An Act relative to family members serving as caregivers

194th Legislature (2025-2026) Introduced by Jim Arciero and 27 co-sponsors

Expands MassHealth HCBS to allow legally liable family members (like guardians or adult children) to be paid caregivers, pending plan amendments and approvals.

Summary: Bill HD 1110 — An Act relative to family members serving as caregivers

Overview

HD 1110 is a proposed Massachusetts bill introduced in the 2025-2026 General Court. The bill seeks to expand who can serve as paid caregivers under MassHealth-funded home and community-based services (HCBS). Specifically, it adds “legally liable family members” to the defined category of “family member” eligible to provide paid caregiving services, and requires the Executive Office of Health and Human Services (EOHHS) to pursue any necessary state plan amendments or waiver approvals to implement this change.

What the bill would do

Amend Section 12 of Chapter 118E of the General Laws (as it appears in the 2022 Official Edition) by adding a new paragraph.

Allow programs of home and community-based services funded under Chapter 118E, in which family members may be paid by MassHealth, to include legally liable family members within the definition of “family member.”

Legally liable family members include, but are not limited to:

Biological, adoptive, foster, or step-parents
Legal guardians
Powers of attorney and healthcare powers of attorney
Adult children of the care recipient

Require EOHHS to file a state plan amendment or waiver application, as may be required, to permit legally liable family members to serve as MassHealth-paid caregivers.

Key definitions and changes

The term “family member” for HCBS paid caregiving would explicitly encompass legally liable family members, broadening who can be compensated for caregiving duties.

The language preserves the ability to override conflicting laws (Notwithstanding clause), ensuring the change can be implemented within MassHealth HCBS programs, subject to appropriate federal/administrative approvals.

Implementation and timeline considerations

Implementation hinges on the state filing of a state plan amendment or waiver with federal authorities (as required).

Final enrollment of eligible caregivers would depend on the approval of these plan changes and subsequent programmatic updates within MassHealth HCBS.

Who would be affected

MassHealth beneficiaries receiving HCBS who rely on paid caregivers

Legally liable family members who could be compensated (e.g., parents, guardians, powers of attorney, adult children)

MassHealth HCBS providers and care management entities that administer home- and community-based services

Fiscal and policy considerations

Potential increase in MassHealth expenditures due to expanded eligibility for paid family caregivers

Administrative steps to implement new definitions, eligibility criteria, training, supervision, and oversight

Need to address potential programmatic safeguards (conflicts of interest, quality of care, caregiver qualifications)

Status and sponsorship

Status: Proposed bill (as of the provided text); introduced in the 194th General Court (2025-2026)

Primary sponsor: Representative James J. O’Day (with a broad slate of co-sponsors)

House Docket: No. 1110; Filed January 14, 2025; referenced as House No. 1394 in the accompanying material

Bottom line

HD 1110 aims to broaden access to MassHealth-supported in-home care by recognizing legally liable family members as eligible paid caregivers under HCBS, subject to federal and state plan amendments. If enacted and approved, this could expand the pool of eligible caregivers and potentially affect program costs, oversight, and care dynamics for MassHealth beneficiaries receiving home- and community-based services.