Ruth's Story: The Fight for A Safe and Healthy Learning Environment | | |
Ruth Garcia is an energetic eight-year-old who loves the ocean, space, and dinosaurs. She is the youngest of five sisters and has been raised by her adoptive mother Lisette since she was 29 days old.
When Ruth was in preschool, it was clear to her teachers that she was an incredibly smart student who could quickly learn and retain new material. They also noticed that she struggled with social skills like sharing and paying attention. Ruth took a Vanderbilt Assessment Scale, which determined she has attention deficit hyperactivity disorder (ADHD). Ruth was later diagnosed with post-traumatic stress disorder (PTSD), autism, and pica (an eating disorder related to compulsively eating nonedible items).
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When Ruth started kindergarten, her behaviors started to escalate. She ran away from teachers and other authority figures, hid in small spaces like closets, and would not respond to her own name. In response to her increasingly unsafe behaviors, Lisette asked the school for an individualized education program (IEP) that would address Ruth's needs connected to her health conditions. But the school denied her request. The school claimed that because Ruth was still learning, she did not need an IEP.
After the school denied her IEP request, Ruth’s behavior continued to escalate. She bit people, tore materials down from the wall, and put small items in her mouth. Teachers called for crisis support almost daily.
"I was called two to three times a day at my job to calm Ruth down," Lisette says.
While riding the school bus one afternoon, Ruth found three pennies on floor. Unsupervised with a pica diagnosis, she swallowed them. When Ruth got home, Lisette rushed her to the hospital to get the pennies surgically removed. While at the hospital, Ruth became agitated and physically assaulted one of the nurses. Hospital staff had to restrain and sedate the six-year-old.
“I have never seen anything like that,” Lisette remembers. “I watched the fun, vibrant Ruthie I knew die.”
When Ruth returned to school, the school agreed to give Ruth an IEP for her ADHD and pica, but not for her autism and PTSD. Lisette had attended many IEP meetings as part of her work guiding families in accessing services to support their children's mental and behavioral needs, and she knew she had the right to decline the proposed IEP if it did not offer the support Ruth required (even if the school threatened to call the Department of Children and Families (DCF)). Lisette saw that the proposed social emotional behavioral supports (SEBS) Program did not have the capacity to keep Ruth safe, particularly with her pica diagnosis, so she refused to sign the IEP.
“My job is to protect Ruth,” says Lisette, “I wasn’t asking for much, I was just asking for Ruth to be safe…I don’t want a school to just tolerate Ruth, I want Ruth to learn.”
Since the school refused to offer Ruth enough support to keep her safe in school, Lisette's only option was to remove her from school and have her homeschooled.
After trying several different avenues to get Ruth help, including filing a formal complaint with the Department of Elementary and Secondary Education (DESE), Lisette was at a loss. In February 2024, Springfield's multicultural center connected Lisette with HLA's Mental Health Advocacy Program for Kids (MHAP for Kids) and Staff Attorney Amanda Stutman took the case.
“Amanda was absolutely amazing,” says Lisette, “I wish I could take a microphone and scream it from the mountaintops.”
When Amanda received the case, she immediately coordinated with a neuropsychologist, individual therapist, and ABA therapist to obtain updated recommendations for Ruth. Despite the recommendations, the school still refused to give Ruth additional supports. Through diligent advocacy, Amanda was able to help Lisette resolve the dispute in a satisfactory manner. Ruth is now safe and thriving in school because she is receiving the services she needs.
Lisette believes there are so many other kids like Ruth who need a passionate and hard-working advocate like Amanda in their corner. "We need more people like Amanda," she declares.
Learn more about MHAP for Kids here.
| | HLA Helps Establish New Precedent for PACT Coverage | | McLean Hospital, home to one of the most well-established PACT programs in the country | | |
Noah* was living at home with his parents while taking a class at a community college. Just after his 20th birthday, he experienced a sudden rapid decline in his mental health that destabilized his life. He was admitted to Newton-Wellesley Hospital for treatment. After a month of inpatient care, he was doing a lot better but still needed significant mental health supports to help him stabilize. The transition period after a long stay in a hospital is a critical time for adults experiencing a manic episode and can be full of challenges and risks.
“It’s really ridiculous to expect someone who just got out of the hospital to just go back to once-a-week therapy,” Noah's mother Laura* explains, “For people recovering from a manic episode, it’s a long road back.”
With financial support from extended family, Laura was able to enroll Noah in the Program of Assertive Community Treatment (PACT) at McLean Hospital. PACT is a wrap-around program that offers a variety of services to help stabilize adult patients’ lives when they experience a mental health episode. A team of providers coordinates services for patients in their homes and communities, including social activities and vocational services. They also offer education and support for family members.
“The PACT program was really lifesaving,” Laura says, “Noah was able to get his life back.”
Throughout Noah's six months with PACT services, he learned coping strategies for his mental illness, reenrolled in community college to finish his course, and built stronger connections in his family and community. Laura also learned how to support Noah and navigate life with a family member with a mental illness.
Private insurance historically does not cover PACT services. Noah's extended family was facing a significant financial burden supporting this type of care.
While Noah was receiving PACT services, Laura met Monica Luke. At the time, Monica was advocating and raising funds for PACT at McLean. Monica joined HLA as a Pro Bono Paralegal in July 2023 and began working with Senior Supervising Attorney Wells Wilkinson on mental health parity cases. She brought Noah's case to Wells. The case presented an opportunity to establish a precedent of an insurance company covering PACT services.
Both Laura and Wells pointed out that covering intensive, community-based interventions like PACT is cost-effective for insurers. Individuals with mental health challenges who do not receive these kinds of services can end up re-hospitalized and needing more costly care.
Monica helped Laura submit a reimbursement claim to her insurer to cover PACT, which was was initially denied. Wells and Monica then submitted an internal appeal to have PACT covered under federal and Massachusetts Parity Law.
“Many people don’t know their parity rights,” Monica says. In 2000, Massachusetts passed An Act Relative to Mental Health Benefits, which mandated coverage of all medically necessary treatments for behavioral health conditions. HLA continues to improve access to mental health and substance use services through more aggressive enforcement of parity laws.
After months of the insurer miscommunicating, changing their rules, and hiring outside counsel, they finally agreed that PACT should be covered, but at an out-of-network rate. Wells and Monica filed another appeal, claiming that McLean Hospital is in-network and the carrier did not have any in-network PACT providers which left the family no choice. Finally, in May 2024, the carrier agreed to pay the full cost of Noah's PACT services.
"I'm extremely happy with the result of the case," Laura shares, "Monica and Wells really took on the burden of most of the work." She is proud to be part of this important precedent that moved the needle for other families seeking PACT services.
This is the first time a private carrier has covered or paid for PACT services in Massachusetts. Monica and Wells continue to work on establishing this as a precedent, ensuring that families of all income levels can access these lifesaving behavioral health services.
*Names have been changed.
Learn more about HLA's work enforcing parity laws here.
| | Family Resource Centers Training Series | | |
HLA's Mental Health Advocacy Program for Kids (MHAP for Kids) represents young people and advocates for them to get the mental health services they need. Our attorneys are strategically placed in Family Resource Centers (FRCs) across Massachusetts, allowing us to connect directly with the communities we serve.
In addition to individual representation, the MHAP for Kids team hosts monthly trainings for FRC staff across the Commonwealth. MHAP for Kids attorneys cover a wide range of topics and share their expertise with FRC staff, including those who do not have a MHAP for Kids attorney at their location.
On January 30th, MHAP for Kids kicked off their 4th annual training series. To promote attendance and accessibility, these trainings took place on Zoom and are recorded so they could be shared with those who could not attend.
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January’s training was led by Managing Attorney Lisa Morrow (based in Salem) and Staff Attorney Caitlin Reed (based in Holyoke), and moderated by Senior Paralegal Shy-Anne Laura (based in Boston). To an audience of FRC staff from Worcester, Cape Cod, Lynn, and Brockton, Lisa and Caitlin presented on Understanding the Department of Children and Families (DCF). They explained the basic structure of the organization, the different types of DCF placements, and types of DCF cases. Based on their experience with DCF, Caitlin and Lisa were able to relate the material to situations FRC staff may encounter in their work with families. They highlighted important data on the disproportionately higher rates of family separation in families of color, and fielded questions from FRC staff participants.
On February 27th, staff from the Cape Cod, Attleboro, and Quincy FRCs attended the next training on 51 A/Bs and Care and Protection Cases. Staff Attorneys Kathy Hackett (based in Lawrence) and Jessie Fried (based in Pittsfield) covered the basics of the Massachusetts Juvenile Court, the process of filing a 51A (the initial report of abuse of neglect to DCF), and the timeline of Care and Protection cases. They gave advice to staff on what to do when a family informs them that a 51A has been filed. Jessie explained where in the process a MHAP for Kids attorney may become involved when 51As and 51Bs occur.
| | Slide from the "51 A/Bs and Care and Protection Cases" training depicting the process of filing a 51A | | |
The next training in this series is on Child Requiring Assistance Cases (CRAs) in Juvenile Court. This training has been so popular in past years that MHAP for Kids will host the training twice this year. Lisa Morrow works with the FRC administrators to adapt trainings to topics that are most interesting and useful for the FRC staff. MHAP for Kids offers these trainings to other organizations and agencies, not only the FRCs.
If you are interested in learning more, please email Lisa Morrow at lmorrow@hla-inc.org.
| | Staying Focused in the Wake of Constant Federal Action | | |
For the past two months, there has been a constant wave of news making its way from Washington, D.C. to Massachusetts. Slashes to federal grants, an array of new executive orders, and the constant flurry of social media activity has coalesced into a (mis)information tsunami. Despite all of the harmful policies and other actions from the Trump administration, HLA remains focused on advocating for vulnerable populations seeking health care, including fighting for immigrant and gender-diverse communities.
"Our job is to remain centered on dismantling barriers to health care that have long-existed," says Andrew Cohen, Lead Attorney of HLA's Access to Care and Coverage Practice. "We can't get distracted by executive orders that serve to mainly intimidate and sidetrack us from our work."
Despite the executive orders targeting transgender youth, health care providers in Massachusetts can continue to provide gender-affirming care as they were. HLA continues to monitor efforts to block access to gender-affirming care, but these orders serve to distract from present barriers that HLA attorneys are working on such as insurance coverage for gender-affirming health care to treat gender dysphoria. We are also urging policymakers to plan for potential disruptions to care in the event proposed federal policies interfering with patient care gain traction.
The fear and misinformation spread by these and other executive orders have consequences. Immigrant families in the Commonwealth have refrained from attending doctors’ appointments and accessing other public benefits due to grave concerns with immigration enforcement and deportation.
In response, HLA attorneys Jen Cedor, Mindi Greenberg, Andrew Cohen and Kate Purrington have provided guidance and "know-your-rights" trainings to educate more than 850 patients, providers, and administrators on how to interact with Immigration and Customs Enforcement (ICE) and provide tools to ensure a safe space for all health care consumers.
| | Attorney Andrew Cohen presents to the Mass Academy of Family Physicians on protecting immigrants' access to care, March 2025. | | |
In addition to conducting trainings, HLA is on the steering committee for Protecting Immigrant Families (PIF) MA, which has been developing communication materials to share with immigrant communities regarding accessing public benefits. The bottom line to immigrant families: you can and should continue to access your health care and other benefits.
While there have not been any changes in Massachusetts yet, the proposed budget cuts to Medicaid advanced in Congress would lead to widespread strain our health care system here in the Commonwealth if enacted. Cutting the Medicaid budget by hundreds of millions of dollars or more would place enormous pressure on the MassHealth budget. If that happened, MassHealth may seek to introduce new eligibility requirements or cut coverage for more intensive services. The state would likely look to slash areas of coverage where they do not receive federal funding, including coverage for immigrants and gender-affirming care.
On February 20th, HLA, with our partners in health care advocacy, sent letters to the Massachusetts delegation in Washington, D.C. to urge them to support Medicaid. Collective action by organizations and community members is vital for demonstrating vast public support for representatives to block any budget reconciliation bills that include Medicaid cuts. Encouraging folks to access the care they need, spreading accurate information about policy changes, and continuing to inform representatives about public support for health care access are the most effective ways to keep ourselves and our neighbors safe and healthy in the coming years.
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In 2024, HLA staff provided legal representation in 1,523 cases, some involving numerous clients and legal issues. We recorded a city or town of residence for our client(s) in 1,461 of our cases. The above map shows the number of cases HLA handled in each city and town in the Commonwealth, with darker blue shading representing more cases. Our team represented clients from 216 different cities/towns in 2024!
Interested in how many cases HLA worked on in your town? Check out the full list below:
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o Abington: 2
o Acton: 2
o Acushnet: 1
o Adams: 1
o Agawam: 1
o Amesbury: 2
o Amherst: 8
o Andover: 1
o Ashburnham: 3
o Arlington: 7
o Ashby: 1
o Ashland: 9
o Athol: 6
o Attleboro: 12
o Barnstable: 18
o Becket: 1
o Bellingham: 6
o Belmont: 1
o Beverly: 17
o Billerica: 7
o Blackstone: 2
o Bourne: 2
o Boston: 178
o Boxford: 2
o Braintree: 5
o Brewster: 2
o Bridgewater: 2
o Brimfield: 1
o Brockton: 50
o Brookline: 10
o Burlington: 4
o Cambridge: 18
o Canton: 6
o Carver: 2
o Charlemont: 1
o Chatham: 1
o Chelmsford: 4
o Chelsea: 32
o Cheshire: 1
o Chicopee: 6
o Clinton: 2
o Cohasset: 1
o Concord: 1
o Dalton: 1
o Danvers: 5
o Dartmouth: 6
o Dedham: 2
o Dennis: 3
o Dighton: 1
o Dracut: 9
o Dudley: 1
o Duxbury: 1
o East Bridgewater: 1
o East Longmeadow: 1
o Easthampton: 5
o Eastham: 1
o Easton: 1
o Edgartown: 1
o Everett: 16
o Fairhaven: 3
o Fall River: 24
o Falmouth: 2
o Fitchburg: 17
o Foxborough: 2
o Framingham: 37
o Franklin: 3
o Gardner: 9
o Gloucester: 5
o Grafton: 5
o Granby: 1
o Great Barrington: 2
o Greenfield: 4
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o Groveland: 1
o Hampden: 1
o Hamilton: 2
o Harwich: 2
o Haverhill: 33
o Heath: 1
o Holbrook: 3
o Holden: 2
o Holyoke: 20
o Hopkinton: 1
o Hubbardston: 2
o Hudson: 1
o Hull: 1
o Kingston: 1
o Lancaster: 1
o Lanesborough: 1
o Lawrence: 42
o Lee: 1
o Leicester: 1
o Lenox: 1
o Leominster: 12
o Lexington: 5
o Lincoln: 1
o Longmeadow: 1
o Lowell: 35
o Ludlow: 4
o Lunenburg: 1
o Lynn: 29
o Lynnfield: 1
o Malden: 27
o Mansfield: 2
o Marblehead: 1
o Marlborough: 17
o Marshfield: 1
o Mashpee: 1
o Mattapoisett: 3
o Maynard: 2
o Medfield: 2
o Medford: 8
o Medway: 2
o Melrose: 5
o Mendon: 1
o Methuen: 23
o Middleborough: 5
o Middleton: 3
o Milford: 6
o Millbury: 1
o Montague: 5
o Millis: 2
o Milton: 3
o Natick: 4
o Needham: 3
o New Bedford: 29
o Newton: 15
o Norfolk: 2
o North Adams: 2
o North Andover: 6
o Northbridge: 5
o Northampton: 3
o Northborough: 2
o North Reading: 1
o Northfield: 1
o Norton: 1
o Norwood: 9
o Oak Bluffs: 1
o Oakham: 1
o Orange: 2
o Out of state: 5
o Oxford: 4
o Palmer: 4
o Paxton: 2
o Peabody: 9
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o Pelham: 1
o Pembroke: 2
o Pepperell: 1
o Pittsfield: 13
o Plainville: 3
o Plymouth: 5
o Princeton: 2
o Provincetown: 1
o Quincy: 17
o Randolph: 10
o Raynham: 4
o Revere: 12
o Rockland: 5
o Rockport: 4
o Rowley: 1
o Rutland: 1
o Salem: 10
o Sandwich: 2
o Saugus: 8
o Scituate: 1
o Sharon: 1
o Shelburne: 1
o Shirley: 1
o Shrewsbury: 2
o Shutesbury: 1
o Somerset: 2
o Somerville: 17
o South Hadley: 1
o Southbridge: 7
o Spencer: 3
o Springfield: 59
o Sterling: 3
o Stockbridge: 1
o Stoneham: 7
o Stoughton: 5
o Sturbridge: 1
o Sudbury: 3
o Sutton: 1
o Taunton: 16
o Tewksbury: 2
o Townsend: 1
o Truro: 1
o Tyngsborough: 1
o Uxbridge: 2
o Wakefield: 2
o Walpole: 4
o Waltham: 23
o Ware: 4
o Wareham: 14
o Warren: 2
o Watertown: 5
o Webster: 10
o Wellesley: 1
o Wellfleet: 1
o West Springfield: 3
o West Tisbury: 1
o Westborough: 3
o Westfield: 4
o Westford: 2
o Westhampton: 1
o Westminster: 1
o Westwood: 1
o Weymouth: 9
o Wilbraham: 1
o Williamstown: 1
o Williamsburg: 1
o Wilmington: 2
o Winchester: 1
o Winthrop: 3
o Woburn: 8
o Worcester: 43
o Wrentham: 1
o Yarmouth: 5
| | CELEBRATING MILESTONES & WELCOMING NEW STAFF | | Staff members gathered together on February 12th to celebrate Marisol's 10 years at HLA. | |
Matt's 20 Years
For the past 20 years, Matt Selig has been a driving force in advancing HLA’s mission to ensure health care access for Massachusetts residents with low-income. As HLA’s third and longest-serving executive director, Matt has led the organization in substantially expanding our legal representation of clients, strengthening our ability to advocate for more equitable policies, and engaging with community members. His commitment to building partnerships, diversifying funding, and enhancing operational efficiency has enabled HLA to broaden its reach, deepen its impact, and build a sustainable foundation for the future.
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Mari's 10 Years
During her decade at HLA, Deputy Director Marisol Garcia has made a profound impact on the lives of young people across Massachusetts. She spearheaded the expansion of MHAP for Kids, growing the program to a dedicated team of 23 lawyers and paralegals advocating statewide for youth to access essential mental health care. She championed children’s mental health at the state house and successfully advocated for millions in funding to ensure MHAP for Kids can advocate for more young people.
| | Congratulations, Matt and Mari, on this incredible achievement! Thank you for years of service, dedication, and leadership. You have made a lasting difference, and we are profoundly grateful for all you do! | | New MHAP for Kids Attorney: Eva Conroy | |
Eva Conroy
Eva is a Staff Attorney with the Mental Health Advocacy Program (MHAP) for Kids, serving families at the MOC Fitchburg Family Resource Center. Prior to joining HLA, Eva was a Trial Attorney in the Children and Family Law Division of the Committee for Public Counsel Services. As a trial attorney, she represented families facing state intervention, assisted parents and children navigating forced family separation, and advocated for clients in various juvenile court proceedings. Eva earned her J.D. at Northeastern University School of Law and a B.A. at Emory University.
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Health Law Advocates
70 Franklin Street, Suite 500 | Boston, MA 02110 | 617.338.5241 | www.healthlawadvocates.org
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