To make cuts, state asks those affected
*Boston Globe
March 8, 2026, By Jason Laughlin
Summary:
Facing a significant fiscal cliff driven by federal Medicaid spending reductions, Massachusetts is implementing $32 million in cuts to its 50-year-old Personal Care Attendant (PCA) program, which currently supports approximately 56,000 seniors and people with disabilities. In a unique move to mitigate the impact of these reductions, MassHealth utilized a stakeholder working group—composed of program users, providers, and advocates—to recommend specific trims, such as capping attendant overtime at 60 hours and limiting meal preparation time. While state officials view this collaborative approach as a necessary model for finding savings across other long-term care services to offset a projected $3.5 billion annual deficit by the 2030s, many advocates remain deeply concerned. They warn that while these initial concessions were made to keep the program solvent, further anticipated cuts could jeopardize the independence of the state’s most vulnerable residents and force them into institutional care.
Key excerpts:
- “We were faced with really difficult decisions,’’ said Becca Gutman, a PCA working group participant and vice president of home care for Local 1199 SEIU, which represents 58,000 PCA workers. “We recognized the difficult situation the state is in, and we approached it like we were trying to solve a problem.’’
- Fifty years ago, Charles Carr helped author the proposal that led to Massachusetts’ PCA program. Accustomed to fighting the state to fund services like the PCA program, he suddenly found himself participating in the working group and looking critically at his own brainchild.
“It was really awkward for me,’’ said Carr, a legislative liaison for the Disability Policy Consortium (and a member of Dignity Alliance Massachusetts Coordinating Committee). One of the state’s most prominent disability rights advocates, Carr uses a wheelchair and relies on PCAs himself. “Here I am representing cuts to the program, and I’ve got a whole community of people I’m representing that don’t want to see the program cut at all.’’
The group considered a range of budget-cutting options, such as eliminating overtime entirely. Another was to limit hours for so-called Instrumental Activities of Daily Living, such as house cleaning, food preparation, and bill paying, an option Carr said he fought hard to rule out.
“Where are people going to go to get these services done?’’ Carr recalled asking during discussions with working group members. “It got down to some heated discussions.’’ - “I don’t think this administration is committed to home, community-based services,’’ said Chris Hoeh, a disabled rights activist and PCA user (and a member of Dignity Alliance Massachusetts Coordinating Committee). “They’re making a strategic choice to protect institutions over community-based capacity.’’
- “Because other programs that provide home care services are also being cut, I don’t know what people are going to do and where they’re going to go,’’ said English, who said AdLib works with 1,000 PCA users in Western Massachusetts.