Transcript Highlights:

• including home care.
• I care deeply for my patients, and it is heartbreaking and morally distressing to repeatedly care for
• Without a patient-directed medical order, I often must provide unwanted invasive care due to unclear
• directives.
• This is patient-directed, not someone else-directed, not the choice of some remote person.

Summary: The committee first received an update from the Department of Health on the Cancer Connect Collaborative, the Cancer Innovation Fund, and the new Cancer Connect Collaborative Research Incubator, created and expanded by recent legislation. The department reported that the Cancer Innovation Fund has awarded $80 million to 95 researchers to date, with $60 million available in the current cycle and 65 projects funded across 28 institutions in 16 cancer areas last year. The new pediatric cancer incubator received $30 million and awarded four Florida children’s hospitals $7.5 million each. Senators asked about outreach to oncologists statewide, peer review and accountability, funding for National Cancer Institute-affiliated institutions, and whether underserved and rural areas are being prioritized; the department said it uses website notices, listservs, collaborative outreach, and eligibility criteria favoring rural and high-cancer-care providers, and that it monitors projects through reports, expenditures, and contract provisions. The committee then heard Senate Bill 312 on patient-directed medical orders, which would create a voluntary, portable, physician-authorized electronic registry for patients to document end-of-life and serious-illness treatment preferences. Supporters, including nurses, hospice and emergency care advocates, and medical professionals, said the bill would help ensure patient wishes are accessible in emergencies, reduce unwanted interventions, and improve continuity of care. Opponents, including Florida Right to Life, argued the bill could broaden end-of-life decisions too far, raise privacy and coercion concerns, and allow withdrawal of care inappropriately. The sponsor said the measure is intended to support patient autonomy and is not anti-life, and noted she was open to amendments. After public testimony, the committee voted on SB 312 and reported it favorably. The roll call showed support from Senators Berman and Harrell, with the bill passing on the committee vote. The meeting then adjourned.

Transcript Highlights:

• managed care will provide an option to states to direct payments to providers through managed care.
• give states the ability to to direct payments to certain provides to managed care plans.
• The goal of state direct payments are intended to promote quality and access to managed care.
• Has an comp isn't competent care, charity care which is a different funding streams and the direct payment
• care is not my the department's direct care staff.

Transcript Highlights:

• So please take care of that.
• donation because a directed donation, the chain of custody of a directed donation is vastly different
• Yeah, but you specifically pointed out the directed donors. Absolutely, that's in directed donors.
• directed donors?
• So this company with no direct patient care, patient-doctor relationship ignored the orders of these

Transcript Highlights:

• Direct primary care offers really high-quality care at a dramatically lower cost.
• Direct primary care offers really high-quality care at a dramatically lower cost.
• My first experience with direct primary care came when I was a home care nurse caring for a young ALS
• that direct primary care doctors provide.
• that direct primary care doctors provide.

Keywords: 995, all

Summary: The committee held a public hearing with testimony on several health care bills, with most of the discussion focused on primary care access, community health center reimbursement, midwifery and birth centers, telehealth, hospital-at-home, direct primary care, and trans-inclusive health care access. Chair Feeney and Chair Murphy opened by noting the large number of signups and asking testifiers to keep remarks brief because of time constraints. Legislators and witnesses repeatedly emphasized that Massachusetts’ primary care system is under strain and that federal policy changes and reimbursement gaps are worsening financial pressure on providers. On community health centers, Representative Blay, Senator Lovely, Michael Curry, Bethany Keeley, Jag Deep Trevetti, Sean Cahill, and Christina Severin all supported H. 1096/S. 711, which would require commercial insurers to pay federally qualified health centers at least the MassHealth prospective payment system rate. They argued that commercial plans currently reimburse health centers below Medicaid rates, threatening sustainability, staffing, and access, especially as federal cuts and coverage losses could increase uncompensated care. Testifiers said the bill would stabilize health centers, protect primary care access, and not cost the state money. A second major topic was H. 1117/S. 784 on sustaining birth centers and the midwifery workforce. Senator Lovely, Senator Miranda, Emily Anesta, Rebecca Orden, Catherine Rushworth, Nishira Burrill, Joel Sutherland, Rachel Blessington, Joelle Ward, and others described the 2024 maternal health omnibus as an important first step, but said birth centers and midwives still face low reimbursement, workforce shortages, and financial instability. They urged reimbursement parity, a workforce development fund, and support for freestanding birth centers, citing improved outcomes, lower C-section rates, better patient experience, and racial equity in maternal health. Several speakers shared personal birth stories and said the bill would help preserve and expand birth options in communities like Roxbury, Worcester, and the North Shore. The committee also heard support for H. 1343 on direct primary care from Dr. Garofalo, Dr. Altman, Dr. Nair, Stephanie Cameron, Dr. Haley Moke-Blessed, and others, who said current insurance rules force patients to use a separate in-network primary care doctor for referrals and sometimes prevent physicians from dispensing medications. They argued the bill would reduce delays, administrative burden, and costs while improving continuity of care. In addition, Dr. Miklides and Sue Stempeck supported H. 1141 on hospital-at-home parity, saying the model has strong outcomes and should be reimbursed at the same rate as brick-and-mortar hospital care. Heather Myers and Katrina Cook testified on telehealth and digital health equity, urging broader coverage for asynchronous care, remote monitoring, interpreter services, and digital literacy supports. SEIU Local 509 supported H. 1188/S. 681 on trans-inclusive health care access, saying it would remove arbitrary insurance barriers to gender-affirming care. No votes or committee actions were taken during the hearing.

Transcript Highlights:

• They modeled wages, and regardless of the type of care, whether it's delegated or directed, the wages
• For personal care consumer directed, it was a little lower, not quite $25.50 an hour.
• crisis, specifically the shortage of direct care workers.
• It has the largest share of the direct care workforce.
• This recognition is crucial for effectively recruiting and retaining direct care workers.

Transcript Highlights:

• </c><00:00:50.039><c> care</c> hour and 45 minutes for the direct care hour and 45 minutes for the direct
• </c><00:01:19.400><c> care</c> director for direct care director for direct care treatment<00:01:22.119
• </c> experienced Direct Care staff to deliver experienced Direct Care staff to deliver those<00:03:26.760
• Direct Care and treatment pressures that Direct Care and treatment is<00:04:42.800><c> facing</c><00
• Direct Care and treatment challenged at Direct Care and treatment that<00:39:38.359><c> we</c><00:39:

Keywords: 1183, house

Transcript Highlights:

• </c><00:05:15.800><c> care</c><00:05:15.960><c> and</c> it's the department of direct care and it's the
• [questionable]: I'll answer that because I do the direct care and treatment part.
• [questionable]: I'll answer that because I do the direct care and treatment part.
• [questionable]: I'll answer that because I do the direct care and treatment part.
• You know, we really want to care for them well. um Direct Care and treatment services um Direct Care

Keywords: 1183, house

Transcript Highlights:

• We need to increase wage funding for our direct care staff who take care of the most vulnerable people
• you that 107% was spent on direct care staff.
• I manage the direct care team caring for individuals with Intellectual and Developmental Disabilities
• I urge you to increase direct care wages to $17.50 per hour.
• Direct care workers deserve better.

Bills: SB1, SB 1

Keywords: appropriations, budget, state funding, education, healthcare, infrastructure, campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards, 1185, senate, all

Transcript Highlights:

• </c> Direct Care and treatment vulnerable Direct Care and treatment vulnerable adult<00:03:53.959><c>
• c> it</c> money for direct care and treatment it money for direct care and treatment it will<00:13:04.160
• direct care and treatment Department of direct care and treatment and<00:25:02.080><c> its</c><00:25:
• </c><00:44:18.839><c> care</c> beds um and then there are direct care beds um and then there are direct
• c> site</c><00:47:56.839><c> sites</c> the direct care and treatment site sites the direct care and treatment

Keywords: 1183, house

Transcript Highlights:

• There's a direct connection between insufficient funding and the current state of care.
• Direct care attendants provide specialized, compassionate care and become lifelines to our family.
• I urge you to support SB1 and ensure direct care workers receive fair wages.
• We really need at least $17 an hour for direct care. Thank you. Thank you. Thank you.
• Direct care attendants provide specialized, compassionate care and become lifelines to our families.

Bills: SB1, SB 1

Keywords: appropriations, budget, state funding, education, healthcare, infrastructure, campground safety, youth camp regulations, flood safety, emergency evacuation, health and safety standards, 1185, senate, all

Transcript Highlights:

• I state directed payments are a mechanism and the managed care rule that really governs states ability
• to direct a managed care plan to pay a provider a certain amount.
• The the managed care side for state direct payments. Yeah, that it's not called the upper panel in.
• Precision care across cancer.
• managed care side, you know, we've managed care plan contracts have been updated.

Transcript Highlights:

• on strategies to strengthen recruitment and retention of direct care workers.
• The IPAC provision of the access rule really focuses on the direct care workforce and requires states
• of payment rates for direct care workers.
• care to folks who are self-directed.
• I took a few notes, one of which is I believe Sydney, you were talking about direct care work?”

Keywords: 995, all

Summary: The Massachusetts Commission on the Status of Persons with Disabilities’ Long-Term Services and Supports and Health Equity Subcommittee met to hear a presentation from the Lurie Institute for Disability Policy at Brandeis University. Monica Mitra introduced the institute’s work on disability health equity and long-term services and supports, and staff described several research centers focused on community living policy, disability and pregnancy, and parents with disabilities. The presentation emphasized participatory research, accessible dissemination, and the connection between health equity and access to home- and community-based services. Joe Caldwell discussed the Community Living Policy Center’s work on Medicaid HCBS, the direct care workforce crisis, housing, and policy advocacy, including efforts related to the Money Follows the Person program and the Medicaid access rule’s interested parties advisory group. Sid Pickern highlighted a workforce study interviewing direct care workers, a forthcoming policy brief on the access rule, and housing research including Massachusetts’ Alternative Housing Voucher Program. Teresa Nguyen described the Community Living Equity Center’s focus on disparities in community living for people of color, especially a study on self-direction and community living outcomes, and asked for help recruiting participants. Lauren Bixby demonstrated the community living data dashboard, which compares adults who need LTSS with those receiving Medicaid LTSS using ACS and TMSIS data. She explained that the dashboard can be filtered by state and demographics, but noted major race and ethnicity data gaps for Massachusetts and other states. Commissioners praised the dashboard and the institute’s work, asked questions about data sources and the 1115 waiver, and discussed possible connections to the Health Equity Compact. No votes were taken; the meeting ended with an invitation for follow-up, including a forthcoming direct care workforce brief and the institute’s October 28 lecture.

Transcript Highlights:

• care management.
• of care.
• of care.
• of care.
• of care.

Summary: The Assembly Budget Subcommittee on Health held a May Revision hearing covering several health-related budget proposals and broader concerns about the state’s budget structure. The Chair opened by praising some May Revision changes, such as added health IT funding, county administration support tied to Medi-Cal changes, a delay in Medi-Cal cuts for some lawfully present immigrants, and additional support for Covered California subsidies, while criticizing proposed increases in Medi-Cal premiums, changes to senior eligibility, the lack of a Medi-Cal dental solution, and other reductions affecting counties, mobile crisis units, workforce incentives, and physician shortages. The Legislative Analyst’s Office said the state’s budget condition remains weak despite progress on the structural deficit, and the Department of Finance said the May Revision uses a mix of reductions, reforms, revenue proposals, and fund shifts to cut out-year deficits. The committee first heard Department of State Hospitals proposals, including adjustments to county bed billing authority, contract exemption language for online clinical/pharmacy subscriptions, reversion of unspent funds, a revised Metro Central Utility Plant replacement project, electronic health record implementation, and workforce development funded partly through Behavioral Health Services Act resources. DSH also described savings and realignments in incompetent-to-stand-trial and conditional release programs, including extending the independent placement panel program and shifting funds to support additional bed capacity and a mental health rehab center. Members asked about the use of BHSA funds for workforce programs, and the department said the proposal would replace General Fund support with BHSA reimbursements. The Emergency Medical Services Authority proposed funding for statewide behavioral health crisis response guidance and for enterprise system development, and the Department of Managed Health Care proposed modernization of its complaint system and claims-settlement data system to improve oversight and comply with AB 3275. The largest discussion centered on the administration’s BHSA spending plan under Proposition 1, including state-directed prevention, workforce, and other uses, plus General Fund offsets for existing programs. The LAO questioned whether some proposed offsets fit Proposition 1’s non-supplant and eligible-use requirements, while the administration argued the uses were consistent with the measure and that the state-directed share can be adjusted annually. The Commission for Behavioral Health’s proposals drew the most public and member concern. The administration proposed cutting the commission’s Innovation Partnership Fund from $20 million to $10 million and reducing the Community Advocacy Program by $6.7 million, while redirecting BHSA dollars to other state purposes and direct services. Commissioners, advocates, and several members argued the cuts would weaken community voice, reduce support for underserved populations, and disrupt grants already in process; they also objected to using BHSA funds to backfill General Fund commitments. Public commenters, including youth, disability, behavioral health, LGBTQ, tribal, veteran, immigrant, and community-based organization representatives, overwhelmingly opposed the cuts and urged preservation of prevention, advocacy, mobile crisis, and innovation funding. No votes or final actions were taken during the hearing.

Transcript Highlights:

• Thank you. things they they don't care this doesn't things they they don't care this doesn't care<00:
• <01:09:46.319><c> payment</c> directed payment directed payment programs<01:09:49.159><c> directed</c
• system, preserve access to care, and do just like 40 other states are doing now with their own directed
• As was mentioned earlier, our managed care Medicaid directed payment program proposes to have hospitals
• As was mentioned earlier, our managed care Medicaid directed payment program proposes to have hospitals

Keywords: 1183, house

Transcript Highlights:

• Um, personal care homes are of care.
• for</c><00:09:42.640><c> the</c> personal care homes that cared for the personal care homes that cared
• </c> care for.
• As owners of 16 personal care care for.
• to the managed care organizations and is actually paid out through a directed payment.

Keywords: 958, all

Summary: The Health and Family Services committee heard an informational presentation on Kentucky personal care homes from representatives of the Kentucky Association of Healthcare Facilities, Management Systems of Kentucky, and Elder Care Partners. Witnesses described personal care homes as a lower-cost, 24/7 residential option for adults, often with serious mental illness, who do not meet nursing home criteria but need structured supervision, medication assistance, meals, and daily support. They said the homes are regulated by the Cabinet for Health and Family Services, are not Medicaid-funded, and are supported largely through state supplementation payments and residents’ SSI income. The presenters argued that the current reimbursement rate of about $50.70 per day is no longer sufficient to cover staffing, food, insurance, utilities, maintenance, and other costs, and said the sector has shrunk significantly over time. They cited figures showing a decline from 64 to 34 homes serving the seriously mentally ill since 2002, with 30 closures over 23 years, and said the loss of beds contributes to homelessness, hospital overcrowding, and longer psychiatric stays. They also gave examples of residents who had spent many months in hospitals before being successfully placed in personal care homes, which they said can prevent more costly institutional care. Committee members asked about staffing credentials, fraud controls, referral processes, and how reimbursement works in other states. The presenters said Kentucky does not require licensed or certified staff in these facilities, though some homes use certified medication technicians or an LPN, and they described a county case-manager-based assessment process used to set individualized rates in other states such as Minnesota. Members expressed support for the work but emphasized the need for documentation of savings and budget offsets. The presenters said they are seeking an incremental reimbursement increase over two years, roughly 25% to 50% in the first year and another 50% after that, and urged the committee to support the homes to prevent further closures.

Transcript Highlights:

• However, direct support workers provide highly specialized care.
• for them: those direct support professionals. safe staffing levels, and quality care.
• We opted to go self-directed because we saw their quality of care was decreasing.
• Direct service workers provide daily assistance that makes this possible by supporting personal care,
• Direct service workers provide daily assistance that make this possible by supporting personal care,

Summary: The committee heard public testimony on several budget requests tied to health and human services. Louisiana Children’s Advocacy Centers asked for continued support and a supplemental appropriation of $1.173 million for infrastructure and standardization, explaining that the money would expand use of the Guardify digital evidence system, improve chain of custody, and reduce reliance on DVDs. Baton Rouge and statewide CAC leaders said prior funding helped eliminate a therapy wait list and speed services for abused children. Members asked detailed questions about the digital system, MDT coordination, and how the request related to SB 237, which would strengthen multidisciplinary review of child abuse cases. The Alzheimer’s Association sought $824,000 to sustain the dementia care specialist program, saying it helps families navigate services, keep loved ones at home longer, and reduce Medicaid costs. AARP and the Live at Home Coalition also testified for 750 additional Community Choice waiver slots at a state cost of $3.3 million, arguing that home- and community-based care is cheaper than nursing homes and that the current wait list is more than 11,000 people. Legislators discussed the size of the need, the state’s long-term care spending mix, and whether more support should go to family caregivers and community-based options. Testimony also focused on disability support services, substance use treatment, and developmental disability provider rates. A parent and direct support worker described the Children’s Choice waiver’s 20-hour cap and low pay, saying it makes it hard to retain caregivers and meet the needs of medically fragile children. Odyssey House and O’Brien House asked for higher Medicaid reimbursement rates under ASAM 4, warned that removal of room-and-board payments and weak Medicaid eligibility pathways are reducing access, and called for more oversight of sober living homes; members questioned outcomes data, length of stay, and links to homelessness. Finally, the Arc of Louisiana said the LDH rate study confirmed underfunding and supported a $53.6 million increase in state general funds, with local ARC leaders describing the services they provide and the need for higher direct support professional wages.

Transcript Highlights:

• , physical health care, but behavioral health care.
• Managed care organizations are the Health Care Authority contracts with managed care organizations to
• help us with delivering behavioral health care. ...health care authority contracts with managed care
• continuum of care.
• Really, it's not anything direct.

Bills: HB1634

Keywords: mental health, behavioral support, education, school districts, student assistance, 904, all

Transcript Highlights:

• So roles found within nursing, behavioral health, direct care, and primary care are the priority focus
• And I'm going to begin with direct care and the home and community-based services grant program.
• I want to talk a little bit about another direct care effort that we are embarking on, focused on certified
• And you don't want to see direct care staff and people with disability suffering.
• It's a lot of direct care people, right? Entry-level and frontline managers.

Keywords: 995, all

Summary: The subcommittee met to approve the April and May minutes, welcome a new member, and hear an update from Gina Frey of EOHHS on statewide health and human services workforce development efforts. Frey described cross-secretariat initiatives under the Workforce Skills Cabinet, including MA Repay loan repayment awards, expanded community college and tuition supports, ESOL/work-readiness programming for immigrants, and efforts to build career pathways and reduce attrition in nursing, behavioral health, direct care, and primary care. She also reviewed a $46 million ARPA-funded home and community-based services grant program that supported 82 grantees, led to hiring 8,752 new staff, over 1,000 interns, 2,000 new certifications, and a drop in vacancy rates from 22% to 12%. Members raised concerns about the impact of immigration policy changes on the direct care workforce, including losses of trained workers in provider agencies, and asked whether any exemption or other relief efforts were underway. Frey said EOHHS is tracking the issue closely but did not identify a specific exemption effort. The discussion also touched on Medicaid and related program changes, with Frey noting the administration is focused on understanding potential impacts to eligibility and work requirements. Rep. Howard asked about initiatives for direct support professionals and wraparound supports, and Frey said those efforts are often led by individual agencies such as MassAbility and DDS, with EOHHS coordinating across them. The latter part of the meeting shifted to planning FY26 subcommittee goals and possible events. Members discussed using the Health Policy Commission’s Behavioral Health Workforce Center and possibly asking for a study comparing compensation in DDS and related direct care roles against health care and education jobs. They also discussed a possible cross-state public event on immigration’s impact on the workforce, especially for people with disabilities and direct support services, and agreed to continue refining goals and event ideas by email and at the next meeting. Frey provided a website link and contact information for Amy Doyle at the Health Policy Commission to facilitate future presentations.

Transcript Highlights:

• However, direct support workers provide highly specialized care.
• for them, those direct support professionals. safe staffing levels, and quality care.
• And developmental disabilities, but number two is to those who are caring for them, those direct support
• We opted to go self-directed because we saw their quality of care was decreasing.
• Direct service workers provide daily assistance that makes this possible by supporting personal care,

Keywords: 965, house, all

Transcript Highlights:

• But most importantly, is addressing the needs of low-wage workers in long-term care: the direct care
• So we see a high, high turnover rate with our direct care workers.
• And when we talk about market, we're not just talking about other direct support, home care, etc.
• the supply of direct-care workers.
• care compensation, and it's over 90% in the consumer-directed system.

Summary: The committee met for what was described as its final meeting, with members and staff reflecting on the work of the Joint Legislative Executive Committee on Aging and Long-Term Care and noting that future work would likely shift to standing health and wellness committees. The meeting began with introductions and then moved into updates on major initiatives that originated from the committee, including Washington Cares, the Dementia Action Collaborative, and Medicaid long-term care programs. Presenters emphasized that these efforts were developed through long-term legislative-executive collaboration and were intended to help Washington prepare for the state’s aging population. On Washington Cares, DSHS described the program’s development from a 2014 research effort to its 2019 enactment, premium collection beginning in 2023, portability improvements in 2024, and 2025 changes including a grandfathered opt-out fix and a framework for supplemental private long-term care insurance. The agency said benefits are expected to go fully live next summer, with a pilot of up to 400 applicants planned for next January. On dementia policy, the Dementia Action Collaborative reported on the state dementia plan, Project ECHO training for providers, and pilot dementia-capable community programs at area agencies on aging, citing preliminary results that about 85% of family caregivers said services helped people remain at home. DSHS also reviewed Medicaid Transformation Project initiatives, including Medicaid Alternative Care, Tailored Supports for Older Adults, presumptive eligibility, and health-related social needs benefits such as rental assistance, nutrition support, and home modifications. The committee then heard an emerging issues panel from ombuds and disability advocates. Patricia Hunter of the long-term care ombuds program raised concerns about staffing shortages, resident rights, surveillance technology, private equity ownership of facilities, and illegal discharges or evictions. Betty Sweeterman of the Developmental Disabilities Ombuds discussed people stuck in hospitals without medical need, gaps in behavioral health services for people with developmental disabilities, and the need for better workforce training. Todd Carlyle of Disability Rights Washington urged expansion and bundling of community supports such as PACT, GOSH, and peer bridgers to reduce repeated institutionalization and support discharge from inpatient psychiatric settings. Provider and labor panels followed, with nursing home, assisted living, supported living, and union representatives all emphasizing workforce shortages, low wages, Medicaid rate inadequacy, case management bottlenecks, behavioral health complexity, and the need for more flexible care models and stronger accountability for rate increases. No formal votes were taken; the meeting ended with public comment on manufactured housing and closing remarks thanking staff and participants for the committee’s work.