BOSTON, MA — In testimony delivered before the Joint Committee on Aging and Independence, the Massachusetts Assisted Living Association (Mass-ALA) urged lawmakers to act on two key pieces of legislation aimed at expanding access to assisted living for older adults and clarifying the legal framework that governs these communities.
The association’s testimony supports Senate Bill 474/House Bill 791, titled “An Act Relative to Assisted Living and the Frail Elder Waiver,” and House Bill 770, “An Act Clarifying the Classification of Assisted Living Residences.” Together, the bills aim to address financial and regulatory barriers that advocates say are limiting options for aging adults across the Commonwealth.
Expanding Access Through the Frail Elder Waiver
At the heart of the access issue is the Frail Elder Waiver, a Medicaid program that allows eligible older adults to receive long-term care services in home settings or skilled nursing facilities. However, Massachusetts currently does not allow the waiver to be used in assisted living residences (ALRs)—a restriction that sets it apart from most other states.
“Expanding the Frail Elder Waiver to include assisted living is a cost-effective way to provide independence and quality of life for more older adults,” said Brian Doherty, President and CEO of Mass-ALA. “This change would bring Massachusetts in line with the majority of the country and ensure that families can choose the care setting that best meets their needs.”
Mass-ALA emphasized that ALRs provide a unique community-based care model that fills a critical gap between home care and nursing homes. Without proper Medicaid coverage, however, many older adults cannot afford to access assisted living services, especially as costs continue to rise.
Doherty noted that although some reimbursement options like Group Adult Foster Care (GAFC) and the Program of All-Inclusive Care for the Elderly (PACE) are available, they are not well-suited to the assisted living setting. The Frail Elder Waiver, he argued, would be a much better fit—both financially and logistically—for this type of care.
Clarifying the Role of Landlord-Tenant Law
The second legislative priority, House Bill 770, aims to resolve growing legal confusion over how landlord-tenant law applies to assisted living communities. Mass-ALA warns that recent court decisions have blurred important distinctions between ALRs and traditional rental housing, jeopardizing the services and protections that define assisted living.
“Assisted living is not akin to an apartment complex—it’s a unique setting where older adults receive the support they need to thrive,” said Doherty. “Clarifying the law will protect the integrity of these communities and ensure that regulations reflect their specialized role in our continuum of care.”
H. 770 seeks to reaffirm the original intent of Chapter 19D, which treats assisted living as a hybrid model that combines housing with care—distinct from both nursing homes and standard rental apartments. During the COVID-19 pandemic, assisted living providers faced challenges implementing health measures due to restrictions tied to landlord-tenant law, highlighting the need for clearer legal boundaries.
The bill would exempt ALRs from a broad application of standard landlord/tenant statutes while maintaining essential resident protections—preserving the balance between autonomy, safety, and care.
A Voice on the Advisory Council
Mass-ALA also voiced support for Senate Bill 469, which would grant the organization a seat on the Assisted Living Advisory Council (ALAC). Representing nearly 90% of assisted living providers across the state, Mass-ALA argues that its inclusion on the council would bring a valuable provider perspective to policymaking.
Looking Ahead
With Massachusetts’ aging population projected to increase significantly in the coming decade, Mass-ALA stressed the urgency of enacting policies that are flexible, inclusive, and reflective of real-world care needs.
“These bills are essential to ensuring that older adults across the Commonwealth can live with dignity, independence, and the support they deserve,” said Doherty. “Massachusetts has an opportunity to lead with thoughtful, forward-looking solutions—and now is the time to act.”
