Section summary
Counting everything placed, the largest clause placed in a single town in ten budgets is the FY2026 $31 million for the state-run Pappas Rehabilitation Hospital for Children in Canton, a policy dispute over a state facility. In the same debate the Senate passed the Pappas amendment 39 to 0 and rejected, in a bundle without a vote, a $30.4 million increase in TAFDC and EAEDC cash grants. Thirty-five towns, home to 50,388 people, had no earmark placed in them in ten budgets on the second or third measure, and 33 of them rank in the top half of the state for competitive grant dollars per resident.
Every item in the budget can be justified at some level, and most have an advocate with standing. The two cases below were chosen because they sit at the extremes of the whole distribution.
The largest town-placed clause in ten years
The FY2026 budget directed “not less than $31,000,000” to the continued operation of the Pappas Rehabilitation Hospital for Children in Canton. Counting everything placed, the third measure, it is the largest clause placed in a single town in ten budgets: $31 million in Canton, six times the next largest ($5 million, also a state facility).
It is the Legislature funding the continued operation of a state-run Department of Public Health children’s hospital, with 60 beds and 36 patients in January 2025, that the administration had proposed to close for an estimated $31 million saving. It is a policy dispute over a state facility, and the money is placed in Canton because the hospital is there. It counts on the third measure only: the clause does not name the town, and it pays for a state facility rather than a local organization. The town-level model in section 6 uses the second measure, so it does not include this clause.
The clause is a gross appropriation. At 36 patients it comes to about $861,000 a patient-year; at the census of 24 recorded in October 2025, $1.29 million. The Pappas Working Group’s FY2024 figures give the cost both ways: $42.8 million gross, about $1.07 million a patient-year at an average census of 40, and a state share after federal Medicaid reimbursement of $25.6 million, about $640,000 a patient-year. On the other side of the ledger, MassHealth authorized 1,588,175 hours of pediatric home nursing for 573 children in 2024, and 517,866 of those hours were never delivered. At the state’s rates they would have cost $27.9 million to $40.3 million. The comparison has a limit: the hours went unfilled mainly because there are not enough nurses.
The Legislature’s case is serious. Pappas holds the only pediatric beds in the public health hospital system. The governor’s own working group rated closure poorly and called the proposed Westfield unit a supplement, not a replacement. Staff say the falling census reflects admissions that were blocked. The administration’s case is serious too: a rebuilt campus was priced at more than $440 million, and most of the January 2025 patients were adults waiting for a placement. The FY2027 budget dropped the $31 million language, and a special commission is due to report by December 31, 2026.
In the same May 2025 debate the Senate took up two amendments of about the same size. Amendment 543, filed by Sen. Dylan Fernandes, $31 million for Pappas and $4.8 million for the Pocasset Mental Health Center, passed 39 to 0. Amendment 522, filed by Assistant Majority Leader Sal DiDomenico, $30.4 million to raise TAFDC and EAEDC cash grants 10% from January 2026, reaching more than 106,000 people in TAFDC households, was rejected in a bundle without a vote. The Senate’s choice has a defense: 543 refused a proposed cut inside lines already funded, while 522 started a permanent increase that would cost about twice as much in a full year, every year. The Senate budget had also already protected the April 2025 increase. The pairing still shows the pattern in section 5: a place with a building and a constituency, against a benefit spread across a state.
The Losers Club
Thirty-five towns, home to 50,388 people, had no enacted earmark placed in them in any of the ten budgets, on the second or the third measure. Every one has fewer than 5,300 residents. Seventeen are in Berkshire County, six in Franklin, four each in Hampshire and Dukes, three in Hampden and one in Worcester. Counting only earmarks that name the town, 39 had none. The club spans rich and poor: Chilmark and Edgartown on Martha’s Vineyard rank 350th and 344th of 351 on need; Savoy and Plainfield rank 15th and 27th.
The absence of earmarks is not the absence of state money. Thirty-three of the 35 rank in the top half of the state for competitive grant dollars per resident, and 20 in the top 50. Mount Washington is in the club and seventh in the state in competitive awards per resident. The club measures one channel, and it reflects how earmarks are written: to a named organization or project, which small towns without a full-time staff or a local nonprofit rarely have. That is a capacity story as much as a power story. A test of administrative capacity points the same way. Among the smallest two fifths of towns, the third with the smallest town halls (47 towns, median population 954, median general-government spending $317,000 a year) score a median 0.52 on core infrastructure, and 4% have ever won a Complete Streets award. The third with the largest (median population 5,496, $1.76 million a year) score 1.03, and 47% have won one. Town-hall size and population rise together, so the two cannot be fully separated.