Jaxston is five years old and lives in Dartmouth with his mom, Cathleen, and two older siblings. Like most five-year-olds, Jaxston has a lot of energy and is learning (and pushing) boundaries. But, Cathleen realized early on that his behavior went beyond tantrums and "normal boy behavior."

"Jaxston started acting out at two years old and I knew something wasn't right," says Cathleen.

Cathleen took Jaxston to a neuropsychologist and he was diagnosed with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). At two-years-old, Cathleen felt it was too early to prescribe Jaxston medication, and his doctor agreed.

In order to return to a regular work schedule, Cathleen enrolled Jaxston in a day care program when he was two-years-old. Within a few weeks, Jaxston received disciplinary action. After an incident with another student, Jaxston was expelled. Cathleen requested an evaluation of Jaxston from Child and Family Services (CFS), but he was found ineligible for special placement. Yet Cathleen could not find any school environment that could manage his behavior. Jaxston was too young to receive serious behavior management treatment and too high need for standard day care.

By the time Jaxston was expelled from his second school, Cathleen was at a loss. “I went to (a child serving agency's) office and said, ‘I’m not leaving until you help me.’ And I stayed in that office. I needed someone to pay attention to my son.” Finally Cathleen was able to obtain a referral to a neuropsychologist. After an assessment, Jaxston, at only age four, was placed on medication.

When Jaxston entered pre-kindergarten at a public school in Dartmouth, his behavior intensified and he was eventually expelled. As Cathleen scrambled to find a school placement and mental health care for her son, she began to feel trapped by the inefficiency in children’s mental health care.

“It’s a domino effect. I couldn’t find any place that would take Jaxston. I ended up resigning from my job of 16 years and applied for unemployment because taking care of him was a full-time job.”

That’s when Cathleen found Kendal Poirier, an attorney with HLA's Mental Health Advocacy Program (MHAP) for Kids. “Kendal walked me through everything. She fought for Jaxston and knew how to get him the services he needed.”

Attorney Poirier was able to secure Jaxston a comprehensive evaluation that made him eligible for schools in the South Shore that specialize in, not only managing Jaxston’s behavior, but teaching him the skills to manage his own behavior. “Kendal came with me to tour the schools. She asked questions I would have never thought of,” Cathleen says. “There is no way Jaxston would be getting the support he needs without Kendal. He is learning how to regulate and has ongoing therapy.”

“What makes this case so compelling is the degree of disciplinary action that Jaxston received. Can you imagine expelling a four-year old?” says Kendal.

Cathleen’s experience is similar to many parents’ experience navigating the complicated world of children’s mental health care and their education. For MHAP for Kids attorneys, their clientele receives the bulk of their mental health services in their school placement. There are many hurdles to finding placement in a school that effectively supports children's behavioral management.

“Jaxston will be six this month and is doing so good. Just the other day, I was cooking food and something went wrong and I had a strong reaction to it. Jaxston says, ‘mommy, do you want to go the calming room?’ He is noticing the signs in himself and even in other people. He has done a 180 and it’s all because of Kendal.”

Learn more about MHAP for Kids here.

Dr. Indranee Rajapreyar is a physician specializing in advanced heart failure and heart transplantation at Tufts Medical Center. In November 2024, she met E.S. in the ICU. E.S. was experiencing acute heart failure and required a heart transplant. However, E.S.’ MassHealth Limited insurance plan would not cover the surgery. 

Once Dr. Rajapreyar learned of the limitation in her patient’s coverage, she quickly searched for help. As each day passed, E.S.'s health status became more complicated and threatened E.S.'s chances of survival.

After reaching out to several other organizations to no response, Dr. Rajapreyar took a suggestion from her colleague at Tufts and decided to call HLA. HLA Paralegal Evan Saito connected with Dr. Rajapreyar that day.

“HLA understood the urgency of the situation,” Dr. Rajapreyar says, praising HLA’s rapid response time.

Evan put her in touch with Supervising Attorney Jennifer Cedor. With E.S. having only their expired Italian visa waiver and no other documents, Jen was able to upgrade their coverage to MassHealth Family Assistance within a couple of hours.

“Jen worked really quickly to turn this around for us,” says Dr. Rajapreyar. Despite her low level of optimism when she first reached out, Dr. Rajapreyar describes feeling grateful for HLA’s efficiency and understanding of the situation. E.S. underwent a successful heart transplant and remains in stable condition at Tufts Medical Center.  After further advocacy with MassHealth, Jen was eventually able to upgrade E.S. to MassHealth Standard, the most comprehensive public insurance coverage available.  

HLA staff joined staff from the Atrius Health Equity Foundation, Health Care For All and the Brazilian American Center (Framingham), the Cambodian Mutual Assistance Association (Lowell), the Immigrants' Assistance Center (New Bedford), Lawrence Community Works, The Neighborhood Developers (Chelsea), NeighborWorks Housing Solutions (Quincy), Pinnacle Partnerships (Brockton), Women Encouraging Empowerment (Revere), and Urban Edge Housing Corp. (Boston/Roxbury) at Bentley University on August 8th to kick off our collaboration ahead of our Monthly Medical Training Series launched on October 8th.

Massachusetts is the leading state in health insurance coverage. Yet, nearly half of Massachusetts residents (41.3%) reported that they have difficulty paying their medical bills, and nearly one-third (28.8%) forego treatment solely due to cost according to the Center for Health Information and Analysis. Medical debt poses serious obstacles to health care, other basic necessities, and financial stability for many, especially among lower to middle income, and Black and Hispanic Massachusetts, residents.

Relieving and preventing medical debt has been a longstanding pillar of HLA’s work. Hundreds of individuals call HLA’s intake line each year seeking help to resolve their medical debt. A generous grant from the Atrius Health Equity Foundation, as well as support raised through a special appeal at our 2023 Benefit Breakfast in which Coverys, Community Care Cooperative and the Whistleblower Law Collaborative matched donations from attendees, allowed us to expand our Medical Debt Initiative in 2024.

As part of this program expansion, HLA, in partnership with the Atrius Health Equity Foundation, Health Care For All, and Undue Medical Debt, launched a monthly Medical Debt Training Series for nine community-based agencies.

Our monthly Medical Debt Training Series empowers the staff of our partner organizations to assist their clients by training them how to 1) identify medical debt and causes of medical debt, 2) identify a medical bill, and 3) know when to refer their clients to HLA when legal representation is needed.

The community-based agencies we are proud to work with are: the Brazilian American Center (Framingham), the Cambodian Mutual Assistance Association (Lowell), the Immigrants' Assistance Center (New Bedford), Lawrence Community Works (Lawrence), The Neighborhood Developers (Chelsea), NeighborWorks Housing Solutions (Quincy), Pinnacle Partnerships (Brockton), Women Encouraging Empowerment (Revere), and Urban Edge Housing Corp. (Boston/Roxbury).

In August, HLA – with our partners in relieving consumer medical debt – conducted a full-day training at Bentley University with over 30 people representing the nine community-based agencies. Through presentations, small group work, and reviewing sample medical bills, advocates were given tools to better support their constituents.

In October and November, virtual trainings were held to address two distinct types of medical debt: debt incurred due to being underinsured by MassHealth, and debt incurred due to coverage gaps by private insurers.

Since September, we have seen an increase in medical debt referrals, primarily due to the Medical Debt Training Series. This quarter alone, HLA eliminated nearly $480,000 in medical debt, our highest quarterly total in the 13 years we have been collecting this data.

There is still a lot of work to do -- a large population of health care consumers continue to rack up unjust medical debt across Massachusetts -- but by sharing our expertise and partnering with community-based agencies, we can make an even bigger impact.

From left, Chris Hoeh, Jim Wice, Brian Shea, and Dan Simon demonstrated outside Governor Maura Healey's office at the State House to protect access to a Massachusetts home care program. Courtesy of Boston Center for Independent Living via the Boston Globe.

Across the state, at-home health care is a necessary service for many consumers who have disabilities. They allow individuals to stay at home, with their families, and in their communities. HLA has been a longstanding partner with disability rights organizations to advocate for quality and affordable at-home health care. In 2024 alone, HLA represented more than 90 consumers who had their services reduced or cut completely (including representing Rosie and successfully reinstating all 88 personal care attendant hours she relies. Watch the video here).

Currently, community-based organizations (CBOs) and independent living centers evaluate the medical needs of consumers with disabilities who receive at-home health care, such as personal care attendants (PCAs) and home health aides, to ensure they are getting the appropriate care. But earlier this year, MassHealth proposed to reform this assessment process. Instead of individuals who are fairly familiar with the scope of their patient’s medical needs, MassHealth proposed consolidating these entities and implementing a uniform process to conduct evaluations.

Many disability advocates, including HLA, expressed strong concern over what this policy would really mean for consumers who rely on at-home health care. The Boston Globe wrote in June, "For some, losing those few hours of home care could mean the difference between living at home and being forced into nursing care. For months, activists in the state’s disabled community have demonstrated and met with officials to prevent any PCA restrictions."

In partnership with Greater Boston Legal Services, Mass Law Reform Institute, and others, HLA submitted a letter strongly opposing the proposal. "The system is by no means perfect, but this proposed solution would not make things better. In fact, it would make things worse. A lot worse," says HLA Attorney Kyra Sweeney.

In response to the overwhelming response calling to drop the proposal, MassHealth formed the Implementation Advisory Council and began accepting applications to join. In September, roughly 30 stakeholders were accepted to serve on the Council: consumers, disability advocates (many of whom also rely on at-home health services), representatives of independent living centers, nurses, insurance providers, and Attorney Sweeney, the only legal aid representative on the council.

The Implementation Advisory Council began meeting in October and has since met more than once per month to review aspects of a new, more comprehensive policy proposal. In the next few months, a new policy is expected to be proposed. Attorney Sweeney is hopeful but knows there is still a lot of work to ensure whatever process MassHealth implements serves our clients. Attorney Sweeney says, "The process of getting evaluated for PCA services needs to be thorough and personalized. That determines how many hours a consumer can receive, which in turn, determines if they can stay at home."

Breakfast Recap

On the morning of Friday, November 15th, more than 600 health care lawyers, providers, insurance company officials, advocates and other esteemed guests convened at the Boston Sheraton Hotel to attend HLA's 29th Annual Benefit Breakfast.

The program was filled with updates on HLA’s work, stories from our clients, and remarks from featured speaker Suleika Jaouad. We had a surprise virtual visit from Massachusetts’ Attorney General Andrea Joy Campbell who shared how her team will continue to protect health care access in Massachusetts in the coming years. We heard from Lucy Lopes about how HLA's MHAP for Kids helped her access ABA services and residential care for her son. Ms. Jaouad, an Emmy Award winner, reflected on her journey following a leukemia diagnosis at the age of 22 with wisdom, humor, and candidness.

At the 29^th Annual Benefit Breakfast, we highlighted HLA’s work advocating for in-home and community-care for people with disabilities. We premiered “Rosie’s Story,” a client video that showcases how HLA’s attorneys advocate for clients with disabilities and ensure their access to vital in-home services. Up to $10,000 of donations made at the Breakfast were matched by Orrick LLP and Suzanne Durrell of Whistleblower Law Collaborative and earmarked for HLA’s health care at home initiative.

Thank you to all of our sponsors and attendees for helping us reach our fundraising goal which will allow us to continue protecting health care access for residents across Massachusetts. 

Rebecca Rodman and Lori Berry join HLA's Board of Directors

Rebecca Rodman

Senior Counsel

Husch Blackwell, LLP

Boston, MA

(she/her)

Rebecca is a Senior Counsel with a health care regulatory practice at Husch Blackwell, LLP. Previously she was General Counsel at the Massachusetts Department of Public Health. 

Lori Berry

Former CEO

Lynn Community Health Center

(she/her)

Lori is the former CEO of the Lynn Community Health Center, and was one of the founders of Community Care Cooperative (C3) - a community health center-operated accountable care organization. She is also currently a member of the Board of Directors of Health Care For All and serves as a management consultant to non-profit organizations.

Meet the new staff members who joined us in 2024

Health Law Advocates

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