Massachusetts is taking its first formal step toward a publicly funded long-term care insurance program, responding to rising demand, escalating care costs, and the mounting fiscal pressure on families and the state budget. A recent feasibility study outlined the potential structure of such a program, estimating that a payroll tax between 0.68% and 2.74% would be required to fund benefits for services including home care, assisted living, and nursing home care — services that can cost between $87,000 and more than $180,000 annually.

With only a small share of older adults holding private long-term care insurance, many middle-income residents find themselves forced to spend down assets or turn to Medicaid for help. Long-term care already consumes roughly one-third of Medicaid’s spending in Massachusetts, creating long-term pressure on the state budget.

Legislation now before lawmakers would establish a commission to design a statewide program, drawing on the experience of Washington state’s long-term care trust. The Home Care Alliance is slated to serve on that commission, ensuring that provider, workforce, and consumer perspectives help shape how Massachusetts approaches this increasingly urgent challenge.