Bill
S 474
Directs EOHHS to pursue federal approval so frail-elder MassHealth members can choose assisted living instead of nursing home care, capped at 80% of institutional cost.
Status snapshot
- Introduced: February 6, 2025 (filed as Senate Docket No. 1319)
- Principal petitioners/authors in bill text: Senator Patricia D. Jehlen; co‑petitioners Thomas M. Stanley and Dylan A. Fernandes
- Committee activity: Referred to multiple committees (Elder Affairs/Aging & Independence; Health Care Financing; Ways & Means/Codes). Committee recommended “ought to pass” (11/17/2025) and referred to Senate Ways & Means.
- Note: There are inconsistent sponsor listings in the materials provided; the bill text identifies Jehlen and co‑petitioners above.
Purpose
- Directs the Executive Office of Health and Human Services (EOHHS) to pursue federal approvals so MassHealth members who qualify for the frail elder home-and-community–based services (HCBS) waiver may choose to receive assisted living as an alternative to institutional nursing home care.
Key provisions
1. Federal approval actions (deadline: within 90 days of the act’s effective date)
- EOHHS must submit applications (state plan amendments/options, waivers, or demonstrations) to establish an “assisted living” service enabling Medicaid‑eligible, nursing‑home‑at‑risk individuals to reside in certified assisted living residences.
- Rate limit: the average daily rate for the assisted living service, when combined with Supplemental Security Income (SSI) and the state supplementary payment, must not exceed 80% of the cost of substantially similar institutional care for the equivalent waiver year, as shown by the Factor G value in Appendix J of the MassHealth frail elder waiver (0059.R08.00).
- EOHHS/MassHealth must implement a rate schedule that uses disproportionate share (DSH) payment methodologies to promote equitable economic access between assisted living and institutional settings.
Reporting to Ways & Means (deadline: within 120 days)
Barriers analysis by Executive Office of Aging & Independence (deadline: within 180 days)
Who would be affected
- Primary: MassHealth members eligible for the frail elder waiver (Medicaid‑eligible older adults at risk of nursing home placement).
- Secondary: Certified assisted living providers, nursing facilities, counties/municipalities (development/availability considerations), MassHealth program budget and state Medicaid financing.
- Stakeholders: EOHHs, Executive Office of Aging & Independence, assisted living operators, consumer advocates, managed care plans.
Potential impact and considerations
- Could expand community‑based options and reduce nursing home admissions for frail elders, contingent on federal approvals and operational design.
- Fiscal effect depends on negotiated rates, federal match, and whether the assisted living benefit is cheaper than institutional care (bill caps combined payment at 80% of institutional cost benchmark).
- Equity/access concerns remain for low‑income neighborhoods and “difficult development areas”; the bill mandates study of those barriers.
- Implementation requires federal waivers/approvals and administrative rulemaking; timelines in the bill are reporting deadlines, not immediate benefit rollout.
Procedural next steps
- EOHHS and EOAI must complete the submissions and reports within the stated deadlines after the law’s effective date. Any actual program launch would follow federal approvals and MassHealth policy/rate setting.
Compiled from official sources — confirm details with the bill’s official record.
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