The 2024 Serious Illness Scorecard from the Center to Advance Palliative Care ranked Massachusetts at the top nationally, tying for first place in overall palliative care capacity. Nearly all hospitals in the state—large and small—report having palliative care programs, giving an estimated 96.5% of inpatients access to this essential service. Massachusetts also boasts a strong workforce, with more than 600 board-certified clinicians and six fellowship programs training the next generation of specialists. 

Statewide organizations, including the Hospice & Palliative Care Federation of Massachusetts and the Coalition for Serious Illness Care, provide strong leadership and coordination. Still, gaps remain: while Massachusetts offers a Medicaid benefit for pediatric palliative care, no such coverage exists yet for adults, and rural access lags behind urban areas. These findings underscore both Massachusetts’ national leadership and the continued need for investment to ensure every patient and family facing serious illness has the support they need.

At least 13 million Americans live with a serious illness, often facing pain, symptoms, emotional stress, complex decisions, preventable crises, and caregiver strain. Palliative care—specialized medical care that focuses on relieving symptoms and improving quality of life—offers an evidence-based solution. Yet, access and quality vary widely across the country.

What is Palliative Care?

Palliative care is specialized health care for people living with a serious illness. Its purpose is to ease symptoms and stress, helping patients and families maintain quality of life. It is based on patient needs, not prognosis, and is appropriate at any age or stage of illness, whether or not curative treatment is being pursued.

The U.S. Serious Illness Scorecard

The Center to Advance Palliative Care (CAPC) publishes the Serious Illness Scorecard, which measures each state’s ability to deliver high-quality palliative care. States are evaluated across five domains:

1. Availability of specialty-trained palliative care professionals
2. Payment mechanisms for palliative care services
3. State structures to support awareness and access
4. Basic training for all clinicians in palliative care
5. Systems to support function and caregiving needs

Scores are given from zero to five stars. No state yet achieves five stars; in 2024, two states scored 4.5, six states earned 4.0, while thirteen states scored 2.0 or below. Every state has capacity, but all have opportunities for improvement.

Massachusetts Performance

Massachusetts emerged as a national leader, tying for first place in the 2024 Scorecard. The state benefits from several strong structures:

1. A legislatively established Palliative Care and Quality of Life Interdisciplinary Advisory Council
2. The Hospice & Palliative Care Federation of Massachusetts
3. The Massachusetts Coalition for Serious Illness Care, focused on adult needs

While Massachusetts lacks a pediatric-specific coalition and a statewide capacity assessment, it still stands out for the breadth and depth of its programs.

Hospital and Community Access

Hospital-based palliative care in Massachusetts is widely available. All large hospitals (300+ beds) and even the smallest facilities (<50 beds) report offering palliative care services. An estimated 96.5% of inpatients in Massachusetts hospitals have access to palliative care—well above the national average. Access is strongest in urban and suburban hospitals, though rural access lags behind.

In addition, at least 19 community-based programs operate in the state, though this is likely an undercount. Community palliative care ensures patients can receive consistent support outside of hospital settings.

Workforce and Training

Massachusetts has:

• 215 board-certified physicians in palliative care
• 98 advanced practice nurses
• 312 registered nurses with specialty certification

There are also 313 certified prescribing clinicians (4.5 per 100,000 residents) and 20 pediatricians trained in hospice and palliative medicine. Massachusetts supports a pipeline of future providers with six fellowship programs in hospice and palliative medicine.

Payment and Policy

While Massachusetts has no dedicated Medicaid benefit for adult palliative care, it does offer a separate pediatric Medicaid benefit. This makes the state one of the few with a formalized pediatric program, though adult coverage remains an area for growth.

Looking Ahead

Massachusetts’ strong showing reflects decades of investment in professional training, hospital programs, and advocacy. However, opportunities remain:

• Expanding adult Medicaid coverage
• Building rural access
• Establishing pediatric coalitions
• Supporting workforce growth through loan forgiveness and continuing education

With these steps, Massachusetts can continue to lead the way, ensuring people with serious illness—and their caregivers—receive the compassionate, comprehensive care they deserve.