Thirty years in, the non-profit health care access-focused law firm Health Law Advocates has no shortage of individual and systemic crises on its plate. 

On the monthly Health or Consequences episode of The Codcast, John McDonough of the Harvard TH Chan School of Public Health and Paul Hattis of the Lown Institute talked with Matt Selig, the executive director of Health Law Advocates about the day-to-day work of its 42 staff members and the “devastating” series of federal policy changes rolled out over the last year. 

Health Law Advocates represents about 1,500 people a year free of charge, Selig said. The group was created in 1995 by lawyer and advocate Steve Rosenfeld, inspired by his time volunteering to take calls on the Healthcare for All helpline. 

“A lot of people were calling about problems accessing healthcare, but they were actually legal issues, because the client’s rights were being violated,” Selig said. “But there was a gap, because there was no place that he could really refer them to for legal representation, because most of the callers couldn’t afford an attorney,” but they still made slightly too much to be eligible for legal help from groups who handle people on public benefits.  

Now in their 30th year and fielding thousands of calls every year, Selig said, Health Law Advocates check that potential clients are people who live in Massachusetts, make up to three times the federal poverty level, and have a healthcare access problem that staff can help them address. The income guidelines this year cover clients who make $46,950 as a single person or about $96,000 for a household of four. 

Their bread-and-butter work is includes medical debt problems or health insurance issues like problems qualifying for general enrollment or getting care to cover a specific service. Access to mental health care for young people is another broad area of focus, which involves representing families on issues in schools and special education programs, getting insurance coverage, services through state agencies, and advocacy in the juvenile justice system “where way too many kids with untreated mental illness end up,” Selig said. 

One example of their mental health work Selig offered involved a 4-year-old English language learner. The young girl can get physical when she becomes overwhelmed, he said, and had trouble coping when her preschool routine was disrupted. Once, she reacted badly to a change and pushed another student, “and when the dad came, she was surrounded by a group of, like, five adults yelling at her,” Selig said. 

Calls from the school became routine, with the parents told to pick their child up multiple days a week.  

“The little girl’s mom tried advocating with the school, to provide some services that could address these very clear emotional challenges that the 4-year-old was having,” Selig said. “But the school did not provide any support services whatsoever, and eventually, another incident led to the little girl being removed from the school for three days.” 

Health Law Advocates got involved after the suspension and made sure that if behavior problems occurred, the school would determine if it was related to her emotional disability. The child was able to stay in that preschool with these news systems in place until the legal group helped her family transition her to a new school. 

The non-profit has also worked to push state systems like MassHealth to improve care access. 

“Most of our policy advocacy involves improving the nitty-gritty of public policy,” Selig said. “The regulations and other policies and practices in the weeds that really affect access to healthcare as much, or sometimes even more, than statutes themselves, and are also easier to change.” 

During the episode, Selig, McDonough, and Hattis discuss the history and capacity of Health Law Advocates (3:00), their focus on children’s mental health and the worsening landscape of medical debt (20:00), and the risk to Massachusetts health care systems from federal policy shifts (28:45).