Most states prohibit utility companies from terminating service to low-income households when occupants present a medical letter confirming a household member has a chronic serious illness. It is unclear how many patients receive these letters and whether screening for health-related social needs (HRSN) identifies these patients. We analyzed characteristics of adult patients at a safety-net hospital with a utility shut-off protection letter 2009-2018. A total of 2973 patients received a letter; most were non-Hispanic black, and had government insurance. Among patients who received a letter in 2018, 70% were screened for HRSN. Among these, only 16% screened positive for difficulty paying utility bills.