Does your agency have to file with Massachusetts?
Massachusetts requires entities that provide minimum essential coverage to Massachusetts residents to report it to the Massachusetts Department of Revenue (DOR). In practice that means:
| Your situation | Who files | What gets filed |
|---|---|---|
| Any plan (or no plan), 6+ MA employees | You, the employer | HIRD report via MassTaxConnect, Nov 15 – Dec 15 each year |
| Fully insured group plan | The carrier | Carrier issues Form MA 1099-HC to covered MA residents by Jan 31 and reports to DOR |
| Self-insured or level-funded plan | You, the employer | Ensure MA employees receive Form MA 1099-HC by Jan 31 and the data reaches DOR (bulk electronic filing if the carrier/TPA does not do it) |
| Under 6 MA employees, no plan | No one | No HIRD; nothing to file (but see the employer mandate below) |
The HIRD is unusual: it applies regardless of whether you offer coverage and regardless of ALE status, and it collects plan details DOR uses for MassHealth premium assistance. You count as having 6+ employees if you reported six or more on any DUA quarterly wage report in the past 12 months; an out-of-state employer that does not file DUA reports counts anyone hired for wages to perform work in Massachusetts.
Massachusetts deadlines and penalties
| Date | Obligation | Applies to | Penalty |
|---|---|---|---|
| November 15 – December 15 | File the HIRD via MassTaxConnect | Every employer with 6+ MA employees | $1,000–$5,000 per violation for knowingly failing to file or falsifying (M.G.L. c. 118E, § 78). DOR notes the information reported is not itself used to impose penalties |
| January 31 | Furnish Form MA 1099-HC to covered MA residents and report to DOR | Carriers (insured); employers (self-insured) | $50 per individual, up to $50,000 per year |
Note the HIRD falls in Q4 of the coverage year, unlike every other reporting item on this page, which falls in Q1 of the following year.
Is your agency an Applicable Large Employer?
Count full-time employees (30+ hours a week or 130+ a month) and add full-time equivalents from everyone else: total part-time hours in the month ÷ 120. Average the monthly totals over the prior calendar year.
Worked example. A Massachusetts agency has 45 caregivers and office staff at 130+ hours a month, plus 30 part-time caregivers averaging 60 hours a month.
- Full-time employees: 45
- Part-time FTEs: 30 × 60 = 1,800 hours ÷ 120 = 15
- Total: 60 → the agency is an ALE.
Two home care specifics. Entities under common ownership are combined under the controlled-group rules, so multiple agency LLCs or franchise territories with the same owners count as one employer. And caregivers with variable hours can be classified using the IRS look-back measurement method (a 3–12 month measurement period followed by a stability period), which is how most agencies decide who must be offered coverage without re-running the math every month.
What an ALE owes if it doesn't comply (2026 amounts)
- 4980H(a), no offer: if you don't offer minimum essential coverage to at least 95% of full-time employees and any one of them gets a subsidy on the Massachusetts Health Connector, you owe $3,340 per full-time employee minus the first 30. In the example above: (45 − 30) × $3,340 = $50,100 a year, triggered by a single subsidized caregiver.
- 4980H(b), unaffordable offer: if you offer coverage that's unaffordable or below minimum value, you owe $5,010 for each full-time employee who enrolls in a subsidized marketplace plan.
Which Massachusetts caregivers can actually trigger a penalty
Penalties are only triggered when a full-time employee actually receives a premium tax credit on the marketplace. Who can get one depends on income:
| Caregiver household income | Can they get a marketplace subsidy? | Can they trigger a penalty for you? |
|---|---|---|
| Below 138% FPL | No. Massachusetts expanded Medicaid, so adults to 138% FPL qualify for Medicaid and cannot receive a marketplace credit | No |
| 138%–400% FPL | Yes | Yes — each one is a potential $5,010 (b) trigger, or the single trigger for the (a) penalty |
| Above 400% FPL | Generally no in 2026, now that the enhanced credits have expired | No |
Massachusetts expanded Medicaid (MassHealth); combined with ConnectorCare, low-wage caregivers have broad subsidized options. kff.org ↗
Massachusetts runs the Health Connector, the nation's oldest exchange, with ConnectorCare subsidized plans. mahealthconnector.org ↗
What counts as "affordable" for a Massachusetts caregiver in 2026
Coverage is affordable if the caregiver's self-only contribution is no more than 9.96% of household income. Since you can't know household income, the IRS provides three safe harbors:
| Safe harbor | How it's calculated | 2026 monthly ceiling for a Massachusetts caregiver |
|---|---|---|
| Federal poverty line | FPL × 9.96% ÷ 12 | $129.89 regardless of wage |
| Rate of pay | Lowest hourly rate × 130 hours × 9.96% | $194.22 at the $15.00 minimum |
| W-2 wages | 9.96% of Box 1 wages | Varies; known only after year-end |
The Massachusetts-specific point: because the state minimum wage is $15.00, the rate-of-pay safe harbor gives Massachusetts agencies far more room than the $129.89 FPL figure most national guides quote. An agency paying $15.00 can charge up to $194.22 a month for self-only coverage and still be safe from the (b) penalty. Use each caregiver's actual lowest hourly rate; where local minimums are higher, the ceiling is higher still.
A CHOICE (formerly known as ICHRA) counts as an offer of coverage. It's affordable if the caregiver's cost for the lowest-cost self-only silver plan on the Massachusetts Health Connector for their rating area, minus your monthly allowance, stays within the 9.96% test.
IRS Rev. Proc. 2025-25 ↗ · IRS HRAs ↗ · minimum wage → see the Massachusetts wage & hour page
2026 compliance calendar: Massachusetts and federal together
| Date | Obligation | Who | Authority |
|---|---|---|---|
| Ongoing | Track caregiver hours under your measurement/stability periods | ALEs | IRS |
| Mar 2, 2026 | Furnish Form 1095-C to full-time employees, or post a website notice and furnish within 30 days on request | ALEs | IRS |
| Mar 31, 2026 | E-file Forms 1094-C/1095-C with the IRS (e-filing required at 10+ returns) | ALEs | IRS |
| Jan 31, 2026 | Furnish Form MA 1099-HC to covered MA residents | Carriers; self-insured employers | MA DOR |
| Nov 15 – Dec 15, 2026 | File the HIRD for 2026 | Every employer with 6+ MA employees | MA DOR |
The Massachusetts rows apply to self-insured/level-funded sponsors (and to every employer for any item marked as such above); the IRS rows apply to ALEs. If you also employ caregivers who live in other reporting states under a self-insured plan, see the state-by-state ACA hub.
Other Massachusetts benefit mandates that touch home care agencies
These aren't ACA rules, but they land on the same desk.
- MA PFML. Massachusetts PFML provides up to 12 weeks family / 20 weeks medical (26 combined) leave, funded by a payroll contribution (0.88% of wages in 2026 for 25+ headcount employers; employers under 25 are exempt from the employer share). mass.gov ↗
Frequently asked questions
We don't offer health insurance. Do we still file the HIRD?
Yes, if you have 6 or more Massachusetts employees. The HIRD is required regardless of whether you offer coverage, and knowingly failing to file carries a $1,000–$5,000 penalty per violation.
Our plan is fully insured. Do we have to do anything about Form 1099-HC?
The carrier issues it. Confirm with the carrier that Massachusetts residents received it by January 31 and keep that confirmation; the $50-per-individual penalty attaches to whoever fails to furnish or report.
We're a New Hampshire agency with a few caregivers who work in Massachusetts. Does the HIRD apply?
Count the employees you reported on Massachusetts DUA quarterly wage reports in the past 12 months. If that reaches six in any report, you file. Out-of-state employers that don't file DUA reports count anyone hired for wages to perform work in Massachusetts.
We have 48 full-time caregivers and a handful of part-timers. Are we under the threshold?
Probably not. Add the part-timers' monthly hours and divide by 120. Two part-timers at 120 hours a month between them add one FTE, which puts you at 49; a third pushes you to 50 and ALE status the following year.
Can a caregiver on Medicaid trigger a penalty against us?
No. Penalties are triggered only by full-time employees who receive a marketplace premium tax credit. Massachusetts caregivers below 138% FPL qualify for Medicaid instead, so they can't trigger 4980H. Caregivers between 138% and 400% FPL can.
We pay the Massachusetts minimum of $15.00. What's the most we can charge for self-only coverage?
Under the rate-of-pay safe harbor, $15.00 × 130 hours × 9.96% = $194.22 a month in 2026. That's well above the $129.89 FPL figure, so rate of pay is the better harbor for Massachusetts agencies.
Not legal advice. Confirm details with the cited official sources or counsel. Full disclaimer
- https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVII/Chapter118E/Section78
- https://www.irs.gov/affordable-care-act/employers/identifying-full-time-employees
- https://www.irs.gov/affordable-care-act/employers/information-reporting-by-applicable-large-employers
- https://www.irs.gov/newsroom/health-reimbursement-arrangements-hras
- https://www.irs.gov/pub/irs-drop/rp-25-25.pdf
- https://www.irs.gov/pub/irs-drop/rp-25-26.pdf
- https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/
- https://www.mahealthconnector.org
- https://www.mass.gov/info-details/form-ma-1099-hc-proof-of-health-insurance
- https://www.mass.gov/info-details/health-insurance-responsibility-disclosure-hird-faqs
- https://www.mass.gov/orgs/department-of-family-and-medical-leave