Category: SCII State Profiles Tags: Massachusetts, Disability Policy, Community Integration, Olmstead, HCBS, Disability Rights, SCII 2026, State Profile, Independent Living, Policy Analysis, Marsters v. Healey, Rosie D. v. Romney, DOJ Settlement
Introduction
Massachusetts presents a genuine contradiction: a state with unusually generous, court-ordered Medicaid behavioral-health entitlements (via the Rosie D.-mandated Children’s Behavioral Health Initiative) and a $1 billion, DOJ-reinforced commitment to move people out of nursing homes, yet one that has required three separate generations of federal civil-rights litigation since 1998 (Rolland, Rosie D., Marsters) to compel compliance with Olmstead‘s integration mandate — and that still operates two state-run ICF/IID institutions housing 247 people, with advocacy currently underway over whether to close or preserve them.
2026 SCII Score Card
| Composite Score | 62 / 100 |
| National Rank | Part of the 2026 rolling expansion — see the full ranking on the SCII Data Analysis page |
| Tier | 🟡 Tier 2 — Progressing |
| Active DOJ Olmstead Action | Yes — DOJ Civil Rights Division filed two Statements of Interest (2023) supporting plaintiffs in Marsters v. Healey on class certification and standing; $1B settlement approved June 2024 |
| Olmstead Plan Status | Current — 2024 Olmstead Update Report (released Jan. 21, 2025), reviewing the 2018 plan against four measurable pillars |
| Judicial Posture | Protected — First Circuit; denied Massachusetts’s en banc petition in Rosie D. v. Romney (2020), leaving continued federal monitoring in place |
| Data Current As Of | 2026 (source data dated 1998–2026) |
Domain Scores
| Domain | Score | Notes |
|---|---|---|
| Institutional Population Burden | 12 / 20 | Two remaining ICFs (Wrentham 159 + Hogan 88 = 247 residents); 2024 Marsters settlement commits to transitioning ≥2,400 nursing-facility residents with disabilities over 8 years |
| HCBS Infrastructure | 10 / 20 | Three DDS waivers plus a capped Children’s Autism Waiver; state does not publicly release DDS waiver waitlist figures — a transparency gap this methodology treats as a red flag |
| Olmstead Compliance | 11 / 15 | Three generations of active federal litigation since 1998 (Rolland, Rosie D., Marsters); current, dated Olmstead Update Report; durability of gains remains litigation-dependent rather than legislatively embedded |
| Criminal Justice Diversion | 10 / 15 | 24/7/365 Behavioral Health Help Line with 60-minute mobile crisis response standard; 988 in-state answer rate 87% (July 2024); 8 dedicated mental health court sessions statewide |
| Housing & Economic Self-Determination | 9 / 15 | DDS regulatory (not statutory) 14(c) prohibition effective Oct. 2024; mandatory SSI state supplement ($128.82/month, 2026); Alternative Housing Voucher Program serves only 741 people statewide (FY2024) |
| Voice, Oversight & Civil Rights | 10 / 15 | Disability Law Center confirmed as P&A, directly involved in the Marsters settlement; ILC network, LTC ombudsman capacity, and state civil rights statute scope not independently verified |
Critical Population Counts
| Setting | Count | Source |
|---|---|---|
| Nursing facility residents under 65 | Not separately reported; best proxy: ≥2,400 committed to community transition over 8 years under the 2024 Marsters v. Healey settlement (cross-disability class, transition target not a snapshot count) | Boston Globe [3]; Justice in Aging [4] |
| State psychiatric hospital census | Not separately reported for DMH’s civil hospitals; partial proxy: Tewksbury Hospital 144 psychiatric beds, Lemuel Shattuck Hospital 75 beds (expanding toward 95) — distinct DPH facilities | Treatment Advocacy Center, MA state page [18] |
| ICF/IID residents | 247 across two remaining state-run ICFs — Wrentham Developmental Center (159) and Hogan Regional Center (88), FY2024 | GBH News [16]; COFAR Blog [17] |
| Estimated incarcerated adults with serious mental illness | Not separately reported for Massachusetts | Bureau of Justice Statistics (national context only) [37] |
| Chronically homeless adults with disabilities | Approximate only — 17,975 total homeless persons statewide (2024 PIT); a secondary estimate (~20% chronic) suggests ~3,600, not independently verified against a primary HUD table | HUD 2024 AHAR Part 1 [21]; HUD CoC Performance Profile, MA [22] |
| HCBS waiver waitlist (DDS waivers) | Not publicly released by the state — a transparency gap noted by the Massachusetts Developmental Disabilities Council | MA Developmental Disabilities Council [24] |
Three Strengths
1. An unusually active, DOJ-reinforced Olmstead enforcement ecosystem with a live, numeric settlement. Massachusetts is one of the few states with a current, DOJ-backed consent settlement carrying a specific numeric target (≥2,400 people transitioned) and an 8-year timeline, arrived at after the Civil Rights Division filed two Statements of Interest in 2023 supporting plaintiffs on class certification and Article III standing [1][2][3][4][9][10].
2. A statewide, always-on behavioral health crisis infrastructure. The Behavioral Health Help Line operates 24/7/365 statewide, feeding into Mobile Crisis Intervention teams that commit to a 60-minute in-person response standard regardless of insurance status, layered with 8 dedicated mental health court sessions and a pre-arrest co-responder diversion model pioneered in Framingham in 2003, now replicated across dozens of municipalities [25][26][27][28][29][30][31].
3. Regulatory elimination of subminimum wage in the state’s largest disability employment system, paired with a real state SSI supplement. DDS’s October 2024 regulatory prohibition on subminimum-wage payment covers the state’s largest disability-employment funding stream, and Massachusetts is among the minority of states that pay a mandatory cash supplement on top of federal SSI ($128.82/month as of 2026) [13][14][15][34][35].
Three Critical Gaps
1. Persistent reliance on institutional settings that has required recurring litigation, rather than sustained voluntary implementation, to unwind. Two ICFs (247 residents combined) remain open a quarter-century after Rolland v. Cellucci first challenged the state’s over-reliance on institutional placement, and it took a fresh 2022 lawsuit (Marsters) to produce a binding nursing-facility transition commitment [5][6][16][17][36].
2. HCBS waitlist opacity that undermines this domain’s own screening standard. Unlike states that publish waiver waitlist size and wait times, Massachusetts does not publicly release DDS waiver waiting-list figures — making it impossible for outside researchers or families to verify whether the state screens for eligibility before waitlisting [23][24].
3. A narrow, regulatory-only 14(c) phase-out with unverified employment outcomes. Because Massachusetts eliminated subminimum wage through DDS regulatory guidance rather than statute, the ban’s durability and its reach beyond DDS-funded providers are both open questions; no verified competitive-integrated-employment rate for Massachusetts could be located [13][14][15].
Key Insight
Massachusetts’s SCII profile is best read as a state whose disability-rights outcomes are driven almost entirely by litigation rather than by proactive administrative design — every major community-integration advance in the record (the 1999 Rolland settlement, the 2007 Rosie D. remedial plan, the 2024 Marsters $1 billion commitment) followed a federal lawsuit, often with the DOJ Civil Rights Division needing to intervene to keep the case alive. That pattern has produced real, DOJ-verified infrastructure, but it has not produced the kind of voluntary, transparent, self-monitoring system (published waitlists, statutory rather than regulatory 14(c) elimination, fully closed institutions) that distinguishes the Tier 1 states in this Index. The result is a solid, above-median Tier 2 performer: better resourced and more actively supervised than most, but one whose progress remains contingent on continued external legal pressure rather than durable institutional reform.
References
[1] Massachusetts Executive Office of Health and Human Services. (2025). 2024 Olmstead Update Report. Mass.gov. https://www.mass.gov/info-details/2024-olmstead-update-report
[2] The Arc of Massachusetts. Olmstead Massachusetts. https://thearcofmass.org/olmsteadmassachusetts/
[3] Boston Globe. (2024, April 21). Massachusetts commits $1 billion to move thousands out of nursing homes in wake of lawsuit settlement. https://www.bostonglobe.com/2024/04/21/metro/nursing-home-settlement-disabled-massachusetts/
[4] Justice in Aging. (2024). Massachusetts Court Approves Landmark Cross-Disability Settlement Agreement on Behalf of Individuals Stuck in Nursing Facilities. https://justiceinaging.org/massachusetts-court-approves-landmark-cross-disability-settlement-agreement-on-behalf-of-individuals-stuck-in-nursing-facilities/
[5] Center for Public Representation. Rolland v. Cellucci. https://www.centerforpublicrep.org/court_case/rolland-v-cellucci/
[6] Center for Public Representation. Marsters, et al v. Healey, et al. https://www.centerforpublicrep.org/court_case/marsters-et-al-v-healey-et-al/
[7] Center for Public Representation. Rosie D. v. Romney. https://www.centerforpublicrep.org/court_case/rosie-d-v-romney/
[8] Civil Rights Litigation Clearinghouse. Rosie D. v. Romney, 3:01-cv-30199 (D. Mass.). https://clearinghouse.net/case/11227/
[9] U.S. Department of Justice, Civil Rights Division. Marsters v. Healey (case page). https://www.justice.gov/crt/case/marsters-v-healey
[10] U.S. Department of Justice, Civil Rights Division. (2023, September 20). Statement of Interest, Marsters v. Healey. https://www.justice.gov/crt/case-document/statement-interest-marsters-v-healey-0
[11] Disability Law Center. https://www.dlc-ma.org/
[12] Disability Law Center. (2024, May 2). Marsters v. Healey – Notice of Settlement Agreement. https://www.dlc-ma.org/2024/05/02/marsters-v-healey-notice-of-settlement-agreement/
[13] APSE (Association of People Supporting Employment First). Eliminating 14(c) & Subminimum Wage. https://apse.org/eliminating-14c-subminimum-wage/
[14] Federal Register. (2024, December 4). Employment of Workers With Disabilities Under Section 14(c) of the Fair Labor Standards Act. https://www.federalregister.gov/documents/2024/12/04/2024-27880/employment-of-workers-with-disabilities-under-section-14c-of-the-fair-labor-standards-act
[15] Massachusetts Department of Elementary and Secondary Education. (2017). Administrative Advisory SPED 2017-1: Guidance on Students with Disabilities and Subminimum Wage Employment. https://www.doe.mass.edu/sped/advisories/2017-1.html
[16] GBH News. (2025, September 17). Is Mass. trying to close last two facilities for developmentally disabled adults? https://www.wgbh.org/news/local/2025-09-17/is-mass-trying-to-close-last-two-facilities-for-developmentally-disabled-adults
[17] COFAR Blog. (2023, January 26). Continuing drop in number of residents threatens continued existence of DDS state-run facilities. https://cofarblog.com/2023/01/26/continuing-drop-in-number-of-residents-in-state-run-dds-facilities-threatens-their-continued-existence/
[18] Treatment Advocacy Center. Massachusetts. https://www.tac.org/map_directory/massachusetts/
[19] Treatment Advocacy Center. (2024, January). Prevention Over Punishment (report). https://www.tac.org/wp-content/uploads/2024/01/Prevention-Over-Punishment-Full-Report.pdf
[20] NRI, Inc. (2025, July). Use of State Psychiatric Hospitals, 2025. https://nri-inc.org/media/4bofjpqy/smha-use-of-state-psychiatric-hospitals-july-2025-final.pdf
[21] HUD Office of Community Planning and Development. (2024). The 2024 Annual Homelessness Assessment Report (AHAR) to Congress, Part 1. https://www.huduser.gov/portal/publications/2024-ahar-part-1-pit-estimates-of-homelessness.html
[22] HUD Exchange. (2024). Continuum of Care Performance Profile: Massachusetts. https://files.hudexchange.info/reports/published/CoC_Perf_State_MA_2024.pdf
[23] KFF. (2024). A Look at Waiting Lists for Medicaid Home- and Community-Based Services from 2016 to 2024. https://www.kff.org/medicaid/a-look-at-waiting-lists-for-medicaid-home-and-community-based-services-from-2016-to-2024/
[24] Massachusetts Developmental Disabilities Council. MDDC Policy Spotlight: Medicaid. https://www.mass.gov/doc/mddc-policy-spotlight-medicaid/download
[25] Massachusetts Executive Office of Health and Human Services. Behavioral Health Help Line (BHHL) FAQ. https://www.mass.gov/info-details/behavioral-health-help-line-bhhl-faq
[26] Massachusetts Executive Office of Health and Human Services. Mobile Crisis Intervention. https://www.mass.gov/info-details/mobile-crisis-intervention
[27] Massachusetts Executive Office of Health and Human Services. CBHC Crisis Care. https://www.mass.gov/cbhc-crisis-care
[28] GBH News. (2024, July 16). Two years in, Massachusetts 988 mental health hotline has received more than 130,000 calls. https://www.wgbh.org/news/local/2024-07-16/two-years-in-massachusetts-988-mental-health-hotline-has-received-more-than-130-000-calls
[29] Massachusetts Trial Court. Specialty Courts Department. https://www.mass.gov/specialty-courts
[30] NAMI Massachusetts. NAMI Mass Criminal Justice Diversion Project. https://namimass.org/nami-mass-criminal-justice-diversion-project/
[31] Advocates. Jail Diversion Services. https://advocates.org/services/jail-diversion
[32] Massachusetts Department of Housing and Community Development. Alternative Housing Voucher Program (AHVP) Fact Sheet. https://www.mass.gov/doc/ahvp-fact-sheet-1/download
[33] Heller School for Social Policy and Management, Brandeis University. The Massachusetts Alternative Housing Voucher Program (AHVP): A Case Study. https://heller.brandeis.edu/community-living-policy/research-policy/pdfs/case-studies/massachusetts-ahvp-case-study.pdf
[34] Massachusetts Department of Transitional Assistance. Emergency Aid to the Elderly, Disabled and Children (EAEDC). https://www.mass.gov/info-details/emergency-aid-to-the-elderly-disabled-and-children-eaedc
[35] Massachusetts Executive Office of Health and Human Services. Massachusetts State Supplement Program (SSP). https://www.mass.gov/massachusetts-state-supplement-program-ssp
[36] U.S. Department of Health and Human Services, Office of Inspector General. (2024). Massachusetts Could Better Ensure That Intermediate Care Facilities for Individuals With Intellectual Disabilities Comply With Federal Requirements for Life Safety and Emergency Preparedness. https://oig.hhs.gov/documents/audit/10030/A-01-24-00001.pdf
[37] Bureau of Justice Statistics. Mental Health Problems of Prison and Jail Inmates. https://bjs.ojp.gov/library/publications/mental-health-problems-prison-and-jail-inmates
[38] Work Without Limits. (2025). DDS HCBS MassHealth Waivers. https://www.workwithoutlimits.org/siteassets/pdf-resources-new-branding/3-dds-hcbs-masshealth-waivers-2025.pdf
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