Help paying water bill and avoiding shutoff for medically vulnerable patients

Introduction

If you are living with a serious illness, disability, or complex health needs, running water is not optional. It supports safe hygiene, medication routines, wound care, and day to day health. When a water bill becomes unmanageable, it can feel urgent and frightening, especially if you have received a shutoff notice.

This guide walks you through practical steps to lower your bill, request protections, and find assistance. It is written for patients, caregivers, and older adults, and it focuses on steps you can take even if you are tired, stressed, or managing medical appointments.

Why avoiding a water shutoff matters for your health

Public health guidance emphasizes that many illnesses spread when people cannot wash hands with soap and clean, running water. Losing water service can also make basic personal hygiene harder during an illness, after using the bathroom, and when caring for someone who is sick.

Research on water insecurity describes how unaffordable water can push households to cut back on essential use, and how shutoffs are associated with stress and health strain in medically and financially vulnerable communities.

If you are older or managing a chronic condition, disruptions to hydration and daily routines can also increase risk, especially if it becomes harder to drink enough fluids and maintain safe hygiene.

If you have a shutoff notice, focus on these steps first

If a shutoff date is listed, treat it like a deadline. Acting early often gives you more options.

1. Call the water utility the same day you receive the notice.
2. Ask what amount is needed to stop the shutoff today, and whether a smaller payment can hold the account while you apply for help.
3. Ask about a payment plan, due date extension, or any customer assistance program (discount rate, income based plan, arrears forgiveness).
4. Ask whether the utility has a medical hardship policy or a medical certification process to delay shutoff when loss of service could worsen a medical condition.
5. Write down the date, the person you spoke with, and what they promised. Ask for confirmation by mail or email if possible.
6. If you are a tenant and the water account is in a landlord’s name, tell the utility right away. Some protections and processes are different for tenants.

A short script you can use on the phone

You can say:

• “I am calling because I received a shutoff notice. I need to keep water service on for health reasons. What are my options to prevent shutoff today?”
• “Can you place a temporary hold while I apply for assistance or set up a payment plan?”
• “Do you offer a medical hardship delay or medical certification for households where shutoff could worsen a serious illness or disability?”
• “What documents do you need, and what is the deadline to submit them?”

Ways to lower what you owe

Even when money is tight, you may be able to reduce the immediate amount due.

Ask for a review of your bill and usage

Consider asking the utility to review:

• Whether the bill is estimated versus based on a meter read
• Whether there was a recent rate change or fee you do not understand
• Whether a leak, running toilet, or irrigation issue could have spiked usage
• Whether the account shows missed payments you believe you made

If you find a likely leak or billing error, ask whether the utility offers a one time leak adjustment or bill correction.

Request a payment plan that matches your cash flow

Many utilities offer payment plans or budget billing. Helpful options to ask about include:

• A longer repayment period to spread out past due balances
• A lower required down payment to start the plan
• A due date change that better matches your income schedule
• Waived late fees or reconnection fees in hardship situations

If you are medically vulnerable, tell them that keeping service on is part of staying safe at home.

Customer assistance programs

Across the U.S., many water utilities operate customer assistance programs. These can include:

• A discounted “lifeline” rate
• Income based monthly bill caps
• Partial forgiveness of past due balances after on time payments
• Emergency grants funded locally

If your utility says there is no program, ask whether your city, county, or local community action agency has emergency utility funds.

Medical vulnerability protections you can ask about

Some locations allow a temporary delay of shutoff when a clinician certifies that loss of utility service could worsen a serious illness or disability. Policies differ widely, and they may depend on whether your utility is public, private, or regulated by a state commission.

Some state policies also explicitly recognize that water shutoffs can threaten health, with disproportionate impacts on older adults, people with disabilities, and people with serious medical conditions. Even if you are not sure what applies where you live, it is worth asking the question directly.

What to do:

1. Ask your utility whether a medical certification, medical hardship, or “serious illness” protection applies to water service.
2. If yes, ask for the exact form and submission deadline.
3. Contact your clinician’s office and request that they complete the form quickly. If you have a home health nurse or clinic social worker, they may also help coordinate this.
4. Use the delay to set up longer term help, such as a payment plan or assistance application.

How to request a clinician letter without oversharing

A medical certification usually does not need detailed diagnoses. In many programs, the key point is that loss of water service could worsen a medical condition or put someone at risk. If you are unsure what is safe to share, ask your clinician to keep it general and only include what the utility requires.

Where to look for help paying the water bill

Water bill assistance is often local. Start with the sources most likely to have direct funding or a way to negotiate with the utility.

Your local utility and city or county programs

Ask your utility if they partner with any of these:

• A customer assistance program administrator
• A community action agency
• A local nonprofit that runs emergency utility funds
• A senior services department or area agency on aging

2-1-1 and aging services

If you do not know what programs exist in your area, 2-1-1 can help you find local resources, and the Eldercare Locator can connect older adults and caregivers to aging services in their community.

If you heard about LIHWAP

The Low Income Household Water Assistance Program (LIHWAP) was a federal program that helped some households pay water and wastewater bills in prior years. Availability now depends on your state and local provider, and some areas may no longer have funds.

If a local agency mentions LIHWAP, ask whether funds are still available and whether there is an alternative program if not.

If your water is already shut off

If water service is off, focus on restoration and short term safety.

1. Call the utility and ask what is required to restore service, including any minimum payment and whether you can start a payment plan.
2. Ask whether a medical hardship process can speed reconnection if shutoff could worsen a serious illness or disability.
3. If your utility is regulated, contact the state utility consumer office to ask about complaint and reconnection options.
4. Use safe water sources for drinking, food preparation, and medication until service is restored. Follow public health guidance for personal hygiene during a water disruption.

If you are caring for someone who is medically fragile, contact their clinical team. They may help document urgency, coordinate home health needs, or connect you with a social worker.

Planning ahead when you have ongoing medical needs at home

If you rely on water for daily care tasks, a short plan can reduce stress and risk:

• Keep the utility’s billing and shutoff department phone number saved in your phone.
• Set a reminder to call as soon as a bill is late, not when a shutoff date is near.
• Ask your clinician’s office what documentation they can provide quickly if utility service is threatened.
• Keep a small emergency supply of potable water for short disruptions, especially if you have mobility limits or cannot easily leave home.

How Understood Care can help

If you are dealing with a shutoff notice while also managing health needs, it can help to have someone organize the steps with you.

Understood Care advocates can help you:

• Call the utility, understand your options, and request payment plans or temporary holds
• Gather documents for assistance programs and submit applications on time
• Coordinate with clinicians when medical documentation is needed
• Track deadlines, follow up, and keep a clear record of calls and letters

Learn more:

• Financial Help https://understoodcare.com/uc-articles/financial-help
• Application Help https://understoodcare.com/care-types/application-help
• Social Support https://understoodcare.com/care-types/social-support
• Care Coordination https://understoodcare.com/care-types/care-coordination
• Analyze Bills https://understoodcare.com/care-types/analyze-bills‍

FAQ

• How can I get help paying my water bill if I am medically vulnerable? Contact your water utility right away and ask about payment plans, customer assistance programs, and any medical hardship or medical certification options. If you need help finding local programs, call 2-1-1 or contact aging services.
• Can my doctor stop my water from being shut off? In some areas, a licensed clinician can complete a medical certification that temporarily delays a shutoff when loss of service could worsen a serious illness or disability. Policies and deadlines vary, so ask your utility what they accept and how quickly it must be submitted.
• What should I say to my water company to avoid shutoff? Tell them you received a shutoff notice and you need to keep water on for health reasons. Ask what payment today would stop shutoff, whether they can place a temporary hold, and what assistance programs or hardship protections exist.
• Is there a federal program to help pay a water bill? Some households received help through LIHWAP in prior years, but current availability depends on local agencies and remaining funds. Your utility, community action agency, 2-1-1, or aging services can tell you what is available now.
• What if my water is already shut off and I have a medical condition? Call the utility immediately and ask about reconnection requirements and any medical hardship process. If you have a clinician or home health team, ask them for urgent documentation and support.
• How do I find emergency water assistance near me? Your water utility may partner with local nonprofits or community action agencies. You can also call 2-1-1 for local referrals. Older adults can use the Eldercare Locator to connect with aging services.

References

• CDC: About handwashing (Clean Hands)
  https://www.cdc.gov/clean-hands/about/index.html
• CDC: Guidelines for personal hygiene during an emergency
  https://www.cdc.gov/water-emergency/safety/guidelines-for-personal-hygiene-during-an-emergency.html
• National Institute on Aging: Good hydration linked to healthy aging
  https://www.nia.nih.gov/news/good-hydration-linked-healthy-aging
• EPA: Water utility customer assistance programs compendium
  https://www.epa.gov/sustainable-water-infrastructure/water-utility-customer-assistance-programs-compendium
• PLOS Water: The high health risks of unaffordable water
  https://journals.plos.org/water/article?id=10.1371/journal.pwat.0000077
• Journal of Public Health (Oxford Academic): Water insecurity and psychosocial distress, Detroit water shutoffs
  https://academic.oup.com/jpubhealth/article-abstract/43/4/839/5904497
• Office of Community Services: LIHWAP fact sheet (FY23 annual report)
  https://ocsannualreport.acf.hhs.gov/annual-report-fy23/lihwap-fact-sheet
• California Department of Community Services and Development: LIHWAP
  https://www.csd.ca.gov/lihwap
• Philadelphia Department of Public Health: Protecting patients from utility disconnections (health advisory)
  https://hip.phila.gov/health-alerts/protecting-patients-from-utility-disconnections/
• Philadelphia Water Department: Water customer medical certification form (medical delay)
  https://www.phila.gov/media/20231212101110/Water-customer-medical-certification-form.pdf
• Office of the Ohio Consumers' Counsel: 30-day medical certificate fact sheet
  https://www.occ.ohio.gov/factsheet/30-day-medical-certificate
• California State Water Resources Control Board: Water Shutoff Protection Act guide
  https://www.waterboards.ca.gov/drinking_water/certlic/drinkingwater/shutoff-protection.html
• California Department of Justice: Water Shutoff Protection Act legal alert (Sept 19, 2024)
  https://oag.ca.gov/system/files/attachments/press-docs/9.19.2024.Amended%20Water%20Shut%20Off%20Legal%20Alert%20%282%29.pdf
• California Public Utilities Commission: Restart utility service after a shutoff
  https://www.cpuc.ca.gov/consumer-support/consumer-programs-and-services/cpuc-utility-service-management/utility-service-management#restart-utility-service-after-a-shutoff
• 2-1-1 Texas (Texas Health and Human Services Commission): About 2-1-1 Texas
  https://www.211texas.org/about-2-1-1/
• Eldercare Locator (Administration for Community Living): Home
  https://eldercare.acl.gov/home‍