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Layla's Story: The Harms of
School Discipline in Preschool
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At four years old, Layla is a confident child who loves to be a leader in her preschool classroom. According to her mom Natasha, Layla thrives in a space that allows her to be her authentic, confident self.
Two months into the school year, Layla’s teacher left unexpectedly, and her preschool class was moved to a different classroom. The disruption to her routine was difficult, and Layla’s behavior began to change. As an English language learner, she often struggled to communicate her emotions and, when overwhelmed, sometimes lashed out physically — biting or pushing when frustrated.
One day, when Layla wasn’t allowed to be the line leader, she pushed a classmate. The teacher responded by calling the school’s crisis team and calling Layla’s parents to pick her up. When her father, Jullisses, arrived, he was horrified to find his young daughter surrounded by five adults yelling and pulling at her backpack.
| | Layla at her preschool graduation. | | |
After that day, calls from the school became routine. Natasha and Jullisses were asked to pick Layla up early multiple times each week. Meanwhile, Natasha continued to advocate for Layla to receive a language assessment and services to help with her communication skills, but the school dismissed those concerns, insisting the interventions were unnecessary. Already coping with postpartum depression, Natasha said the stress of Layla’s struggles and the lack of school support sent the family “into a really dark hole. I knew something was wrong, this wasn’t normal," says Natasha.
Layla’s teachers continued to send her to the principal’s office almost daily. On one occasion this past December, Layla was in the principal’s office for hours. Feeling frustrated and ignored, she tried to get the principal’s attention by biting her. The school responded by sending Layla home with an emergency removal for three days.
Worried this would lead to the school suspending Layla, Natasha contacted HLA's Mental Health Advocacy Program (MHAP) for Kids’ and was connected with Elaine Marshall, MHAP for Kids' School Discipline Advocacy Program (SDAP) Fellow. Elaine jumped into action, and demanded that, if Layla were to be removed again, the school conduct a manifestation determination review — a legal safeguard to assess whether Layla’s behavior was connected to a potential disability. After Elaine started working with Layla’s family, Layla was not removed from her classroom again.
Elaine worked with Natasha and Jullisses to review Layla’s special education evaluations and helped them understand the options available. In Layla’s Individualized Education Program (IEP) eligibility meeting, Natasha described how Elaine was able to “speak [the school’s] language,” and effectively facilitate a conversation about what Layla needs.
In early February 2025, Layla and her family toured a new school that was recommended by her school district due to their smaller class sizes and language services. Layla started at the school the following week and is now thriving in the new environment. She no longer goes to school afraid of being seen as the "bad kid," and her parents have not been called once by the new school to pick Layla up for behavioral issues. HLA is continuing to work with the family to ensure Layla receives the services she is entitled to in order to succeed in this new school.
“It was a turning point for us to have Elaine on our side,” Natasha emphasized, “As immigrants, we tend to take what we get. I don’t think I would have known those options or understood my rights completely without Elaine.”
Learn more about MHAP for Kids here.
| | Marcelo's Story: Ensuring Access to Emergency Medical Supplies for Immigrants | | |
Marcelo* emigrated to the United States from Portugal in the early 1990s. He settled in Massachusetts and now lives close to his extended family. In 2020, at the age of 59, Marcelo was diagnosed with Amyotrophic Lateral Sclerosis (ALS).
As his ALS became more severe, he required a BiPAP machine to help him breathe. In 2023, HLA represented Marcelo and won an upgrade of his MassHealth benefits, which then covered his ventilator and additional supplies. But, in 2024, MassHealth reduced coverage for certain categories of immigrants. When Marcelo went to renew his insurance, he was downgraded to MassHealth Limited, a plan designed to cover only emergency health services for immigrants. This meant that Marcelo’s BiPAP machine was no longer covered.
“That machine is by his side 24/7. He could not live without it,” Marcelo’s nephew Fernando* explained.
Marcelo and his family received numerous calls from the BiPAP machine supplier because they suddenly stopped receiving payments from MassHealth. They even threatened to come take away the ventilator from Marcelo if they did not receive payment. A nonprofit organization that provides resources and supplies for people with ALS loaned Marcelo a BiPAP machine. Unfortunately, this ventilator did not function in the same way and was not as effective. The out-of-pocket cost for this machine is $10,000, which would have placed a significant financial burden on Marcelo and his family.
After learning about Marcelo’s downgrade in insurance, HLA Staff Attorney Kyra Sweeney worked swiftly to draft a letter to MassHealth leadership to explain why Marcelo's ventilator and supplies should be covered under MassHealth Limited. Since Marcelo cannot live without his ventilator and taking it away would cause a medical emergency, Kyra argued that the machine should be covered under MassHealth Limited. Despite initial resistance, Kyra kept advocating. Ultimately, Kyra's argument succeeded, and HLA ensured Marcelo’s BiPAP machine, and any supply refills he needs, were covered under his insurance.
“I could have sworn he wasn’t going to get coverage because of the current [political] climate,” Fernando admitted, “but Kyra did an amazing job.”
HLA believes that people with disabilities should have sufficient support to remain in their communities. Ensuring people with disabilities have the necessary supports to remain at home and in their communities is the primary focus of HLA's Advocating for Health Care At Home Initiative, which Kyra leads. If Marcelo did not have access to a ventilator in his home, he would be in a hospital or an institution, and could not spend as much time with his family.
“His nieces and nephews really keep him going, he lights up when he sees them,” said Fernando.
“[Fernando] is a really amazing advocate for his uncle,” Kyra adds, “I really enjoyed working with them.”
Learn more about HLA's Immigrant Health Care Access Initiative, which also supported this case, here.
*Names have been changed.
| | The Cost of Care: Medical Debt as a Barrier to Health Equity | | From left to right: Ashley Blackburn (HCFA), Chi Chi Wu (NCLC), Edily Velasquez (TND), and Jason Reis (HLA). | | |
On April 8th, Jason Reis, HLA's Medical Debt Advocate, spoke on a panel at the Atrius Health Equity Foundation's "Medical Debt & Health Equity in MA: What You Need to Know" convening at the Boston Bar Association. The event attracted dozens of health care stakeholders, including attorneys and lawmakers, and covered the wide-reaching and ever-present issue of medical debt. The event offered a fascinating overview of how medical debt affects the lives of thousands of health care consumers across the Commonwealth and built support for legislation and services to shield consumers from unaffordable -- and unwarranted -- medical bills.
Jason was joined by Chi Chi Wu, senior attorney at the National Consumer Law Center (NCLC), and Edily Velasquez, financial coach at The Neighborhood Developers (TND) in Chelsea. The panel was moderated by Health Care For All's (HCFA) Ashley Blackburn, who asked: Who is affected by medical debt? The answer: roughly 1 in 8 Massachusetts residents. The panelists shared their expertise and experience working with clients burdened by medical debt and the profound toll this debt takes on individuals and families.
To alleviate this crisis, the panel proposed a few solutions: strengthen hospital financial assistance, ban reporting medial debt to credit agencies, and reduce the rate of uninsured and underinsured health care consumers by restoring recent reductions in Health Safety Net eligibility. Additionally, HLA, with support from the Atrius Health Equity Foundation, is conducting ongoing conferences to inform community members and service providers how to identify and resolve medical debt, expanding capacity to combat medical debt across Massachusetts.
Thank you to the Atrius Health Equity Foundation for organizing this event and our partners in the fight for affordable health care for your advocacy and collaboration.
Read more about HLA's Medical Debt Initiative here.
| | The Big Ugly Bill: What Medicaid Cuts Mean for Health Care in Massachusetts | | |
Early in the morning on May 22nd, the U.S. House of Representatives narrowly passed the One Big Beautiful Bill Act. This budget reconciliation bill contains sweeping changes to Medicaid and the Affordable Care Act (ACA), including new work requirements, increased administrative burden, and a shorter enrollment period -- all of which are expected to result in millions of Americans losing their health care coverage, including more than 200,000 Massachusetts residents.
Over the past few weeks, HLA staff, along with our partners in the Massachusetts Coalition for Coverage and Care (MCCC) and the Immigrant Health Access Coalition (IHAC), examined how this bill will impact health care consumers, particularly those who rely on Medicaid. The bill will slash federal funding of our state's Medicaid program, MassHealth, by placing limitations on using provider taxes for Medicaid reimbursement, prohibit the use of Medicaid funds for gender-affirming care and abortions, and place further strain on health care providers.
The bill also takes aim at immigrant communities. With our IHAC partners, we found that many immigrants, already navigating a complex and exclusionary health care system, will face increased barriers to accessing coverage, and, in many cases, will lose coverage entirely.
| | In addition, people with disabilities will experience more disruptions in their care if this bill becomes law. Dennis Heaphy, an advocate with the Disability Policy Consortium and member of HLA's Board of Directors, spoke at a press conference alongside Governor Healey and members of the Massachusetts congressional delegation. He emphasized that Medicaid is essential for helping people with disabilities receive at-home health services that allow them to remain in their communities. The proposed cuts, Dennis warns, would jeopardize these vital services. | | HLA Board Member Dennis Heaphy speaking at a press conference alongside members of the Massachusetts Democrats about the Medicaid cuts. Photo by Brett Phelps for the Boston Globe. | | |
The ripple effects caused by the bill will impact our entire health care system. Michael Curry, President and CEO of the Massachusetts League of Community Health Centers, described at a recent MCCC meeting the devastating impact these cuts will have on community health centers across the Commonwealth. Also, when patients lose health care coverage, they often turn to emergency departments for care, resulting in overcrowding, longer wait times, and higher health care costs.
In response to this threat, HLA is taking action. When the ACA was at risk of being repealed in 2017, phone banking proved to be an effective tool to mobilize constituents to put the pressure on their representatives. The week following the passage of the House bill, we joined Health Care for All (HCFA) and SEIU 1199 in their Medicaid Defenders phone banking campaign and called constituents in key swing districts and were able to connect them directly to their congressional representatives to voice their opposition to Medicaid cuts.
“I had one woman who said she had already called her Congressman's office every day,” Emily Tabor, Manager of Donor Relations and Events, said when describing a constituent who asked to be patched through to her Congressman's office to voice her opinion again.
The One Big Beautiful Bill Act is now in the Senate. On June 16, the Senate Finance Committee published their version of the bill, which proposed deeper cuts to Medicaid and excludes even more immigrants from receiving coverage. With the August deadline for raising the debt ceiling approaching quickly, the Senate will look to pass the bill by the end of June. The House and Senate will have to vote again on an identical version of the bill again before it goes to the President’s desk.
The bottom line is clear: health care for millions of Americans is under serious threat. But while this "One Big Ugly Bill" looms large in Washington, HLA and our partners remain steadfast. We will continue to band together with colleagues, community members, and fellow advocates to fight for the right to health care for all.
Interested in joining the campaign to defend Medicaid? Email Emily Tabor at etabor@hla-inc.org.
| | 10 Years of Data: New Report Shows Families Continue to Thrive with MHAP for Kids | | |
In March 2025, the Boston University School of Public Health (BUSPH) released its latest report on the impact of HLA's Mental Health Advocacy Program (MHAP) for Kids titled Mental Health Advocacy Program for Kids Report of Baseline and Follow up Evaluation Data March 2017-November 2024.
BUSPH has been collecting data and evaluating MHAP for Kids since the program was first piloted as J-MHAP in 2015. Ten years of analyzing this data have proven that MHAP for Kids improves the mental health and educational success of children across Massachusetts. Attorneys achieve these outcomes by providing individualized legal assistance to help children access mental health services and divert them from the juvenile court system.
Trends Over 10 Years
Since the program originated in Essex and Middlesex counties, MHAP for Kids has expanded to serve families throughout the entire Commonwealth. The program has attorney based in 15 Family Resource Centers located from one end of the state to the other. MHAP for Kids attorneys have represented 3,282 youth between March 2017 and November 2024 (see Figure 1). The average age of clients has decreased from 16 years old in BUSPH’s 2017 report to 12 years old in the current report. The decline in the average age suggests that MHAP for Kids has successfully reached kids further upstream -- before they experience more intensive interventions or court involvement. This is in part due to the shift in client referral sources. In the early years of the program, MHAP for Kids received most referrals from the Essex and Middlesex juvenile courts. However, BUSPH found that health care organizations now provide the most referrals to MHAP for Kids, likely due to strengthening our partnership with Accountable Care Organizations (ACOs).
| | Figure 1 from BUSPH's report Mental Health Advocacy Program (MHAP) for Kids Report of Baseline and Follow up Evaluation Data March 2017-November 2024. Note: This graph illustrates client enrollment in MHAP for Kids from March 2017 to November 2024, with the orange line representing total enrollment and the blue line representing enrollment by quarter. | | |
Collecting the Data
BUSPH Fellows and MHAP for Kids paralegals collect data from families through interviews and questionnaires, both before and after a case is handled by an HLA attorney. Baseline information is gathered prior to attorney assignment, and follow-up data is collected at case closure. They collect data on children and families’ risk factors, barriers to accessing services, and engagement with different services. The report uses this data to assess the association between staff attorney involvement and youth and family outcomes.
Consistent Positive Outcomes
Based on data collected at both baseline and follow-up, the report found statistically significant improvements in youth mental health and overall family functioning. Parents also experienced mental health gains, with fewer reporting symptoms of depression after working with MHAP for Kids. In addition, parents reported feeling less financially strained—an important outcome, as families often face job disruptions or income loss when trying to manage their child’s mental health needs.
| | Figure 2. This graph illustrates the percentage of families served by MHAP for Kids who are utilizing different mental health services at baseline and follow-up. | | |
The report also found a decline in the need for intensive, costly interventions such as inpatient hospitalization (33% reduced to 15%), visiting the emergency room (43% reduced to 19%), and in-home mobile crisis team services (42% reduced to 24%). MHAP for Kids attorneys connect children with more appropriate, community-based services. For example, there was an increase in families accessing school services including specialized classrooms and school placements.
| | | Families reported that they encountered fewer barriers to care after working with MHAP for Kids. There was an increase from 3% to 10% in people who reported experiencing no barriers to care at all. Additionally, there was a reduction in families experiencing barriers related to bureaucratic delays, incomplete information, and distrust of professionals. MHAP for Kids continues to effectively work towards HLA's mission of achieving universal access to high quality health care across Massachusetts. | | |
Sharing the Results with Stakeholders
On June 17, HLA hosted a virtual event to share the findings of the new BUSPH reports. Over 50 stakeholders joined the call, including staff and representatives from the MA State House, Department of Children & Families (DCF), Family Resource Centers, hospitals, and other state agencies. Johanna Cuello, former client of HLA Attorney Toni Kokenis, spoke about her experience trying to access services for her son, Johnathan, who has autism and struggled in school. She shared how Toni helped her access an out-of-district placement for Johnathan that is more appropriate for his needs. Dr. Trish Elliot, professor at BUSPH and lead researcher for its evaluation of MHAP for Kids, broke down the data from the newest reports and shared some of the trends she observed about the program through collecting and analyzing data over the past 10 years. A recording of the virtual event can be found here.
We are so grateful for our partnership with BUSPH, particularly Dr. Trish Elliot and Isabel Redman for their incredible work and support. Their evaluation is critical in helping HLA demonstrate MHAP for Kids' continued impact on families across the Commonwealth.
Thank you to our partners in the State House for your support and investment in children's mental health, without whom, the expansion of MHAP for Kids would not be possible.
Read the quantitative report here and the qualitative report here.
| | Save the Date for HLA's 30th Annual Benefit Breakfast! | | |
Thursday, November 20, 2025
Sheraton Boston Hotel
39 Dalton Street
Boston, MA 02199
Coffee Hour 7:00 a.m.
Main Event: 8:00 a.m.
We hope to see you there!
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Lois Cornell
Executive Vice President
Massachusetts Medical Society
| | | WELCOME, SUMMER LAW CLERKS! | |
Morgan Salmon
Morgan is a rising 2L at Suffolk University Law School with a B.A. in Economics from Clark Atlanta University. Her passion for mental health and youth advocacy grew out of her work with nonprofit organizations focused on promoting health and wellness, particularly in combating youth tobacco use. This summer, she is excited to join Health Law Advocates to deepen her understanding of health care advocacy and further explore the intersection of law and health
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Tania Carrizales
Tania grew up in Eagle Pass, Texas and is a rising 2L at Notre Dame Law School. After graduating with her BA in Biology cum laude from Texas A&M International University in 2018, Tania worked in the education and nonprofit health care spheres. Tania is actively engaged with the Hispanic Law Student Association and LGBTQ+ Law Forum at Notre Dame and is excited for her upcoming involvement with the Project for the Defense of Mexican Nationals at NDLS’s exoneration clinic. Tania is especially passionate about advocating for immigrant communities and hopes to center her legal career in the service of underrepresented groups. In her free time, she enjoys cheering for Mexico’s national soccer team, running a very slow mile, and watching nature documentaries.
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Rebekah Collins
Rebekah is a rising 2L student at Suffolk University Law School (Suffolk Law). She is originally from Springfield, Illinois. She is a graduate of Tuskegee University (English, BA), and Penn State University (Criminal Justice, MA). Prior to starting law school, she was an FBI Intelligence Analyst where she worked on international human rights, civil rights, public corruption, false claims act, health care fraud, counterterrorism, violent crimes against children, human trafficking, and all other violent crime threat programs. Currently, she participates in Suffolk Law’s Progress to Success, Black Law Students Association, Health and Biomedical Law Society, and Women’s Law Association. She is grateful and excited for this incredible opportunity to work with Health Law Advocates.
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Candace Stewart
Candace is passionate about health systems management, policy advocacy, and health equity. She is currently a third-year law student (3L) at Northeastern University School of Law with plans to ultimately work in health equity policy advocacy. She is excited to gain hands-on legal experience as a law clerk on the Affordable Access to Care & Coverage (ACC) Team at HLA.
| | We are excited to have Morgan, Tania, Rebekah, and Candace with us supporting our two legal legal teams, MHAP for Kids and Access to Care and Coverage. HLA is proud to share our experience and lift up the next generation of public interest lawyers. | | | | |
