Strategic Grants to Alleviate Medical Debt in Eastern MA

Eliminating Nearly Half a Billion Dollars in Medical Debt

Overview

In this initiative, we are investing nearly $10 million with the aim to relieve half a billion dollars in medical debt, on behalf of low- and middle- income residents of Eastern Massachusetts.

We are collaborating with Undue Medical Debt, Health Law Advocates, Health Care for All, and several community-based organizations and Financial Opportunity Centers across Eastern Massachusetts.

In two years, since 2025:

  • Undue Medical Debt abolished $84 million in medical debt for over 52,000 people in Eastern Massachusetts. 

  • Health Law Advocates (HLA) represented hundreds of clients across Eastern Massachusetts on medical debt issues. Over two years, HLA has eliminated $2.5M of medical debt for its clients.  

  • Advocates and coaches at community-based organizations and Financial Opportunity Centers across Eastern Massachusetts have identified hundreds of people with medical debt and helped refer them for assistance. With Health Law Advocate’s mentorship, they have begun to directly help clients resolve their medical debt.

  • Health Care for All elevated medical debt as a central health policy and health equity issue in Massachusetts.

Background:

The Atrius Health Equity Foundation aims to close the gap in life expectancy across neighborhoods in Eastern Massachusetts. Medical debt hurts families economically and impedes access to care. What’s more, it disproportionately affects communities of color. Statewide, 17.9% of Black residents report that someone in their family has medical debt, compared with 13.6% of White residents. Medical debt is also projected to increase, due to federal policy changes enacted in 2025. With over 1 in 8 Massachusetts residents facing this burden, we are dedicating close to $10 million over five years to alleviate medical debt in Eastern Massachusetts. With this funding, we aim to relieve nearly half a billion dollars in debt, on behalf of low- and middle-income residents of Eastern Massachusetts. 

Under this initiative, we are currently funding the following organizations:

  • Undue Medical Debt is a national non-profit organization that acquires and abolishes medical debt from health care providers for people with low to moderate incomes (below 400 percent of the Federal Poverty Level and/or with debt that is 5% or more of household income). Since its founding in 2014, Undue Medical Debt has acquired and abolished $25 billion in medical debt for 15 million individuals.

  • Health Law Advocates (HLA) is a non-profit public interest law firm in Massachusetts and the state’s leading provider of pro bono legal representation to residents with low incomes experiencing difficulty accessing or paying for needed medical services. HLA represents consumers who are being pursued by providers and collectors for unaffordable and sometimes incorrect medical bills.

  • Financial Opportunity Centers: These organizations play a vital role in promoting the financial well-being of community members by providing financial counseling, education and advocacy. As part of this program, HLA is training Lawrence Community Works and The Neighborhood Developers’ CONNECT staff to identify and support clients who are facing medical debt.

    • Lawrence CommunityWorks, Inc. (LCW) is a community development corporation founded in 1986 that weaves together community planning, organizing, and asset-building efforts with high-quality affordable housing and commercial development to create vibrant neighborhoods and empowered residents. LCW helps people build assets through homeownership, education and training, and financial planning and counseling.

    • The Neighborhood Developers (TND) is a community development corporation founded in 1978, which serves Chelsea, Revere, and Everett. TND develops and preserves affordable housing and provides services to help clients gain economic independence and self-sufficiency. The CONNECT financial opportunity center at TND offers financial and career coaching, free tax prep, and referrals to education and training opportunities, among other supports.

  • Health Care For All (HCFA) is a non-profit organization and the leading state-wide consumer health advocacy organization in Massachusetts. HCFA is working with a diverse set of stakeholders, including community-based organizations (CBOs), to develop and secure policy solutions to permanently reduce the burden of medical debt in Massachusetts. HCFA is currently partnering with the Brazilian-American Center (BRACE), Cambodian Mutual Assistance Association of Greater Lowell, Immigrants’ Assistance Center, Pinnacle Partnerships and Women Encouraging Empowerment.

We believe strongly in the power of cross-sectoral collaboration. By uniting community-based organizations with experts in health policy and law research, we are growing a powerful coalition to eliminate medical debt in Eastern Massachusetts. 

Medical Debt Initiative Event (April 2025, Boston, MA)
PRESS RELEASE: ELIMINATING $30M IN MEDICAL DEBT IN EASTERN MASSACHUSETTS
NEWS: ELIMINATING $30M IN MEDICAL DEBT IN EASTERN MASSACHUSETTS

Consumer Stories of Impact (* all names have been changed)

  • Adam, a Bristol County resident in his 40s, faced insurance denials amounting to nearly $16,000 in uncovered services. Adam’s employer-sponsored health plan denied the claims because he also had Medicare coverage. HLA  determined the private plan should have paid the claims as secondary coverage and requested a claim file related to the plan's denials. In response, the plan recognized its error and reversed the denials, covering the bills in full.   

  • Benny, a Massachusetts man in his 40s, had two medical bills totaling over $16,000 despite being enrolled in MassHealth Limited and the Health Safety Net at the time of service. HLA determined that Benny's providers had failed to send claims to MassHealth despite being legally obligated to do so. Through much advocacy, HLA forced the providers to file claims with MassHealth, which eventually covered the charges in full. Through the advocacy process, Benny was able to concentrate on his cancer treatments without having to worry about his medical debt.   

  • Diana, a Middlesex county resident in her 60s, incurred over $240,000 in medical debt due to an insurance denial of an emergency hospitalization and follow-up outpatient specialty care. Diana speaks and reads Cantonese, but not English, and her health plan denied payment for all services because a hospital staff person incorrectly designated the underlying condition as a work-related injury. The health plan’s follow-up letters to the client investigating this issue were confusing, intimidating, and only provided in English. HLA successfully appealed all the denials, securing coverage for the out-of-network emergency services and follow-up outpatient specialist services.  

  • Fong, an immigrant in her 40s with a history of severe trauma, had a mental health crisis that resulted in an ambulance ride to the ER, and then an inter-hospital transfer to a behavioral health hospital on the following day. On the dates of service, she was enrolled in a Connector Care plan, but the ambulance provider didn’t have her insurance information, so it billed her more than $3,000 for both rides. HLA ensured the ambulance company submitted a claim to her health plan for the first bill, which the health plan paid in full. The second bill proved more difficult because the provider failed to put in a prior authorization for non-emergency medical transportation. HLA sent a legal demand letter to the provider alleging unfair and deceptive billing practices based on this failure. Initially, the ambulance company offered to reduce the charges to approximately $800, which was still unaffordable. After HLA helped Fong submit a financial assistance application, the ambulance company wrote off her entire bill apart from $200 that she had already paid.  

How It Works:

Undue Medical Debt uses data analytics to pinpoint the debt of those most in need, by qualifying debt files based on whether the individual’s income is below 400% of the federal poverty level and/or their medical debt exceeds 5% of their household income.

They then buy, or receive via donation, debt from hospitals and other health care providers in large, bundled portfolios at a fraction of the original debt’s face value; on average, one dollar erases $100 of medical debt. 

Debt relief is source-based, meaning it cannot be requested. Recipients are qualified based on income and don’t need to apply. Once the debt is acquired, patients receive an Undue Medical Debt branded letter in the mail (instead of a letter from a collections company or another bill from the provider) informing them that their debt has been erased with no penalties or tax consequences. An announcement notifies the community when debt relief letters are on their way.

Medical Debt Abolishment Letters

The $1 Difference

One in eight Massachusetts residents faces the burden of medical debt. Medical debt can be abolished at pennies on the dollar. Just $1 of contributed funds can retire over $100 worth of debt.  

Local initiatives have the chance to wipe out medical debt and reduce racial inequities.  

Learn more about our plan in this Boston Business Journal article (2024). 

Frequently Asked Questions (FAQs)

How Can I Help?

If you are a hospital or health care provider who would like to donate or sell your medical debt, please contact Undue Medical Debt or email us at the Foundation at info@atriusfoundation.org. 

If you are an individual or organization who would like to support the policy campaign to reduce medical debt, please email Marcella Lampon at Health Care For All. 

If you are a funder who would like to join us in purchasing and abolishing debt, please contact the Foundation at info@atriusfoundation.org.