Here are some excerpts from our conversation:

Senior Living Facilities

Risking Old Age in America (ROA): You have been working [to make improvements] across the whole continuum of care from nursing homes [to] assisted living facilities to home healthcare. Please talk about the legislature’s initiatives in these areas.

Rep. Thomas M. Stanley: In 2024, the governor signed the long-term care reform bill into law. This was the first major legislative update of nursing homes and assisted living residences in over 25 years.

It increases transparency and oversight of nursing homes through new suitability standards for owners and operators. It requires a review of the civil and criminal litigation history of owners and operators; and we put in place tools for the Department of Public Health to monitor and take punitive action against facilities, including increased fines and creating the ability to appoint a temporary manager to oversee a struggling facility.

It expands the suitability reviews of management companies including any [firm] with at least a 5-percent stake in a nursing facility. The law also establishes the long-term care workforce and capital fund to help address the workforce crisis in nursing homes. Money from the fund can be used for Certified Nursing Assistant training grants, career ladder grants for Licensed Practical Nurses, and also leadership training.

The law gives assisted living facilities the ability to offer basic health services, like wound care, eye drops, and medication distribution to their residents.

ROA: The Dignity Alliance [a senior advocacy group]…[has said] state supervision and enforcement of nursing facilities is…not tough enough, that there might be fines and other penalties on the books, but nobody’s applying them to nursing homes that don’t meet their obligations. It sounds like the ability to put them into receivership under the new legislation may be the remedy that’s needed.

Stanley: That’s correct. Under the old rules you would end up in the situation of really punishing or fining a nursing home and end up having it going to foreclosure. In that case, where are the residents going to go? The new law allows the Department of Public Health (DPH) to get in earlier and work with them so that they understand what the DPH is looking for in terms of quality of care and so forth. They can take care of the facility and all the residents so they don’t go astray.

ROA: So the DPH might have felt that it was between a rock and a hard place because if they enforced the regulations, they might lose the nursing home.

Stanley: [Yes]…and the nursing homes, by and large, were not letting them know that they were having certain problems. So this allows the DPH to get in earlier, understand what’s going on and help them make adjustments so that they can right the ship.

Long-Term Care Insurance

Stanley: The state of Washington is really in the forefront of looking down the road to provide for some type of revenue stream…for folks to be able to afford their home care or [other] long-term care needs. So we’re modeling our program after theirs and we’re learning from their mistakes and successes.

ROA: That’s the Washington Cares Fund?

Stanley: Yes, exactly. Last session Senator Jehlen and I worked together to get $500,000 in the state budget for the Executive Office of Health and Human Services to hire an independent firm to conduct the actuary study of various public, private and public-private long-term support service financing options. They hired Milliman to conduct the study. [The full study is available here.]

How it would work in a nutshell is that a public…insurance program would be funded via a payroll tax. After individuals pay into the program for a certain number of years, a vesting period, they would become eligible. And as they age and require long-term support services, they can apply for benefits under the program. There are countless ways to design the program, increasing or decreasing the benefit amount or…the vesting period, determining what the benefit can be used for – home care, assisted living or even paying family caregivers. We have filed legislation to establish a commission to discuss the results of the actuary study and the feasibility of a public long-term care financing program in Massachusetts and potentially recommending a model that works.

ROA: It sounds like this would help a lot, but one question I have about it is that if there’s a vesting period where you have to pay in for a number of years before you can become eligible for the benefit, would it only be available for people who are continuing to work during that time?

Stanley: That’s definitely something that has to be discussed by the commission, but everyone has to contribute and the 10-year vesting period is necessary to get enough money into the program to make it sustainable.

Listen to our entire conversation here.

For more from Harry Margolis, check out his Risking Old Age in America blog and podcast.  He also answers consumer estate planning questions at AskHarry.info.  To stay current on the Squared Away blog, join our free email list.

Legislative negotiators on Tuesday unveiled a $63.4 billion fiscal year 2027 budget that leans into bolstering municipal finances while launching a broader reexamination of how Massachusetts funds cities, towns and public schools, pairing immediate aid increases with new commissions aimed at reshaping long-term formulas.

Lawmakers are expected to approve the compromise budget Wednesday — the first day of the new fiscal year, making it once again a late budget. It emerged after roughly a month of conference committee negotiations between the House and Senate. Lawmakers approved an interim budget Monday.

If both branches approve the compromise Wednesday as expected, Gov. Maura Healey will have until July 11 to sign, veto or return sections with amendments.

The full text of the compromise budget was not available at 4:30 p.m. Wednesday, after the conference jacket was signed. Senate Ways and Means Chair Michael Rodrigues said staffers were working on finalizing the paperwork until 3 a.m. Tuesday, and back in the building before 8 a.m. to complete the work. Healey signed the interim $7.7 billion budget on Tuesday, according to Secretary of State William Galvin’s office.

The spending plan totals about $2.4 billion, or 4%, more than the current budget while avoiding tax or fee increases and preserving the state’s Stabilization Fund. Instead, the budget intends to add another $51 million to reserves, bringing the rainy day account to a projected balance of $8.2 billion.

The House and Senate entered negotiations with budget proposals that differed by roughly $50 million, according to the Massachusetts Taxpayers Foundation.

One of the biggest policy negotiations centered on unrestricted local aid.

The Senate proposed increasing Unrestricted General Government Aid by $53 million and distributing the new funding on a per capita basis. The House proposed a $10 million increase.

Negotiators ultimately settled on a $40 million increase, bringing total UGGA funding to $1.363 billion, while retaining the Senate’s proposal to distribute the new money on a per capita basis.

Asked about discussions on that approach, House Ways and Means Chair Aaron Michlewitz said the conversation will continue in future discussions about local aid. 

“I think it was something we talked about going forward, and something that we’ll probably have to have a further conversation with, from budget to budget. But certainly something to discuss, and we appreciated the conversation that the Senate brought to the table,” he said.

The local aid compromise arrives alongside several efforts to reconsider how Massachusetts finances public education over the long term.

The budget revives the Foundation Budget Review Commission, a 29-member panel charged with examining the state’s K-12 funding formula and recommending updates by October 2028.

Rodrigues said the commission comes after the Legislature completed implementation of the Student Opportunity Act.

“I think it’s time. We fully fulfilled our obligation under the last foundation budget change, the so-called Student Opportunity Act. We completely fulfilled that responsibility. A lot has changed in the close to 10 years that we’ve looked at that change, and it’s time that we update how we distribute Chapter 70 money,” he said.

Michlewitz likewise said lawmakers are entering a new phase of school finance policy.

“Now that the Student Opportunity Act, once the governor signs this budget, once that’s finalized, once that’s implemented through this process, once that will be finally fully implemented, after seven years of discussion, I think it’s now time for us to start a new discussion about how we move forward,” he said. “New issues have arisen since 2019 … but some of the old issues are still there.”

The budget also includes House-backed reforms aimed at improving oversight of special education transportation spending, requiring additional reporting from school districts, creating a centralized transportation database and directing the Department of Elementary and Secondary Education to study the transportation marketplace. Districts often cite transportation as a major strain on their budgets.

The compromise also preserves two major House healthcare initiatives.

Negotiators agreed to extend the ConnectorCare expansion program through 2027, continuing what began as a pilot program providing subsidized insurance coverage for residents earning up to 500% of the federal poverty level.

“We’ve been prioritizing that now for a number of years. We know it’s been very successful in helping people gain insurance, affordable insurance, and benefits at lower premiums with no deductibles and reduced copay,” Michlewitz said. “I think that’s going to become even more important as we go into the uncharted territory of how things get implemented on the federal level.”

The budget also requires MassHealth, the Group Insurance Commission and private insurers to cover HIV pre-exposure prophylaxis, or PrEP, without cost-sharing requirements or prior authorization.

“We just still know that there is a community out there that has to deal with these issues, and we certainly wanted to kind of create an easier pathway for them to be able to gain the access they need,” Michlewitz said.

Among the notable Senate policy wins included in the final budget is the repeal of the state’s Learnfare policy, which reduced Transitional Aid to Families with Dependent Children benefits when children accumulated excessive unexcused school absences.

Negotiators also adopted a Senate-backed proposal removing candidates’ home street addresses from publicly available election materials, replacing them with their municipality of residence or ward and precinct. 

The proposal was first introduced by Sen. Becca Rausch of Needham and gained traction after Minnesota state lawmakers were assassinated last year. Rausch argued during budget negotiations that Massachusetts is the only state requiring candidates’ full home addresses to appear on ballots.

The budget also adopts housing permitting reforms intended to streamline local approvals for development on nonconforming properties and modernize variance standards.

Other outside sections include new criminal protections shielding 16- and 17-year-olds from sexual relationships with adults responsible for their care and wrong-way driving prevention measures.

Rodrigues singled out the child protection language as one of the provisions he was especially pleased survived negotiations.

“I just want to highlight another issue, another initiative that’s in the budget,” he said. “There was an amendment filed by Senator [Joan] Lovely protecting children from indecent assault by people in authority. We’re very happy that that survived.”

In total, there are 135 outside policy sections in the budget, most of which are annual policies that must be revived every year, Rodrigues said. 

The compromise budget also adopts a $1,750 annual cap on MassHealth adult dental services, exceeding the $1,000 limit originally proposed by Healey.

“We went to $1,750, which was in both the House and Senate budgets and an increase from what the governor recommended,” Michlewitz said.

Rodrigues said lawmakers were comfortable with the budget’s 4% spending growth because it remained within the state’s available revenues.

“We have the resources to provide that increase without raising taxes or dipping into the rainy day fund,” he said. “It’s within the margins.”