Primer on Wrentham and Hogan Bundled Care Versus Unbundled Community-Based Care
Understanding Costs: What’s Included—and What’s Left Out
When government compares service models for people with severe intellectual and developmental disabilities (IDD), cost is often a deciding factor. But not all costs are created equal and not all services are included.
Bundled Care: What Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) Provide
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) offer a bundled model of care.
That means:
• 24/7 medical oversight from on-site nurses and nurse practitioners and access to physicians with specific expertise in diagnosing and treating individuals with intellectual disabilities and autism; includes medical care coordination
• Behavioral supports integrated into daily routines
• Personal care assistance—bathing, dressing, feeding—without hourly billing
• Therapies (OT, PT, speech, recreational, vocational) delivered on-site, direct therapies as opposed to consultation only
• Transportation to medical appointments and community outings
• Crisis response and emergency care coordination
• Housing, food, utilities, and maintenance—all included
• ICF/IID facilities run disability-specific activities throughout the week and during the weekend; day programming is included
• Maintenance and updating of augmentative communication devices and other assistive technology
These services are not billed separately or left to parents to fill in the gaps. They’re part of a comprehensive, regulated package designed to meet the complex needs of residents with severe and profound intellectual disabilities, including those who have complex medical needs.
Unbundled Home and Community-Based Services (HCBS): What’s Missing from the Price Tag
Home and Community-Based Services (HCBS) are sometimes mistakenly considered a more affordable and effective option. However, published cost analyses often lack key details. HCBS operates on an à la carte basis—each service requires individual arrangement, staffing, and funding, often from separate sources:
• Community healthcare for individuals with severe and profound IDD is often fragmented and costly—not because the care is excessive, but because providers are rarely trained to meet their complex needs. These services are billed separately through insurance, yet lack the specialized expertise that public congregate settings once ensured
• Nursing care may be unavailable entirely or limited to brief visits
• Behavioral supports may require separate providers and waitlists
• Personal care is billed by the hour, with staffing shortages common
• Therapies may require travel and separate insurance coverage
• Transportation is rarely included and often unreliable
• Emergency response depends on 911, not trained staff on-site
• HCBS does not include day habilitation services in Massachusetts, and this is not included in the DDS budget. It is purely covered by MassHealth alone.
Families may be left coordinating multiple agencies, navigating gaps in coverage, and absorbing hidden costs—financial, emotional, and logistical.
Unbundled Services: Is It Really Cheaper?
Unbundled services may look less expensive on paper. But when critical supports are missing or fragmented, the true cost is borne by families and by taxpayers:
• Caregiver burnout from filling service gaps
• Worker shortages due to low wages and lack of proper onsite support
• Medical crises due to delayed or denied care
• Housing instability when supports fail
• Legal and advocacy costs to fight for basic access
Bundled care in facilities like Wrentham and Hogan isn’t just a line item—it’s a lifeline.
Hidden Costs of Privatization in Massachusetts IDD Services
Did you know?
Massachusetts spends nearly $2.9 billion each year on services for people with intellectual and developmental disabilities (IDD), but the true cost is much higher. When you add up hidden funding streams and expenses like Social Security payments to providers, SNAP benefits, day habilitation programs, lost municipal taxes, and more, our analysis has shown that the real price tag may reach $4.2 billion annually.
What’s the issue?
Privatized group homes (HCBS) often rely on fragmented, unbundled services funded by multiple public programs. This leads to higher cumulative costs, less transparency, and lower wages for frontline staff. Meanwhile, state-operated facilities (ICF/IID) offer bundled care with economies of scale. But access is restricted, limiting real choice for families.
Key facts:
- Over $227 million in Social Security checks go directly to providers each year.
- $411 million is spent on day habilitation services outside the main Massachusetts DDS budget.
- Medical and dental costs for adults with IDD in community settings can exceed $670 million.
- Nonprofit group homes are exempt from property taxes, costing towns nearly $16 million annually.
- $53 million in SNAP benefits are redirected to corporate providers.
- $360,000–$1 million in annual taxpayer subsidies from development bonds.
- Executive pay and labor exploitation remain major concerns.
Coming Soon: Our full cost analysis of the system is currently underway.
Our Commitment
The Saving Wrentham and Hogan Alliance advocates for transparency, accountability, and real choice in IDD services. We believe public funds should serve the public good—not private gain. Families deserve clear information about how care dollars are spent and access to high-quality, state-operated care alongside community-based options.
The Saving Wrentham and Hogan Alliance advocates for transparency in cost comparisons and equity in service access. We believe families deserve:
• Clear, honest accounting of what’s included—and what’s not
• Respect for the full scope of care required by those with severe and profound needs and complex medical conditions.
• Protection from misleading cost-cutting that jeopardizes lives
Let’s build a system that recognizes that complete care for those with complex needs.