHealth. I just can’t say enough about her.”
Tricia’s story is far too common. Complicated applications, re-verification requirements, and other administrative challenges push consumers out of coverage. With the cuts to Medicaid included in the One Big Beautiful Bill Act, these administrative barriers will only multiply - and more families will slip through the cracks.
Our team of experienced attorneys, like Kate, serve as a guidepost by helping consumers navigate these complicated systems. In addition to advocating for individuals, HLA is pushing for systemic reforms that reduce red tape, close coverage gaps, and move us closer to our vision: universal, high-quality health care for all.
| | Preparing Community Centers & Families During Back-to-School Season | | |
Back-to-school season is in full swing! With the beginning of a new school year, there's both excitement and trepidation, as new opportunities and challenges can arise for students and their families. Over the past few weeks, our Mental Health Advocacy Program (MHAP) for Kids team has been busy conducting outreach to help set their communities up for success this academic year and ensure kids with mental health concerns thrive.
MHAP for Kids attorneys are based in Family Resource Centers (FRCs) across Massachusetts. Partnering with FRCs makes it easier for our attorneys to connect directly with the communities they serve. FRCs often host back-to-school events to hand out school supplies, inform families about community-based resources, and offer a space for families to gather. MHAP for Kids attorneys attend these events and hold trainings for FRC staff and families on issues that can arise when students return to school. For example, training parents on how to understand their child's Individualized Education Program (IEP). Without a background in special education, the language used in IEP meetings and documents can often be inaccessible or confusing.
In late August, MHAP for Kids Staff Attorney Tanuja Walsh led an “Introduction to Schools and Systems” training for FRC staff, which provided staff an overview of several different agencies where MHAP for Kids have expertise: the juvenile justice system, special education, community-based mental health services, and the Department of Children and Families. By building this knowledge, FRC staff are better prepared to advocate for their own clients—and they know when to turn to MHAP for Kids for additional support.
| | MHAP for Kids Staff Attorney Eva Conroy joined staff at the Fitchburg FRC for their back-to-school “parent café.” After dropping off their kids with the childcare provided by the FRC, parents could grab a bite to eat and settle in for a guided discussion with Family Support Workers, clinicians, and Eva about educational resources they can access throughout the year. Eva answered parents’ questions about who is involved in Individualized Education Plan (IEP) meetings, how to request a meeting, and who to reach out to at a school when they have concerns about their child. In addition to learning about new resources, parents met with a network of families in similar situations and were able to share their own experiences with each other. | | Attorney Eva Conroy (right) with her FRC at a back-to-school open house. | | |
“Collective knowledge is power,” Eva explains, describing the importance of sharing information about special education services with parents at the start of the school year, “The more people who have this information, the more children will receive these services.”
MHAP for Kids' School Discipline Advocacy Program Fellow, Elaine Marshall, has been travelling around the state to inform FRC staff about school discipline procedures and resources to help them better serve family with kids with mental health challenges. Elaine visited Tanuja in Lowell to provide a training, and answer questions, about how to help families with school discipline matters when a child with mental illness is involved. Although students are still settling in to new classrooms and routines, incidents of school discipline and exclusion can happen early on and require intervention quickly.
Back-to-school events offer the perfect opportunity for MHAP for Kids attorneys to connect with their communities and let families know that they are here to help. When families with kids with mental illness face bumps in the road this academic year, they will know where to turn to ensure their children receive the support they need.
Learn more about MHAP for Kids here. If you are an FRC staff member and want to know more about the statewide training series, reach out to Managing Attorney Lisa Morrow.
| | Advocating for Policies to Alleviate Medical Debt in Massachusetts | |
Medical debt is a pervasive issue that prevents consumers from seeking care across Massachusetts. Improper medical billing and collection practices can lead to financial devastation for families.
“Medical debt usually arises because our insurance system is complex. It’s hard for consumers, and even providers, to navigate and it’s fraught with errors,” Attorney Wells Wilkinson explains.
HLA is committed to eliminating medical debt across Massachusetts. Our multi-pronged approach for protecting families from undue medical debt includes legal representation, collective education, and informing policy debates. Over the past few months, members of our team have testified on various bills in the Massachusetts Legislature that would help alleviate the burden of medical debt in Massachusetts.
In May, HLA Medical Debt Advocate Jason Reis testified on a panel in front of the Joint Committee on Health Care Financing on “An Act to address medical debt through hospital financial assistance reform.” In his testimony, Jason explained how HLA frequently sees with our clients how accessible hospital financial assistance is crucial for consumers' financial security and avoidance of medical debt. However, while representing clients HLA staff sees many hospital financial assistance policies are difficult to navigate, poorly publicized, and unclear. Consumers delay or avoid necessary care due to fears of getting more medical bills.
| Medical Debt Advocate Jason Reis (left) testifying in front of the Joint Committee on Health Care Financing on May 12th. | |
Jason shared a story about an HLA client from Brazil who sought emergency medical care after contracting Covid-19 during a gap in his insurance coverage. His overnight hospital stay resulted in a $12,000 medical bill. No one informed him about the hospital’s financial assistance program, which was only available in English. Subsequently, the bill went to collections and the client experienced significant financial stress.
The bill before the Committee would address some of the barriers to accessing hospital financial assistance by strengthening hospital notification practices, expanding multi-lingual access to financial assistance materials, and streamlining the application process. Ensuring more consumers are informed about repayment options prevents them from taking on undue medical debt that can lead to financial ruin.
| Senior Supervising Attorney Wells Wilkinson testifying in front of the Joint Committee on Financial Services on September 8th. | |
In early September, HLA Senior Supervising Attorney Wells Wilkinson testified in front of the Joint Committee on Consumer Protection and Professional Licensure in support of “An Act alleviating the burden of medical debt for patients and families.” Wells spoke about how several provisions in the bill protect consumers with medical debt from further financial distress. One of those provisions prevents any collections or lawsuit activity related to someone’s medical debt while they are appealing a coverage denial by their health insurance, a process that can take several months.
Another provision prevents the reporting of medical debt on credit reports. Earlier this year, the federal Consumer Financial Protection Bureau finalized a rule to remove medical bills from credit reports, but CFPB leaders appointed by the new federal Administration blocked the rule. Implementing this provision on a state level would protect the financial security of consumers.
“In our experience representing clients, about forty percent of medical debts are due to inappropriate denials by health plans or underinsurance when people have very large deductibles,” Wells described.
An additional provision of the bill would prevent foreclosure on a family’s home to collect these bills. Wells discussed that families can face losing their homes simply because they struggled to navigate the health insurance process.
HLA is proud to share our experience and expertise with the Massachusetts Legislature. Reforms in medical billing and collection practices are crucial to alleviate medical debt for consumers across the Commonwealth.
Learn more about HLA's Medical Debt Initiative here.
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OBBA Update: What's Ahead for
Health Coverage in MA
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The federal One Big Beautiful Bill Act (OBBA) signed into law in July is set to dramatically reshape health coverage in Massachusetts. Immigrants and low-income communities will be disproportionately affected by sweeping cuts and new eligibility requirements.
Beginning January 1, 2026, due to federal cutbacks, roughly 36,000 lawfully present immigrants with incomes below the federal poverty line will have their coverage through our state's ConnectorCare program terminated, unless the state takes action. On October 1, 2026, another 2,500 “qualified” immigrants—including asylees, refugees, and trafficking survivors—will lose Medicaid coverage due to federal cuts, unless the state fills the gap. Then, on January 1, 2027, an additional 26,000 qualified immigrants will lose their ConnectorCare coverage.
While Medicaid coverage for some immigrant groups, such as Green Card holders and Cuban-Haitian entrants won't be impacted by OBBA, this new law will cause many others to lose coverage. Between 141,000–300,000 people currently enrolled in MassHealth could lose coverage due to new work requirements and semi-annual eligibility checks. For many immigrants, the only options left will be MassHealth Limited and the Health Safety Net—programs that fall far short of comprehensive coverage.
Today, Massachusetts benefits enormously by combining federal and state funding to allow most lawfully present immigrants with low-income and no other insurance to be eligible for comprehensive coverage through MassHealth or the Health Connector alongside U.S. citizens. The passage of the OBBA threatens to reverse decades of progress toward universal coverage that has helped our Commonwealth thrive.
Health Law Advocates (HLA) is working with numerous partners to mitigate the negative impact of the OBBA on Massachusetts residents. We are
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Engaging with state health officials to ensure the concerns of low-income residents are heard and urge that policies protect access to health care,
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Working to unite health care stakeholders in defense of universal coverage,
- Developing legal strategies to protect Massachusetts residents' rights with respect to health care access, and
- Informing advocates and consumers about OBBA's provisions and how to navigate them to maintain access to health care.
As these changes approach, which fall especially harshly on immigrants, HLA remains firmly committed to ensuring that Massachusetts does not leave its immigrant communities behind.
| | Legal Network Retrospective | | From Humble Beginnings to a Statewide Network of Advocacy | | HLA staff at the 11th Annual Benefit Breakfast, including current ED, Matt Selig (third from right), who helped expand the Legal Network. 2007. | | |
In the mid-1990s, a small group of attorneys began working with Health Care For All (HCFA) to provide free counsel to health care consumers. Where they saw consumers facing barriers to care that necessitated legal representation but were not being addressed by other legal aid organizations, HCFA called upon members of this legal network to volunteer to assist people for whom the cost of an that would have been out of reach.
Due to the overwhelming demand for this type of assistance, it became clear that a legal aid organization dedicated entirely to health care access was essential. In 1995, Health Law Advocates was founded as a 501(c)(3) public interest law firm, focused exclusively on breaking down barriers to health care for Massachusetts’ most vulnerable residents. Thirty years later, HLA has grown into a team of more than 40 staff, serving thousands of household members each year.
In addition to a dedicated staff, HLA’s Pro Bono Legal Network has nearly 200 volunteer attorneys from a wide range of practice settings. These attorneys take on the same kinds of cases HLA handles every day: undue medical debt, mental health parity violations, wrongful lapses in coverage, and discriminatory practices. Just in the past year, the Legal Network has represented more than 25 consumers.
A recent client, Tyler A., shared his experience working with an HLA Pro Bono Legal Network attorney:
“When I was just 18 years old, I found myself buried under an overwhelming amount of medical debt after an injury. I had no idea how to navigate the confusing world of insurance, billing and collections but I knew something wasn't lining up with my bills. And that's when HLA and Legal Network Staff Attorney Emily Lau stepped into my life and everything changed... I will always be grateful for their guidance, their expertise, but most importantly their truly caring nature. They changed my life in ways that go far beyond a legal case, supporting me and cheering me on through so many phases of my young life.”
The Legal Network has been central to HLA’s mission of justice since our founding, and it remains one of the most powerful ways we extend our reach to communities across Massachusetts. With steep cuts to Medicaid included in the federal budget reconciliation bill signed into law in July, we expect even more calls for legal help in the months ahead.
We invite you to join the Pro Bono Legal Network to help shrink our waitlist and ensure more people can access the care they need. To learn more, contact Emily Tabor.
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Join us November 20th for the
30th Annual Benefit Breakfast!
| | Over the summer, we welcomed four new team members! | |
Caroline Arena
ACC Paralegal
Caroline joined HLA in July as a paralegal with our Access to Care and Coverage Team. She graduated from Middlebury College in 2024 with degrees in Environmental Science and Global Health. Prior to HLA, Caroline was a Clinical Research Coordinator at the Medical Practice Evaluation Center at Massachusetts General Hospital, where she worked on global public health modeling projects focused on infectious diseases. Caroline also served as a Community Health Intern for MaineHealth, supporting programs designed to mitigate food insecurity, and worked at an emergency housing shelter in Vermont. Outside of work, Caroline enjoys hiking, reading, and spending time with her dogs.
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Alex Rhoades
Medical Debt Advocate
Alex joined HLA in August as a Medical Debt Advocate with HLA's Access to Care and Coverage Team. She graduated from the University of North Carolina Wilmington with a degree in International Studies. Prior to HLA, Alex worked in national news as a Field Producer for NBC and MSNBC based in Washington, DC. They covered topics such as politics, civil rights, environmental justice, immigration and health care access. Outside of work Alex enjoys woodworking, going to live music and spending time with their cat Cowboy.
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Rebecca Bruton
Staff Attorney
Rebecca is a Staff Attorney with HLA's Mental Health Advocacy Program (MHAP) for Kids. She is based at the Springfield Family Resource Center. Before joining MHAP for Kids, Rebecca worked at a criminal defense firm for eight years, starting as a paralegal and progressing to chief of staff before becoming an attorney. While working at the firm, Rebecca attended law school at night and graduated from Western New England University School of Law in 2023. Prior to law school, Rebecca earned her B.A. in Psychological Sciences from the University of Connecticut.
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Aly Nguyen
Staff Attorney
Aly joined HLA as a staff attorney with MHAP for Kids in August serving Hyannis and Cape Cod. Aly received her B.S. in Psychology with minors in Global Health and Legal Studies from the University of Oregon. She attended the University of Massachusetts School of Law where she was a senator on the Student Bar Association, the president of If/When/How: Lawyering for Reproductive Justice, and the vice president of the Law Association Against Sexual Exploitation. In her free time, Aly enjoys playing video games, doing yoga, and working on various art projects.
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HLA seeks an experienced, self-motivated, creative plaintiffs' litigator to enhance its in-court practice.
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Staff Attorney
HLA seeks a highly qualified, motivated lawyer with knowledge of the juvenile court, mental health, and/or education systems to join the talented MHAP for Kids team as our staff attorney based in Fitchburg.
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