WITH THREE state-funded youth mental health programs at risk of closing, lawmakers and providers ramped up their opposition this week to Gov. Maura Healey’s proposed budget cuts that come as Massachusetts continues to grapple with a behavioral health care crisis.

Two 15-bed intensive residential treatment programs (IRTP), operated by NFI Massachusetts in Westborough, that serve teenagers with serious mental health and safety issues would close under Healey’s fiscal 2026 spending plan. That would leave just two other IRTPs in the state.

The governor’s budget would also shutter the state’s only clinically intensive residential treatment (CIRT) program, called Three Rivers in Belchertown, that has a dozen beds and treats children ages 6 to 12.

At a budget hearing Monday in Attleboro, Department of Mental Health Commissioner Brooke Doyle said those facilities are slated to close due to low patient counts, inadequate staffing and location hurdles. The cost-saving measure comes as DMH — which would receive a 7 percent overall budget increase under Healey’s proposal — looks to prioritize resources for its over-capacity psychiatric hospitals.

“These programs have been very difficult to maintain adequate and safe staffing within. They’ve been understaffed for extended periods of time, and that has contributed in large part to why we had difficulty keeping all the beds filled,” Doyle said in Attleboro. “The programs do provide a specialized service need, and the reality is, that we haven’t been able to operate them fully today. So what we’re proposing to do is to right-size the IRTP, reflecting the volume that does get utilized.”

Doyle said the state pays for those beds “in full,” regardless of whether or not they are occupied. She argued that makes it “not sustainable to continue to pay for 50 percent utilization.”

Doyle highlighted the state’s investment in community-based mental health resources, though the IRTP and CIRT programs are seen as a last resort to stabilize young patients who repeatedly end up in the hospital and pose significant safety risks to themselves and their family.

“Without these services, youth will continue to cycle through expensive and disruptive emergency and acute hospital services,” Lydia Todd, executive director of NFI Massachusetts, said at a State House budget hearing Tuesday, according to a copy of her prepared remarks. “Their families face income loss because it is impossible to maintain employment when they are regularly needed to respond to mental health crises.”

Todd added, “If this program is closed, the commonwealth will lose a recently renovated facility, a highly credentialed, experienced and skilled multi-disciplinary team of 95 staff, a Joint Commission-accredited program, and most importantly, the ability to help youth and families with the most serious needs to manage their mental health issues in their natural communities, and be less likely to end up in one of our adult systems.”

Todd told the News Service 95 out of 100 positions are filled. 

“We could be fully utilized — no problem,” she said. 

Program leaders and lawmakers contend the programs are underutilized due to a complicated DMH referral process that can leave youth languishing in hospitals for weeks or months before they secure placement. Due to high staff turnover during the COVID pandemic, some hospital mental health providers also were unaware the IRTP and CIRT programs existed, said Sen. Jake Oliveira of Ludlow. 

“It’s my hope that we can restore the funding for these critical programs because everything that we hear from constituents and everything that we read, there is a dire need for youth beds, particularly adolescent mental health beds throughout Massachusetts,” Oliveira told the News Service. “If we have programs that are underutilized, then DMH needs to do a better job with the referral process to get help to families across Massachusetts.”

Doyle admitted the referral process was “too clunky” at the hearing Monday.

“So I’ve actually made some changes to that referral process, going to preview it with stakeholders this month, with a go-live plan for May,” Doyle said.

In another major budget cut, DMH plans to slash the case management workforce in half, which would save the state $12.4 million. That move recently triggered DMH workers represented by SEIU Local 509 to take a vote of no confidence in Doyle. 

Gov. Maura Healey has already hit pause on a controversial plan to shutter a 16-bed psychiatric hospital in Cape Cod. That closure, combined with the three youth mental health programs, would have saved the state a total of $20.1 million, according to a presentation from the Executive Office of Health and Human Services.

As House Democrats prepare to release their budget next week, Rep. Aaron Saunders of Belchertown said he plans to fight to ensure the CIRT, operated by Cutchins Programs for Children & Families, receives funding.

“We need it to be there,” Saunders told the News Service. “It is a level of intervention and service that other programs are not designed to provide, and that to me really is the linchpin.”

Saunders added, “In my conversations with the administration, I’ve tried to impress upon them that there needs to be access, in some way, shape or form, to this level of service.”

Tina Champagne, CEO of Cutchins Programs for Children & Families, urged lawmakers Tuesday to “dig deeper and to save our programs.” In prepared remarks, Champagne said the state remains in the throes of a “children’s mental health crisis” and argued “this is no time for a reduction in intensive mental health services in our state.”

“The decision to cut the CIRT is not only in direct opposition to well-established evidence-based practices for children and families with some of the most persistent and challenging mental health and safety concerns, but also puts the the most vulnerable children and families in the commonwealth at even greater risk by perpetuating the cycle of ACES and traumatic experiences,” Champagne said, referring to adverse childhood experiences.

She added, “The degree of safety and mental health challenges that must occur for youth to be considered for a DMH referral for the CIRT is highly intensive and the youth’s safety concerns are typically quite serious. If these youth could be treated elsewhere in the community, they would have been referred to those services, and usually have already utilized these services, but they are not intensive enough to maintain safety and mental health stabilization.”

At the hearing, Oliveira told Doyle he was insulted by her remarks that signaled the Belchertown program was not viable due to its location in western Massachusetts.

“That’s insulting to any western Mass. lawmaker who might be sending people halfway across the state, hours away to get the programs to utilize them,” Oliveira said.

The commissioner told Oliveira she regretted if her testimony seemed to be “disrespectful.”

“It’s more of a matter that we have to weigh parents’ requests and parents’ priorities, as well,” Doyle said. “So, it has always been a western Mass.-located program. It’s not new. And what we’re seeing is that it is getting a bit more challenging, particularly with workforce constraints, that when we don’t have full staff operating, it requires that the department have to make decisions with parents about whether or not their their child can be safely treated in that environment, based on staff that are available at that time.”

Rep. Kelly Pease, a Westfield Republican, questioned whether the adolescent mental health programs represented the “smart place” for DMH to make cuts. Without providing sufficient care to young Bay Staters early on, the state may exacerbate the prison pipeline and end up incurring more costs in the future, Pease told Health and Human Services Secretary Kate Walsh.

Walsh insisted those programs were 50 percent occupied and emphasized EOHHS’s push to “right-size our behavioral health infrastructure.” Pease argued the low patient census was a function of DMH’s “antiquated process to get a referral.”

“I think the question for the Legislature is: Do you want to pay for standby capacity in two or three programs across the state that may or may not be used?” Walsh said at the hearing Monday. “In the meantime, you should challenge us to significantly improve our antiquated or very complicated processes to get people into these systems — some of which, I will remind us, were the result of court decisions. So we have patient referral pathways for people with, for children with behavioral health challenges that were built by lawyers, with due respect.”

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AS EIGHT BILLS in this legislative session seek to increase the number of dispensaries or cannabis establishments that any one individual or organization can own, the cannabis industry remains divided on whether the Legislature should maintain the current cap of three. 

The state set the license cap in 2017 as a measure to keep large companies from monopolizing the cannabis industry and to protect small cannabis business owners – particularly those who come from communities harmed most by the war on drugs. 

Now, some cannabis operators are saying that the cap restricts their ability to run their businesses. Some cannabis business owners have argued that the Legislature needs to increase the license cap to allow struggling business owners to attract desperately needed capital from large multistate operators and provide an opportunity for them to sell their companies. 

The bills currently pending all seek to raise the license cap from three to either six or nine. One bill seeks to allow companies that have already reached a three-license limit to increase the amount of ownership stake they can have in four additional social equity businesses. 

On Wednesday, at the Legislature’s first cannabis committee hearing of the session, cannabis business owners and leaders spoke in favor of the bills to increase the cap. 

Payton Shubrick, the owner of 6 Bricks dispensary in Springfield, argued in favor of increasing the cap. She said that her business is family-owned and has faced headwinds with the falling price of marijuana since she opened the dispensary. Increasing the license cap will mean that larger companies will have more opportunities to buy up or invest in companies like hers, she testified. 

“At this point in time, I’m sitting on an asset that’s losing value over time with oversaturation and oversupply creating a dynamic where I can’t create a successful exit,” said Shubrick. 

The owner of Apex Noire – the first black-owned dispensary to open in Boston – and a former member of the Boston city council, Tito Jackson, also spoke in support of changing the license cap. 

“Increasing the license cap should be seen as a tool – one that business owners can use if they are able to,” said Jackson. “It does not mean that … everyone has to sell. However, not giving those individuals the options to do so is problematic.” 

Other cannabis business owners testified in opposition.  

“I can guarantee you that raising the cap will do the exact opposite of what other people have mentioned here,” said Ruben Seyde, the owner of Delivered, Inc., a cannabis delivery company. “It is not going to help [social equity businesses like mine]. It is only going to put me in a worse position than the one I am in right now. I am already struggling in this market. If these entities are able to double their resources by partnering up with [multistate operators] and other larger entities, I have no future. I have no viable road from my current to take and to still reach some level of profitability.” 

Ahead of the legislative hearing, nearly 60 business leaders and advocates in the cannabis industry signed a letter urging legislators to continue to cap the number of dispensaries any business can own at three. 

“If the license cap is removed, we’re going to see [multi-state cannabis businesses] gobbling up equity businesses, consolidating the market and devaluing the value of licenses for those who are in the industry,” said Kevin Gilnack, Deputy Director of the cannabis advocacy group Equitable Opportunities Now, in a phone interview ahead of the hearing. 

Kimberly Roy, a commissioner on the Cannabis Control Commission, submitted written testimony to the legislative committee in favor of maintaining the license cap.    

“Current statutory ownership limits help to create a Massachusetts cannabis industry that encourages full participation, competition, locally owned and operated entrepreneurship … while fostering a diverse marketplace,” said Roy. “Current proposals to lift the current license cap threaten to undermine these goals, harm those we are mandated to help and as a by-product may create a ‘Walmart effect’ supply chain where market consolidation, buying power and price manipulation can be controlled by the wealthy few.”  

The cannabis industry has been struggling with the falling price of marijuana and the lack of access to capital. Social equity business owners – who come from disadvantaged backgrounds and, by definition, have limited access to capital – have been particularly hit by debt and the challenges of the industry.  

Two bills that would double cannabis purchase and possession limits and make it easier for those who work in the cannabis industry to get registered received widespread support at the hearing. Currently, every person who works at a cannabis business must get a separate registration for every different licensed establishment. One person may need multiple registrations, which is costly for business owners. The industry widely supports making the change to streamline the process.  

Another bill would make it so that medical marijuana businesses no longer have to cultivate, process, and dispense cannabis to maintain their licenses. In addition to removing that requirement, the bill would also decrease the licensing fee for medical dispensaries and allow people from other states to use their medical marijuana cards at Massachusetts medical dispensaries.  

“​​We need to reinvest in the future of the program, and that means streamlining it, modernizing it, and removing the shackles that limit patient access and prevent equity [owners] from participating in the medical industry,” said Jeremiah MacKinnon, the president of the Massachusetts Patient Advocacy Alliance. “We brought these issues to the [Cannabis Control] Commission’s attention, but after six years of advocacy, nothing’s changed. It has not been on their list of priorities.”  

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MIKE KENNEALY, a former private equity manager who spent four years as state housing and economic development secretary under Gov. Charlie Baker, declared his candidacy for governor on Monday and said Massachusetts is “heading in the wrong direction.” 

Jumping into the ring against Gov. Maura Healey, who plans to seek reelection in 2026, Kennealy released a launch video Monday morning. He pointed to rising expenses, education, the emergency family shelter crisis and outmigration as key areas where the Bay State is struggling.

“The political class on Beacon Hill is more concerned with their future than with ours. Our beacon on a hill has become a beacon in the rearview mirror,” Kennealy said in the video. “The people of Massachusetts expect and deserve better.”

Although the press release announcing Kennealy’s campaign launch made no mention of his party affiliation, a spokesperson confirmed he is running as a Republican.

Other Republicans mentioned as potential candidates for governor include Worcester County Sheriff Lew Evangelidis, former MBTA Chief Administrator Brian Shortsleeve, former U.S. Senate candidate John Deaton, and Sen. Peter Durant, who said last month he would make his decision “relatively shortly.”

Kennealy spent nearly two decades working in private equity before joining the public sector in 2013 as part of the leadership team that worked on turning around Lawrence Public Schools, according to his campaign.

He became an assistant secretary under Baker, and rose to the Cabinet-level role of housing and economic development secretary in December 2018. Healey, who succeeded Baker, later split that job into two separate positions of housing secretary and economic development secretary.

Kennealy stayed in that job for the remainder of Baker’s tenure through 2022, helping to lead the state’s response to the economic upheaval inflicted by the COVID-19 pandemic. Following his time on Beacon Hill, Kennealy worked as senior advisor and chief strategy officer at the Boys and Girls Club of Boston.

His campaign appears poised to spotlight affordability issues, a steady theme on Beacon Hill for Healey and the House and Senate Democratic supermajorities. Kennealy named “a state we can all afford” as his top priority, followed by “a great future for everyone” and “government we can believe in.”

Healey in February announced her intention to seek reelection, saying she believes “there’s a heck of a lot more to do.”

Massachusetts voters over the years have elected a succession of Republican governors while preferring to keep Democrat supermajorities in the House and Senate, as well as an all-Democrat congressional delegation.

A UMass Amherst-WCVB poll of Massachusetts voters conducted in mid-February found about 52% approve of Healey’s job performance so far compared to 36% who disapprove.

Pollsters also asked at the time about hypothetical matchups between Healey and potential Republican challengers, including Kennealy. Four in 10 voters said they’d back Healey over Kennealy, 15% said they would pick Kennealy, and another 39% were not sure.

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ON THE EVE of a legislative hearing on her surtax surplus plan, Gov. Maura Healey submitted another spending bill for the Legislature’s review, filing a $756 million supplemental budget she said would address “time-sensitive deficiencies” in state government accounts.

The proposal Healey filed Wednesday afternoon (HD 4540) includes $134.5 million for supplemental payments to safety-net hospitals, $60 million for direct care for older adults, $240 million for state employee health care costs through the Group Insurance Commission, and more. It would carry a net state cost of $544 million after federal reimbursements, she said.

Healey’s office pitched the $190 million the bill includes for a child care financial assistance program as a way to “support Massachusetts residents at a time of rising costs.” Another $43 million would go toward the Residential Assistance for Families in Transition (RAFT) program that offers aid to families facing potential eviction, which has faced increasing demand during a period of housing strain.

The legislation additionally includes $15 million for grants and marketing related to the American Revolution 250th anniversary celebration, and $15.5 million for more secure electronic benefits transfer cards that Healey said would “help combat food benefit theft.”

“This budget bill proposes targeted investments that improve quality of life in Massachusetts, such as ensuring access to health care, supporting families with child care costs, and making sure veterans get their benefits,” Healey said in a statement alongside the bill. “We’ve also heard clearly from local officials and medical professionals across the state, especially in communities impacted by Steward Health Care’s closures, that they need more support. That’s why we’re proposing significant funding for EMS providers that have faced extraordinary costs. Our administration remains committed to maintaining a responsible state budget that tangibly benefits the people of Massachusetts.”

Other sections of the 25-page bill would ratify collective bargaining agreements with public employees, raise procurement thresholds under public construction laws, and allow Massachusetts Emergency Management Agency vehicles to use red and blue lights when responding to emergencies.

The Legislature’s Joint Committee on Ways and Means is partway through a series of hearings about Healey’s $62 billion fiscal 2026 state budget, and the panel will meet Thursday to consider Healey’s separate $1.3 billion proposal (H 55) to spend surplus surtax revenue.

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MASSACHUSETTS INSPECTOR GENERAL Jeffrey Shapiro called on the Cannabis Control Commission to conduct an audit following the commission’s failure to collect approximately $550,000 in licensing fees since August 2022. 

In a letter to Travis Ahern, the newly appointed executive director, and Bruce Stebbins, the acting commission chair, Shapiro wrote that the agency’s failure to collect fees is an “egregious operational breakdown” that suggests “poor business practices and oversight.”  

In August 2024, the commission publicly admitted to failing to collect $555,671 in license renewal extension fees. The commissioners began to allow license extensions of up to 120 days in August 2022 and directed the staff to collect prorated license fees to cover the extension. The commission failed to collect those extension fees.  

Shapiro also found that the commission staff was granting extensions prior to the commission’s August 2022 vote without having the authority to do so. 

“The inability of CCC staff to implement a key commission initiative should have been readily apparent to supervisors and commissioners in real time,” Shapiro said in a press release. 

The commission has since corrected its mistake by recouping previously uncollected fees and updating the agency’s payment systems. Ahern said in an email statement that only $170,000 fees from the $550,000 remain uncollected as of this week.  

Shapiro said in his letter that the commission still needed to conduct an audit “to ensure that all current licensees have paid all applicable fees and fully understand what revenue went uncollected, as businesses ceased operations.”  

Ahern said that the commission is continuing to meet with the Inspector General’s office about the issues outlined in the letter and that the agency will provide a “more robust response” to the letter within the required 30 days.  

In August 2024, soon after the issue of uncollected fees became widely known, one commissioner, Kimberly Roy, called for a “forensic audit” of the agency. Forensic audits typically examine an organization’s financial records and look for fraud, misconduct, or irregularities. Roy pitched it as a way for the commission to modernize.  

In addition to those uncollected fees, Shapiro flagged that the commission had failed to collect up to $1.2 million in potential provisional licensing fees. Technically, no provisional licensee was able to move forward in the licensing process or become operational without paying the fees, but the commission’s policy does require that those fees be paid within 90 days of initial approval.  

Ahern said that “uncollected provisional application fees referenced in the OIG’s letter is subject to misinterpretation” and that “fees from provisionally approved applicants are only due if the applicants choose to proceed to final licensure.” 

Kevin Gilnack, president of the cannabis advocacy group Equitable Opportunities Now, said that $1.2 million claim seems “pretty sensational,” but it doesn’t seem like “any harm was caused by not enforcing it.” 

“No one can advance without paying the provisional fee [so] it doesn’t sound like the CCC was missing out of any fees,” said Gilnack.  

Last summer, Shapiro called on the Legislature to appoint a receiver and restructure the agency to clarify the leadership roles of the executive director and commission chair. Treasurer Deb Goldberg suspended and subsequently fired the commission’s previous chair, Shannon O’Brien, due to accusations of “racially, ethnically, and culturally insensitive statements.” Goldberg is the appointing authority for the commission chair role. 

O’Brien has alleged that she was fired for trying to rectify the dysfunction at the agency and is still actively fighting her dismissal in court. The commission has had internal conflict, allegations of misconduct, and a slow-moving regulatory process that has frustrated many within the cannabis industry. 

Shapiro said the time for a receiver has passed but that reform at the embattled agency is still necessary. The commission, he said, needs to work out the roles and responsibilities of the chair and executive director. “Until that issue is addressed, I fear that responsibility and accountability will continue to be elusive, and the Commission will struggle to gain its footing to chart a proper path forward,” Shapiro added. 

The commission has asked the Legislature for an increased amount – $30.8 million – in the state’s budget for the fiscal year 2026. This year, the commission operated with a $19.8 million budget.  

Ahern said that the increased budget will be crucial to helping the commission update its “outdated IT infrastructure” and “would address updates to the software that tracks and accounts for license and application fee payments.”  

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TALKS ARE UNDERWAY within state government about establishing a third long-term care home for veterans, Veterans Services Secretary Jon Santiago said Tuesday.

At a Joint Ways and Means Committee hearing in Worcester, the secretary described the next budget cycle as being about the “organizational maturation” of the Executive Office of Veterans Services.

The office became a Cabinet-level office two years ago after governance and operational shortcomings that proved fatal during the pandemic, particularly at the state-run veterans’ homes in Holyoke and Chelsea. He described how things are going at the new Chelsea facility that opened in 2023 and the work underway to prepare for the under-construction new Holyoke home.

Santiago also raised the subject of a $200 million bond authorization that the Legislature, where he served at the time, included in a 2021 law to address long-term care for veterans in other parts of the state.

“There was a $200 million bond bill put forward to look into a third home, right, to increase that geographic equity. That’s something that we’re in a conversation with [the Division of Capital Asset Management and Maintenance], to look where across the Commonwealth we could potentially put a third home and what that would entail,” the secretary said.

The authorization to borrow up to $200 million in the 2021 law is specifically for “increasing geographic equity and accessibility related to the continuum of long-term care services for the Commonwealth’s veterans not primarily served by the Soldiers’ Home in Massachusetts located in the city of Chelsea or the Soldiers’ Home in Holyoke, including the establishment of regional or satellite veterans’ homes.”

The potential for a third state-run veterans’ home came up during a back-and-forth between Santiago and Rep. Russell Holmes of Boston, who asked the secretary about the diversity of the resident veterans served at the state-run facilities.

“It always feels like the Chelsea and the Holyoke homes feel like they’re local, they’re for local people. That’s just historically how they’ve felt; people in the west thought it was for them in the west, people in the east thought Chelsea was for the east. And as you grow from 117 beds, it sounds like, to 234 in Holyoke. And then as you now opened up Chelsea, do you have an answer on diversity of the residents who’s living there?” Holmes asked.

The representative said he was particularly interested in knowing how the state plans to make the additional beds that will come online in Holyoke available and what outreach will be done to make sure all veterans know their options.

“My understanding is, historically, it’s kind of been, you know, who you knew helped you get in. I hope we’re eliminating all of that as a part of this new process,” Holmes said.

Santiago said he “completely agree[s]” with Holmes about the way the Chelsea and Holyoke homes have been viewed. He said the “vast majority of residents there are white male” and told Holmes that while the “current mechanism is a ‘first come, first served’ ” method of accepting new veterans to the homes, it’s something he wants to look at it as part of a 2030 strategic plan.

“Part of that is looking into how we make sure veterans who are underserved, irrespective of their race, maybe, or their gender, are cared to. We have 25,000 women veterans across the commonwealth. Traditionally, they have not gotten the services, respect, that they have fought for and that they have earned,” he said. “And so we’ve changed our management, we’ve changed our programs and policies to better address that, and we look forward to doing it with the veterans of color as well.”

If the state is going to establish a third home, Rep. Kip Diggs of Barnstable said it should be on or near Cape Cod.

“We have 19,000 veterans on the Cape … and what’s important to me is if that third spot, maybe we can get it closer to the Cape. Because, honestly, it’s all about taking care of my area and making sure — you know, our veterans have done so much and asked for so little,” he said. “So I think it’s something that’s just so poignant and so necessary that we bring something down towards the southern part of Mass.”

The secretary responded briefly to point out the “significant cost” that would be associated with any potential third facility. Others, including Sen. John Velis of Westfield, have previously mentioned that conversations about additional veterans facilities were taking place.

Lawmakers dug into a variety of topics with Santiago during their time for questions. Sen. Kelly Dooner of Taunton put a pitch in for finding a way to partner with a nonprofit to repurpose parts of Taunton State Hospital for veteran housing, Sen. Michael Brady of Brockton wanted to know about the impact so far and outlook for additional federal cuts at the VA, Rep. Judith Garcia asked about veteran needs that are not met through the state budget appropriation, and Sen. Ryan Fattman pressed officials on the need for better tracking of suicides among veterans here and especially among Mass. National Guard members.

Santiago said Healey’s budget proposes $206 million for his secretariat, $7.6 million more than the current state budget. He said the budget proposal includes an increase of $13.6 million to veterans benefits and annuities, as well as $80 million to support the state-run veterans homes in Chelsea and Holyoke.

“This overall allotment helps us maintain critical staffing, supports infrastructure improvements, allows us to operate and maintain our two veteran cemeteries in Winchendon and Agawam, and provides health care and supportive services to veterans at the long-term care and independent living facilities in Chelsea and Holyoke,” Santiago said. “We are particularly proud of the transformation happening at both veteran homes over the past two years. They both continue to show progress when it comes to modernization and quality of care, ensuring that Massachusetts veterans receive the highest standard of care.”

Chelsea Veterans Home Superintendent Christine Baldini told lawmakers that the implementation of electronic medical records was a “significant milestone” for her facility.

“This is transforming our health care operation. By replacing traditional paper records with a secure, integrated, digital platform, we have enhanced accuracy, reduced administrative burden and improved overall efficiency. Real-time access to resident information empowers the care team to make informed decisions more quickly, and fosters streamlined communication across all disciplines,” she said.

Holyoke Superintendent Michael Lazo said his team is preparing to expand into the new 234-bed facility the state broke ground on in August 2023. He told the Ways and Means Committee that the larger and modern facility “will require approximately 40% increase in workforce spending, both clinical and non-clinical roles.”

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AT A TIME when lawmakers are wrestling with cost, access and regulatory questions, health care industry power players continued to dominate the Beacon Hill lobbying world last year, spending the most on employing influential insiders who sway development of public policy.

The Massachusetts Association of Health Plans spent $1.3 million on lobbyists in 2024, more than any other individual client in the Bay State, according to data from Secretary of State William Galvin’s office. The organization representing insurers newly supplanted the Massachusetts Health and Hospital Association, which topped lobbying spending in 2022 and 2023 but ranked second last year with $1.1 million.

Those organizations were the only two clients that spent more than $1 million apiece on lobbying last year.

Many health care- and pharmaceutical-adjacent groups ranked near the top in 2024 lobbying spending, too, including the Massachusetts Biotechnology Council ($866,139), Massachusetts Nurses Association ($519,191), Blue Cross Blue Shield of Massachusetts ($460,403) and the Association for Behavioral Healthcare ($459,070).

Health care policy is one of the thorniest and most complex topics for lawmakers to tackle. The Legislature enacted a pair of major reform bills in 2024, including one intended to lower prescription drug costs and another imposing more financial oversight on hospitals following the collapse of Steward Health Care.

But the problems plaguing both providers and patients remain potent. Sen. Cindy Friedman, the Senate’s point person on health care reforms, warned last week that the health care system is “falling apart.”

The total amount paid to lobbyists by all clients across different topics crossed into nine figures in 2024, climbing to $104.1 million.

The same top lobbying shops continue to command the most money from clients.

Each of the five top-earning firms in 2023 retained the same ranking in 2024, led by Smith, Costello and Crawford, which hauled in $6.2 million last year.

Like many lobbying entities around Beacon Hill, Smith, Costello and Crawford counts well-connected former public officials among its ranks. The firm is partly led by former Democrat Reps. Michael Costello, and another former representative, Carlo Basile, is a senior policy advisor. That’s the same title held by Marylou Sudders, who served as health and human services secretary under Gov. Charlie Baker.

Smith, Costello and Crawford’s top-paying client — $180,000 last year — was energy giant Avangrid, a key figure in the state’s push to build out cleaner energy sources including offshore wind.

Tremont Strategies Group earned the second-most of any lobbying firm with about $4.5 million. Former Congressman Chet Atkins, who also served in the Massachusetts House and Senate, is a partner at Tremont.

Rounding out the five top-earning firms were O’Neill and Partners ($4.28 million), Dempsey Associates ($3.77 million) and Kearney, Donovan and McGee ($3.5 million).

The next five ranking spots were all captured by the same firms as 2023, but in a slightly different order. ML Strategies jumped from seventh-most in earnings in 2023 to sixth-most in 2024, flipping with Bay State Strategies Group. Similarly, Issues Management Group climbed from ninth in 2023 to eighth in 2024, swapping places with TSK Associates. The Suffolk Group landed in 10th both years, earning about $2.26 million in 2024.

No individual lobbyist earned more in 2024 than former Senate President Robert Travaglini, who founded what is now known as TSK Associates after leaving the Legislature.

Travaglini hauled in $854,000 from his lobbying clients in 2024, according to data from Galvin’s office. Basile, who was the top earner in 2023, landed in second last year with $830,000 in lobbying salary.

The private sector can be much more lucrative for lawmakers than remaining in the Legislature. The current Senate president, Karen Spilka, earned $203,286 in total pay last year, according to state payroll records, less than one-quarter as much as Travaglini brought in from lobbying clients.

Fourteen lobbyists earned more than half a million dollars from their firms last year, and 56 brought in at least $250,000.

Three other registered lobbyists were paid at least $250,000 directly by clients: Mass. Association of Health Plans President Lora Pellegrini ($469,233 from MAHP), Clark University Vice President for Government and Community Affairs Joseph Corazzini (nearly $235,000 from the Trustees of Clark University), and OpenCape CEO Steven Johnston ($246,159 from OpenCapeCorporation).

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