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Lawmakers press HHS over personal care attendant program growth, administration proposes benchmark cap
Summary
Committee members and EOHHS officials debated proposed limits for the Personal Care Attendant (PCA) program, with the administration proposing that PCA spending grow within the Health Policy Commission benchmark to control rapid long‑term care cost increases while stressing intentions to prioritize the most clinically necessary services.
Senators and representatives pressed Secretary Kate Walsh and MassHealth officials about proposed changes to the Personal Care Attendant (PCA) program during the H.1 hearing.
Senator Robin Kennedy described the stakes: PCAs help people remain at home and avoid higher‑cost institutional care, and she asked whether EOHHS has performed a cost‑benefit assessment comparing PCA services to long‑term care placements. "Over the last couple years...the governor has proposed restricting access to the personal care attendant program and making pretty significant cuts," Kennedy said.
Walsh replied that the administration’s stated aim is to ensure people can ‘‘age with dignity and independence in their own homes’’ and that the House 1 proposal is not intended to cut services for people who already receive necessary care. She said the budget would prioritize homemaker services driven by medical need and described the PCA proposal as a constraint on growth rather than an outright cut: "I would not characterize the PCA program as being capped. I would characterize it as being challenged...the PCA program would live within the health care benchmark."
Assistant Secretary Mike Levine explained the administration’s technical approach: the proposal would tie PCA spending growth to the Health Policy Commission benchmark (approximately 3.6% annually), creating a transparent limit on how fast the benefit can expand. Levine and Walsh warned lawmakers that unchecked growth could make the program unsustainable and that federal match reductions would further complicate funding.
Member concerns: Several legislators said past proposals to reduce PCA hours (for example, prior suggested 10‑hour cuts or hard hourly caps) risked denying people critical hours that keep them safely at home. Representative Todd Smola described projections showing PCA spending rising from about $1.2 billion in 2020 to $2.0 billion by 2027 — a 67% increase — and said policymakers must consider alternatives beyond simple dollar caps.
Administration response and next steps: Walsh and Levine invited a broader, transparent assessment comparing PCA services to institutional care and urged legislative partnership on prioritizing services. They repeatedly stressed that federal Medicaid uncertainty could force more severe choices and asked the committee to weigh whether constrained growth or deeper cuts would best preserve services for the most clinically urgent cases.
