BOSTON (SHNS) – Patients in Massachusetts continue to languish in hospital emergency departments for hours before receiving appropriate care, with the issue particularly acute for the state’s most vulnerable residents with behavioral health issues.
The Health Policy Commission released a new report on Wednesday March 25, 2026 on emergency department boarding with data stretching from 2020 to 2024.
Eleven percent of emergency department visits in 2024 led to patients “boarding” there, compared to 7.5% in 2020, according to a Health Policy Commission report released Wednesday. Nationwide, Massachusetts in 2024 posted the second longest wait time for patients in emergency departments for any type of visit — and the sixth longest for behavioral health visits.
Emergency department boarding, as defined by the Legislature, happens when a patient waits more than 12 hours after an initial assessment to be placed in an appropriate care setting, such as an inpatient unit or community-based acute treatment. The HPC says boarding remains a “crisis” for behavioral health patients due to a shortage of beds, a lack of facilities capable of handling individuals with medical complexities, transportation delays and potentially unstable housing, among other factors.
About 32% of behavioral health visits resulted in boarding in 2020, with that figure rising to nearly 40% in 2022 and declining to 37.5% in 2024.
Patients with MassHealth coverage or who had unstable housing were more likely to go to the emergency room for a behavioral health issue and board for more than 12 or 24 hours, the report says. Patients who were Black and living in the “lowest income communities” were also more likely to board in emergency departments.
“We still see, because of the lack of access to regular visits, maybe to primary care or to sub-specialists, they are using the emergency room as a way to take care of themselves, even if it’s not emergent,” Massachusetts Medical Society President Dr. Olivia Liao told the News Service Wednesday.
The HPC report found that between 2022 and 2024, wait times of more than 24 hours decreased for adults and children awaiting psychiatric beds. About 21% of adults in 2022 had to wait more than 48 hours for a bed, compared to 13% in 2024.
Emergency department boarding was more costly for MassHealth and commercial insurers, according to a report from Health Policy Commission released on Wednesday, March 25, 2026.
Commercial insurers and MassHealth paid more for emergency department visits among patients who boarded and were discharged into their community, compared to visits without boarding, according to the report. Leigh Simons of the Massachusetts Health and Hospital Association said she sees that increased reimbursement as a “real success.”
“ED providers, now that they have reimbursement for the behavioral health care delivered in EDs — which they previously didn’t have — have been able to provide interventions, stabilization and treatment that have stabilized these patients and allowed them to be discharged home rather than going to inpatient units,” Simons, the MHA’s vice president of policy and regulatory affairs, told the News Service.
In an effort to alleviate emergency department boarding during the Baker administration, the state launched a help line and opened 25 community behavioral health centers, which are open 24/7 and offer crisis intervention services. Some centers have crisis stabilization beds.
A 2022 law also removed prior authorization requirements to admit behavioral health patients into inpatient care, the report noted. Prior authorization can still be required for certain intensive outpatient and partial hospitalization programs, “which may delay discharge from the ED into outpatient care,” the report says.
The report recommends that the Health Policy Commission and the Center for Health Information and Analysis study admission and discharge practices at freestanding psychiatric facilities, as well as their workforce needs and payment rates. The state should also boost access to community-based care; ensure adequate provider reimbursements, including for “stepdown care and community-based care”; support alternative transportation options for patients experiencing mental health crises; and expand data collection efforts on patients moved into observation status.
The HPC also suggests revising ambulance diversion regulations for behavioral health emergencies. EMS providers are currently required to take patients to the nearest emergency department — even if hospitals don’t have inpatient psychiatric beds, which can contribute to boarding. The Department of Public Health, the Department of Mental Health, MassHealth and other stakeholders should consider steering ambulances to hospitals where there are appropriate beds, the report says.
“The Commonwealth has invested in tackling this challenge, and now is the time to take that commitment even further by executing the recommendations put forth by the HPC,” HPC Executive Director David Seltz said. “This action is critical for the health and well-being of patients and their families, hospital staff, and emergency medical services across the Commonwealth.”
Simons said the state must improve the flow of patients through health care settings.
“I think we’ve done a lot of work on what we call the front door of getting people into inpatient units,” she said. “But the biggest logjam in the system right now is being able to discharge patients to the community. And when patients get stuck in inpatient units, of course that means people can’t be admitted from the ED into those units.”
Beacon Hill Democrats are currently focused on other health care challenges, including escalating affordability woes and primary care reform. A bill establishing a primary care spending target and introducing a new payment model is expected to emerge in the Senate next month.
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