Naming federal Medicaid cuts as one of their biggest obstacles, House Democrats unveiled their fiscal 2027 budget Wednesday that would still grow MassHealth spending by hundreds of millions of dollars, while incorporating a more modest cap on dental benefits and adopting some of the governor’s other cost-cutting measures.
MassHealth would be funded at $22.41 billion under the House Ways and Means Committee proposal, representing more than one-third of the overall budget and a $282 million increase over fiscal 2026. Chair Aaron Michlewitz said Massachusetts is staring down several “storm clouds” in the second half of fiscal 2027, including when health care components of the federal One Big Beautiful Bill Act take effect and trigger massive coverage losses.
“Many could wind up in our free care pool, further straining MassHealth’s already strained budget,” Michlewitz said at a briefing Wednesday morning.
Massachusetts stands to lose $3.5 billion in annual federal health care dollars once the federal law is fully implemented, and the state’s Health Safety Net could see a surge in demand from uninsured and underinsured Bay Staters.
Gov. Maura Healey proposed capping MassHealth adult dental benefits at $1,000 annually, a figure that drew pushback from some lawmakers and oral health providers who said more patients could end up seeking costlier care at hospital emergency departments. The Massachusetts Dental Society has urged the House budget chief to avoid making any dental benefit cuts.
The House Ways and Means Committee recommends a cap of $1,750, which Michlewitz said aligns with the limit for public employees and retirees covered by the Group Insurance Commission. The cap would save the state $35 million annually.
“We heard from a lot of folks that the $1,000 number was not sufficient and was gonna create some further funding challenges down the road, so we wanted to raise that cap,” Michlewitz said.
Healey called on MassHealth to eliminate coverage for GLP-1 drugs for weight loss, also echoing a GIC approach to rein in soaring pharmaceutical spending. Michlewitz said the committee’s budget “didn’t touch the GLP-1 coverage piece” and chalked it up to an “administrative move.”
“But I’m sure we’ll have a further conversation with the membership as we go forward in this,” the North End Democrat said.
House budget writers chose to embrace some of Healey’s health care cost containment measures that would generate just under $1 billion in net savings, according to information provided by a committee spokesperson. Some savings would come from “program integrity” efforts, such as pursuing cheaper vendor contracts to recoup or manage overpayments, and new eligibility work requirements that will kick members off the MassHealth rolls.
When it comes to curbing soaring costs at the MassHealth personal care attendant program, the House Ways and Means budget gives a working group more authority to decide what to cut. Healey’s budget assumed MassHealth would implement recommendations from the working group to shave $32 million, and the governor directed the group to find an additional $68 million in total savings.
“We’re mandating that any additional cuts to the program can only occur when an agreement is reached of the working group,” Michlewitz said. “Currently they’ve signed off on $32 million worth of cuts, that they signed off a couple months ago, but they have not signed off on any further cuts going forward. But if they do come to agreements on further cuts, we give them the flexibility to do so.”
Michlewitz said the Ways and Means budget maintains MassHealth investments in primary care rates and behavioral health, and allocates $175 million for Chapter 257 rates for health and human services workers, $4 million for gender affirming care programs at community health centers, and $4 million to tackle substance use disorders at Mass. and Cass in Boston.
A ConnectorCare pilot program that offers heavily subsidized coverage for people with incomes of up to 500% of the federal poverty level would be extended through the end of 2027 under the budget. House Democrats also want to expand access to HIV prevention medications, such as PrEP, by prohibiting cost-sharing and prior authorization.
Healey’s budget recommended $4.3 million to implement the remaining provisions of the 2024 maternal health law, which looks to grow the midwifery workforce and expand access to alternative care options. There’s no comparable investment in the House Ways and Means budget, and a spokesperson said the House plans on “addressing those costs in a later vehicle.”
Amid escalating food insecurity in the commonwealth, also expected to worsen under federal policy changes, the House Ways and Means budget directs $60 million to the Emergency Food Assistance Program, which is more than what the Greater Boston Food Bank recently requested in its bid to distribute resources to other food banks and pantries around the state.
The committee budget also allocates $20 million to the Healthy Incentives Program, which gives SNAP recipients matching dollars to buy locally grown healthy food. Healey had proposed nearly $30 million for HIP.
Alison Kuznitz is a reporter for State House News Service and State Affairs Pro Massachusetts. Reach her at akuznitz@stateaffairs.com.
