COFAR blog

As the state House of Representatives begins debate today on the Fiscal Year 2027 state budget, we are gaining bipartisan support for our proposed amendments asserting a right of persons with intellectual and developmental disabilities (I/DD) to placements at the Wrentham and Hogan Intermediate Care Facilities (ICFs).

This is a right that not only aligns with federal law, but is consistent with the state’s policy of encouraging “self-direction” among clients in planning and choosing their services.

When it comes to Wrentham and Hogan, not only does the Department of Developmental Services (DDS) not inform disabled individuals and their families of the existence of those facilities, but the Department implies they don’t have a right to placements there.

Wrentham and Hogan are the last two remaining ICFs for persons with I/DD in Massachusetts, and we are concerned that the centers are heading toward closure.

As of today, 12 legislators have indicated their support for Amendment 695, which states that people with I/DD, who have been found to be eligible for ICF-level care, have a right to placement in an ICF residential setting.

A second amendment, which has also gathered the same cosponsors (Amendment 699), requires DDS to report on its efforts to inform families of all residential choices available for care, including ICF care. And a third amendment (Amendment 703) states that residents of ICFs cannot be involuntarily discharged from those facilities.

The cosponsors so far consist of six Democrats and six Republicans, including Republican Representative Marcus Vaughn, the principal sponsor of each of the amendments. Vaughn represents a district that includes the Wrentham Developmental Center.

Among the cosponsors are:

Representative Bradley Jones, a Republican from North Reading, and the House minority leader

Representative Lisa Field, a Democrat from Taunton, who is also a member of the Mass. Nurses Association. The MNA is supporting the effort to keep Wrentham and Hogan open

Representative Sally Kerans, a Democrat from Danvers, in which the Hogan Regional Center is located

Representative John Marsi, a Republican from Worcester

Representative Lindsay Sabasdosa, a Democrat from Chesterfield

Representative David Viera, a Republican from Bourne

Representative Michael Soter, a Republican from Bellingham

Representative Natalie Higgins, a Democrat from Leominster

Representative Amy Mah Sangiolo, a Democrat from Newton

Representative James Hawkins, a Democrat from Attleboro

Representative Norman Orrall, a Republican from Lakeville

We would urge all 160 House members to support these amendments because the language in them stakes out a commonsense position in favor of individual choice. We have always advocated for a full continuum of care for the most vulnerable citizens among us.

As advocates of the Wrentham and Hogan Centers have long pointed out, one size does not fit all. Community-based group homes can be the best choice for many, if not most, people with I/DD. But for a segment of that population, the community system is either not desired or it cannot meet their complex needs.

There can be no clearer example of that than the case of Kristen Robinson, who has been denied admission to Wrentham even though she is legally blind, quadriplegic, and has profound ID and complex medical issues. No community-based residence or nursing home could or would provide residential care for her.

Kristen was finally admitted to Hogan, after a months-long battle by her family, where she is now thriving.

But Kristen is the exception. Potentially, thousands of persons are waiting in Massachusetts for residential placements, and neither Wrentham nor Hogan is being offered as an option to them.

Questionable claim of cost savings

A series of administrations has long argued that closing congregate care facilities and placing residents in group homes saves money. But this argument is short-sighted and misleading.

As a recent report by our partner organization, the Saving Wrentham and Hogan Alliance, has shown, comparisons of the cost per resident of group home and ICF residents are comparisons of apples to oranges. ICF costs are reflected in the ICF line item in the state budget each year. Those include staffing costs, clinical care, food, housing, and facility costs.

In contrast, the costs of serving people in group homes show up in several state and federal budgets, including MassHealth, Housing and Urban Development (HUD) subsidies and in SNAP benefits, in addition to the DDS community residential line item.

The Saving Wrentham and Hogan Alliance report makes the overall point that the community-based group home system incurs an estimated $1.3 billion in taxpayer costs each year that are not included in the  overall $3.3 billion DDS budget.

The DDS line item for corporate group home providers has doubled from a decade ago to more than $2 billion in the current fiscal year. During that same period, the line item for the Wrentham and Hogan facilities has declined by about 14% to roughly $130 million.

So where is the savings in closing ICFs and placing people in the group home system?

Right to an ICF

The assertion in Amendment 695 that ICF-eligible individuals in Massachusetts have a right to placement in an ICF aligns with the establishment of that right in the federal Medicaid Law and regulations.

The landmark Boulet v. Cellucci federal court decision (107 F. Supp. 2d 61 (D. Mass. 2000) cites the Medicaid statute (42 U.S.C., § 1396a(a) (8)), and explicitly states, “…to the extent that the plaintiffs have requested ICF/MR (now ICF/IDD) services, the state must provide those services reasonably promptly.”  

The Boulet decision, which was written by U.S. District Court Judge Douglas Woodlock, required DDS to provide residential services promptly to thousands of clients who had been waiting for placements, in some cases for years. Unfortunately, the decision hasn’t led to a resolution of the problem. Not only are people still waiting months or years for placements, but DDS is badly underutilizing its state-run residential resources, which could help mitigate the problem.

DDS’s policy of personal choice

The right to choose an ICF also aligns with DDS’s stated policy that individuals and their guardians should be able to “self-direct” their care.  The DDS’s Self-Directed Services website page contains the following statement:

DDS helps an individual to have more control in their life and to make decisions about services based on their vision, path, preferences, beliefs and abilities. The individual decides who helps them and how they want that help to be provided, based on what they want in life and their personal goals.

Placement in an ICF should be a part of that choice.

Connection to fight to preserve Pappas

Finally, we believe there are a number of parallels between the Healey administration’s reported policy of restricting admissions to the Pappas Rehabilitation Hospital and its policy of denying most requests for placement at Wrentham and Hogan.

In sum, our budget amendments are intended to preserve choice and to ensure respect for the wishes and preferences of DDS clients and their families. We hope all 160 House members would agree that the right to a choice of residential options along the entire spectrum of care should be respected and upheld.

Please continue to call or email your House member and ask them to cosponsor or sign onto Amendments 695, 699, and 703. You can find your legislator here. Thanks!