WeVote
Log In

Bill

Bill

HD 5454

A communication from the Executive Office of Health and Human Services (see item 4000-0601 contained in Section 111 of Chapter 9 of the Acts of 2025) submitting the Personal Care Attendant (PCA) Working Group report regarding long-term sustainability and cost-containment

194th Legislature (2025-2026)

Transmits PCA Working Group report proposing cost containment: cap PCA overtime at 60 hrs and meal prep at 7 hrs, aiming ~$32M in savings and sustainable program growth.

Placed on file
0
WeVote Research Nonpartisan
Bill Summary · HD 5454

Summary: HD 5454 — PCA Working Group Report on Long-Term Sustainability and Cost-Containment

Overview

  • Bill Number: HD 5454
  • Title: Communication from the Executive Office of Health and Human Services submitting the Personal Care Attendant (PCA) Working Group report regarding long-term sustainability and cost-containment
  • Status: Placed on file
  • Introduced: December 24, 2025
  • Classification: Proposed bill
  • Context: The bill transmits the PCA Working Group’s report and updated recommendations related to the long-term financial sustainability of the Personal Care Attendant program.

Purpose and Intent

  • To authorize and direct the ongoing work of the PCA Working Group (originally established under section 2 of chapter 140 of the acts of 2024 and item 4000-0601) to develop and refine recommendations aimed at ensuring the long-term sustainability of the PCA program.
  • The updated charge emphasizes identifying cost growth targets and methods to achieve them, with final recommendations due to key legislative and executive branches by November 28, 2025.

Key Provisions and Recommendations

  • New Consensus Recommendations (total projected savings: about $32 million):
    1. Cap overtime for PCAs at 60 hours (reducing from 66 hours) — estimated savings: ~$3.9 million.
    2. Cap meal preparation time at 7 hours — estimated savings: ~\$28 million. A medical exception process would allow for special meals when clinically necessary (doctor-documented).
    3. The group endorsed using a composite benchmark approach to project program growth (rather than a hard cap). Components could include growth in older adult population, acuity shifts, wage growth, and state revenue growth. If a benchmark is adopted, it should not automatically cap the program; exceeded growth would be revisited by the group for solutions.
  • Prior Consensus (February 2025) — earlier targeted savings of \$7.4 million included:
    • Enforce overtime cap at 66 hours (approx. \$6.7 million in savings).
    • Address fraudulent activity within the PCA program.
    • Eliminate PCA administrative tasks for members without a live-in exemption (requires EVV use); estimated savings around \$700k.
  • Additional policy-change options considered (illustrative savings, not all adopted):
    • Cap IADLs to the ADL amount.
    • Various reductions in overtime payments (e.g., 66 to 50 hours, etc.).
    • Eliminate IADL authorization where the consumer has a live-in PCA.
    • Cap all IADLs at the average (including meal prep).
    • Stop paying overtime in aggregate and for travel time.
    • Implement an efficiency standard reducing PCA hours by a targeted percentage (TBD).
    • Eliminating overtime pay entirely (noted as a potential but significant policy shift).

Who Is Affected

  • Individuals receiving PCA services and their households.
  • PCA providers and employers (home care agencies and direct care workers).
  • MassHealth and related state agencies administering the PCA program.
  • Stakeholder organizations referenced in the working group (e.g., advocacy groups, industry associations, worker unions).

Data, Process, and Timeline

  • The Working Group met six times (Aug–Nov 2025) and reviewed data on ADLs/IADLs, overtime, program growth/utilization, and wages.
  • Consultations with health economics experts (e.g., Dr. Jon Gruber, Dr. Marc Cohen) and MassHealth data informed the analysis.
  • Final recommendations were prepared with a focus on balancing cost containment with program accessibility and care needs.
  • Legislative action: The bill transmits the PCA Working Group report to the appropriate committees and the Administration for policy development purposes; the report is confidential and for policy development.

Financial Impact (Projected)

  • Estimated total savings in the new consensus: approximately \$32 million.
  • Major savings drivers:
    • Overtime cap reduction to 60 hours (~\$3.9 million).
    • Meal prep cap at 7 hours (~\$28 million).
    • Additional modeled savings from various caps and policy changes (as listed in the proposals).

Note: Some content, including specific modeling details and certain benchmarks, remains confidential and for policy development purposes.

Compiled from official sources — confirm details with the bill’s official record.

Sign in to ask a question.