How Massachusetts pays for disability services

Waiver inventory

Excluded as not IDD/DD/autism: Frail Elder Waiver (0059.R08.00), ABI-RH (40701.R03.00), ABI-N (40702.R03.00), TBI (0359.R05.00), MFP-CL (1027.R02.00), MFP-RS (1028.R02.00). Full list at mass.gov No 1915(i), 1915(k)/CFC, or 1915(b)(3) authority for the IDD population was identified in the CMS Massachusetts waiver factsheet.

State-only funded programs

Massachusetts funds DDS through direct state appropriation to the Department of Developmental Services, with MassHealth claiming federal match centrally for waiver-covered services. The following FY2026 conference-report line items carry substantial state-only components. Administering agency for all is the Department of Developmental Services within the Executive Office of Health and Human Services.

• Autism Omnibus Services, 5920-3020: $77,926,359 (FY2026). Supports for children with autism, including those not eligible for DDS intellectual disability services.
• Autism Division, 5920-3010: $7,928,034 (FY2026). DDS Autism Division operations and the state-funded adult autism support program.
• Turning 22 Program, 5920-5000: $110,653,565 (FY2026). Adult service start-up for young adults aging out of special education entitlement.
• Respite and Family Supports, 5920-3000: $123,950,257 (FY2026). Family support centers, respite, and flexible family funding, much of it for people not enrolled in a waiver.
• DDS State Facilities, 5930-1000: $131,050,113 (FY2026). Wrentham and Hogan ICF/IID campuses.
• Aging with Developmental Disabilities, 5920-3025: $99,000 (FY2026).
• Supportive Technology, 5920-2003: $5,280,717 (FY2026).

Source: malegislature.gov

I could not confirm from a retrieved source which of these lines receive zero federal match, so treat the "state-only" characterization as partial.

County / regional / local funding

None identified. Massachusetts delivers DDS services through six state-run DDS regions and 23 area offices, not counties. No county levy, county board, or local mill levy for IDD services was found. Checked: the FY2026 conference report line item list, the Governor's FY26 DDS appropriation pages, and the DDS provider and family pages at mass.gov. Massachusetts counties have no independent taxing authority for human services.

Funding scale

• Total DDS appropriation, FY2026 (all funds, conference report): approximately $3.26 billion, summing the twelve DDS line items listed in the conference report (5911-1003 $105,441,463; 5911-2000 $47,192,062; 5920-2000 $2,018,989,676; 5920-2003 $5,280,717; 5920-2010 $347,233,269; 5920-2025 $287,388,656; 5920-3000 $123,950,257; 5920-3010 $7,928,034; 5920-3020 $77,926,359; 5920-3025 $99,000; 5920-5000 $110,653,565; 5930-1000 $131,050,113). Sum is mine, not a published total. malegislature.gov
• Largest single line, community residential: 5920-2000 Community Residential and Vendor-Operated Services, $2,018,989,676 FY2026 conference. FY2025 projected $2,047,627,233; FY2024 expended $1,633,480,628; FY2023 expended $1,670,681,631; FY2022 expended $1,570,780,421. The FY2023 to FY2025 jump reflects Chapter 257 rate rebasing. budget.digital.mass.gov
• State-operated residential: 5920-2010, $347,233,269 FY2026. Day and work: 5920-2025, $287,388,656 FY2026. Same source.
• Medicaid HCBS DD waiver spending, state vs federal share: Not found. DDS appropriations are gross; the MassHealth federal reimbursement is booked separately.
• FMAP: Not retrieved from a primary source in this research.
• Spending per participant: Not found. The Community Living Waiver renewal raised the individual annual spending limit from $70,000 to $100,000 to absorb rate increases. mass.gov
• Number of people served in DD waivers: Only the Community Living Waiver projection (3,366 to 4,066 across five years) was located. Adult Supports and Intensive Supports enrollment not found.
• Waiting list: No waiting list figure or explicit no-waitlist statement was found on the DDS waiver pages for individuals and families or for providers. Enrollment into the Children's Autism Waiver is rationed by a periodic open request period rather than a standing list; the 2025 period is closed and DDS directs families to check back in fall 2026 (https://www.mass.gov/lists/autism-waiver-service-program-open-request-period-2025).

Residential funding detail

Massachusetts is the strongest of these three states for published residential rate detail because Chapter 257 of the Acts of 2008 requires EOHHS to set rates by regulation (https://www.mass.gov/chapter-257-implementation-update).

Group homes and 24-hour staffed residences. Paid under 101 CMR 420.00, Rates for Adult Long-Term Residential Services (ALTR), effective July 1, 2026. The structure is a per diem matrix with three axes: - Capacity: 1 person, 2 to 3 people, 4 or more people. - Service tier: Basic, Intermediate, Medical/Clinical Level 1, Level 2, Level 3, and Specialized Behavioral (an acuity ladder). - Direct care FTE: rate cells span roughly 3.0 to 15.5 direct care FTE.

Per diems in the matrix run from approximately $835 to $5,750 per person per day depending on the combination.

Add-on rates (billed on top of the per diem): Direct Care Staff $31.01 per hour or $248.08 per day; Licensed Practical Nurse $56.64 per hour; Registered Nurse $77.66 per hour; Clinician (LICSW) $61.84 per hour; Remote Direct Supports $21.47 per hour; vehicles $36.87 to $87.38 per day from sedan to wheelchair van.

Room and board / facility cost. 101 CMR 420.00 pays a separate site rate for facility costs. For programs operating before July 1, 2014 the site rate is derived from an occupancy index running $4.02 to $164.90 per diem based on annualized facility cost. For new and replacement sites there are geographic maximums of $2,163 to $2,995 per person per month by region. This means the physical plant is funded through the state contract rate, not left entirely to the resident. Residents' SSI still contributes to personal room and board under DDS policy, but the site-rate mechanism is the state-funded component. Federal HCBS rules prohibit waiver payment for room and board, so the site rate is a state-funded element of the contract.

Shared living / host home. Paid under 101 CMR 411.00, effective July 1, 2024, as a two-part rate: an operational payment to the placement agency plus a caregiver stipend paid to the host family. - Shared Living Level A operational $67.53 per day; Level B $103.60 per day; Level C $177.16 per day. - Caregiver stipend ladder: 21 levels, $79.59 to $278.58 per day. - Remote Direct Supports $20.15 per hour. - A separate "Family Residential" per diem of $243.14 appears in the same regulation.

Supported living / in-home. The Adult Supports and Community Living waivers fund Individualized Home Supports, Live-in Caregiver, and Adult Companion rather than a residential per diem. The Intensive Supports waiver adds 24-Hour Self-Directed Home Sharing Support.

ICF/IID. Massachusetts retains state-operated ICF/IID capacity at Wrentham and Hogan, funded at $131,050,113 in FY2026 under line 5930-1000. State-operated community group homes are funded separately at $347,233,269 under 5920-2010.

Comparable service rates

Official rate schedule links

• ALTR (24-hour residential), 101 CMR 420.00, effective July 1, 2026: mass.gov
• Regulation page: mass.gov
• Shared living and placement, 101 CMR 411.00, effective July 1, 2024: mass.gov
• Day habilitation, 101 CMR 348.00, effective Aug 1, 2024: mass.gov
• Community-based day supports, 101 CMR 415.00, effective July 1, 2025: mass.gov
• Supported employment, 101 CMR 419.00, effective July 1, 2025: mass.gov
• Respite, 101 CMR 431.00, effective July 1, 2025: mass.gov
• Developmental and support services, 101 CMR 424.00: mass.gov
• Master index of purchase-of-service rate regulations: mass.gov
• Competitive integrated employment, 101 CMR 410.00: mass.gov

Notable features and flags

• Sept 1, 2024: The three DDS waivers were renewed on a five-year cycle. The Community Living Waiver renewal raised the per-person annual spending limit from $70,000 to $100,000 specifically to accommodate service rate increases (https://www.mass.gov/doc/home-and-community-based-services-waiver-community-living-waiver/download).
• July 1, 2026: New ALTR residential rates took effect under 101 CMR 420.00, including a restructured capacity-by-tier-by-FTE per diem matrix and new geographic site-rate maximums of $2,163 to $2,995 per person per month for new and replacement sites.
• Feb 27, 2026 and March 20, 2026: EOHHS filed proposed amendments to 101 CMR 348.00 (day habilitation) and held a remote public hearing on March 20, 2026, with staff testimony posted. A day habilitation rate change is therefore pending as of this writing (https://mass.gov/regulations/101-CMR-34800-rates-for-day-habilitation-services).
• June 26, 2026: A remote public hearing was held on proposed changes to 101 CMR 411.00 (placement, support, and shared living services), meaning the July 1, 2024 shared living rates are the oldest of the DDS rate sets and are under active revision.
• FY2024 to FY2025: Community residential spending (5920-2000) rose from $1.633 billion expended to $2.048 billion projected, a roughly 25 percent increase in one year, driven by Chapter 257 rate rebasing and direct care wage pressure. The FY2026 conference figure of $2.019 billion is slightly below the FY2025 projection.
• Self-direction: All three DDS waivers offer participant direction through budget authority or employer authority, and the Intensive Supports Waiver includes a distinct 24-Hour Self-Directed Home Sharing Support service (https://www.mass.gov/dds-self-directed-services).

Confidence

Solid: the FY2026 line-item appropriations from the legislature's conference report, the full set of Chapter 257 rate regulations with effective dates and published dollar rates, the waiver inventory and CMS waiver numbers, and the residential rate architecture. The Massachusetts rate picture is unusually well documented because Chapter 257 forces publication. Estimated: the approximately $3.26 billion total is my own sum of the twelve DDS line items and is not a figure Massachusetts publishes; the ALTR per diem range of approximately $835 to $5,750 is a summary of a large matrix rather than a specific cell. Could not find: enrollment for the Adult Supports and Intensive Supports waivers, any waiting list count or explicit no-waitlist statement, the state versus federal split of DDS spending, the Massachusetts FMAP from a primary source, per-participant spending, and the number of slots or per-child budget cap in the Children's Autism Waiver. The web search budget for this session was exhausted partway through, which limited follow-up on enrollment and waitlist questions.

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