Common MLP Activities
Click on the buttons in this interactive graphic to learn more.
Policy Change Strategies
Clinic-Level Changes
Legal Assistance
Training
What happened when the lights and heat got shut off?
Read how the MLP at Boston Medical Center responded.
Turning the Lights and Heat Back On
A Boston MLP Utilities Case Study
No heat or electricity meant asthma attacks, sickle cell pain, and the inability to refrigerate medicine for thousands of low-income people in Boston who could not afford their high, New England winter utility bills.
Click on the buttons for each step to see how the MLP team at Boston Medical Center responded.
Policy Change Strategies
Clinic-Level Changes
Legal Assistance
Training
Turning the Lights and Heat Back On
Legal Assistance
Healthcare team members at Boston Medical Center identified and referred families whose lights and heat been shut off to the MLP legal team. The legal team helped patients restore their utilities, set up payment plans with utility companies, and ensure future shutoff protection.
Utility Shut-off Protection Letters
Training
Massachusetts has laws in place to protect children, the elderly, and chronically ill individuals from having their utilities shutoff, but this protection required medical documentation that could only be provided by a physician. Attorneys, nurses, doctors, and other health care team members developed screening protocols to identify patients at risk for utility shut off, and attorneys trained doctors to write protection letters that included the correct information to demonstrate medical need.
During the first year of the project, physicians wrote letters protecting 193 people from having their utilities shutoff.
Improving the Law
Policy Change Strategies
There were still larger problems with the utility regulations. Only doctors, not nurses or nurse practitioners, were authorized to write and submit protection letters that additionally had to be re-certified every six months, even for medical conditions that were chronic and unchanging like sickle cell disease.Healthcare team members knew that these regulations created an undue burden on families and the clinics, and attorneys understood the process and timing of regulatory change and advocacy.
When the Massachusetts Department of Public Utilities announced a hearing to revise its utility shut off regulations, attorneys and healthcare team members submitted joint testimony that resulted in regulation changes reducing the need for chronic disease re-certification from 12 times per year to twice a year, and allowed nurses and nurse practitioners to write and submit letters.
As a result of the regulation changes, more than 10,000 people with asthma and 400 people with sickle cell disease seen annually at Boston Medical Center are at a significantly reduced risk of the health complications that arise from having their lights, heat, and air conditioning shut off during the year, while also reducing burden on the health care clinic.
Advocacy Through the EHR
Clinic-Level Changes
Widespread screening led to more referrals than the attorneys could handle. And doctors and nurses were spending too much time during patient visits drafting utility letters and consulting with the legal team. Healthcare team members recommended that a utility form letter be added to the patient Electronic Health Record (EHR). As the healthcare team got better at detecting need, they caught more cases before utilities were shutoff, and had an efficient solution embedded in the EHR to advocate for patients.
The next year, physicians wrote 350% more letters, protecting 676 people from having their utilities shut off.
Common MLP Activities
National Center for MLP
Created on June 16, 2025
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Transcript
Common MLP Activities
Click on the buttons in this interactive graphic to learn more.
Policy Change Strategies
Clinic-Level Changes
Legal Assistance
Training
What happened when the lights and heat got shut off?
Read how the MLP at Boston Medical Center responded.
Turning the Lights and Heat Back On
A Boston MLP Utilities Case Study
No heat or electricity meant asthma attacks, sickle cell pain, and the inability to refrigerate medicine for thousands of low-income people in Boston who could not afford their high, New England winter utility bills.
Click on the buttons for each step to see how the MLP team at Boston Medical Center responded.
Policy Change Strategies
Clinic-Level Changes
Legal Assistance
Training
Turning the Lights and Heat Back On
Legal Assistance
Healthcare team members at Boston Medical Center identified and referred families whose lights and heat been shut off to the MLP legal team. The legal team helped patients restore their utilities, set up payment plans with utility companies, and ensure future shutoff protection.
Utility Shut-off Protection Letters
Training
Massachusetts has laws in place to protect children, the elderly, and chronically ill individuals from having their utilities shutoff, but this protection required medical documentation that could only be provided by a physician. Attorneys, nurses, doctors, and other health care team members developed screening protocols to identify patients at risk for utility shut off, and attorneys trained doctors to write protection letters that included the correct information to demonstrate medical need. During the first year of the project, physicians wrote letters protecting 193 people from having their utilities shutoff.
Improving the Law
Policy Change Strategies
There were still larger problems with the utility regulations. Only doctors, not nurses or nurse practitioners, were authorized to write and submit protection letters that additionally had to be re-certified every six months, even for medical conditions that were chronic and unchanging like sickle cell disease.Healthcare team members knew that these regulations created an undue burden on families and the clinics, and attorneys understood the process and timing of regulatory change and advocacy. When the Massachusetts Department of Public Utilities announced a hearing to revise its utility shut off regulations, attorneys and healthcare team members submitted joint testimony that resulted in regulation changes reducing the need for chronic disease re-certification from 12 times per year to twice a year, and allowed nurses and nurse practitioners to write and submit letters. As a result of the regulation changes, more than 10,000 people with asthma and 400 people with sickle cell disease seen annually at Boston Medical Center are at a significantly reduced risk of the health complications that arise from having their lights, heat, and air conditioning shut off during the year, while also reducing burden on the health care clinic.
Advocacy Through the EHR
Clinic-Level Changes
Widespread screening led to more referrals than the attorneys could handle. And doctors and nurses were spending too much time during patient visits drafting utility letters and consulting with the legal team. Healthcare team members recommended that a utility form letter be added to the patient Electronic Health Record (EHR). As the healthcare team got better at detecting need, they caught more cases before utilities were shutoff, and had an efficient solution embedded in the EHR to advocate for patients. The next year, physicians wrote 350% more letters, protecting 676 people from having their utilities shut off.