Massachusetts Supported Decision Making: What Families Can Do Right Now Without a Statute

Parents searching for SDM resources in Massachusetts quickly hit a confusing wall: advocacy organizations recommend it, disability rights groups promote it, the court system acknowledges it — but Massachusetts has not passed a supported decision-making statute. The bill exists. It is moving. But it is not law yet.

That does not mean families need to wait. SDM agreements are functional right now in Massachusetts. They just require more deliberate construction than they would in a state with a finalized statute.

The Legislative Status (as of 2026)

House Bill 4852 ("An Act relative to supported decision-making agreements for certain adults") was reported favorably by the Joint Committee on Children, Families and Persons with Disabilities. Its reporting deadline was subsequently extended through December 31, 2026. Senate Bill 155, a companion bill, was reported favorably on October 16, 2025, and referred to the Senate Ways and Means Committee.

If enacted, the bills would require courts to consider SDM before establishing guardianship, require school districts to introduce the SDM option at IEP meetings, and shield third parties from liability when they rely on a properly executed SDM agreement. These protections do not exist yet.

What SDM Actually Is

Supported decision-making is a structured arrangement where an adult with a disability retains full legal authority to make their own choices but designates trusted people — parents, siblings, counselors, mentors — as "supporters." The supporters help the adult:

• Gather and understand relevant information
• Weigh options and consequences
• Communicate decisions to third parties (doctors, schools, landlords, employers)

The adult makes the final call. The supporters assist, but they do not override. This is fundamentally different from guardianship, where the guardian's decisions replace the ward's.

Building a Functional SDM Agreement in Massachusetts Today

Without statutory backing, an SDM agreement in Massachusetts is essentially a contractual document between the adult and their supporters. It works — hospitals and schools generally respect it — but it needs companion documents to fill the legal gaps that a statute would otherwise cover.

Step 1: Use a Recognized Template

The Center for Public Representation (CPR) publishes a Massachusetts-specific SDM agreement template with detailed instructions. The document identifies the adult's supporters by name, specifies the domains where support is needed (medical, financial, educational, housing, employment), and describes the type of support each supporter provides.

This template has been used in Massachusetts since the CPR and the Massachusetts Advocates for Supported Decision-Making (MASDM) coalition began piloting SDM programs. Hospitals, schools, and DDS service coordinators increasingly recognize it.

Step 2: Pair It with Legally Binding Companion Documents

The SDM agreement alone does not grant legal authority. To make the arrangement enforceable in practice, pair it with:

• HIPAA Release — allows designated supporters to access the adult's medical records and participate in medical discussions
• Health Care Proxy (M.G.L. c. 201D) — gives a designated agent authority to make medical decisions if the adult loses capacity (dormant until activated by a physician's certification)
• FERPA Release — if the adult is still in a school program, authorizes supporters to access educational records
• Durable Power of Attorney — if financial support is needed, this covers banking, contracts, and benefits coordination

Each companion document has its own execution requirements (witnesses, and notarization or recording when required for real-estate POAs). The SDM agreement is voluntary and should be signed according to the current template instructions; having it witnessed strengthens its credibility with third parties.

Step 3: Introduce It at the IEP Meeting

Under DESE's SPED 2011-1 advisory, when the student reaches the age of majority, the adult student can choose among three options at an IEP meeting: full self-determination, shared decision-making, or full delegation. The SDM agreement maps directly onto the "shared decision-making" option. Bring the signed agreement to the IEP meeting and ask the team to note it in the student's file.

What Happens When a Third Party Refuses

This is the gap that a statute would close. Without a law requiring third parties to accept SDM agreements, a bank or hospital could theoretically refuse to honor one. In practice, refusals are uncommon when the agreement is paired with the legally binding companion documents listed above. If a provider refuses to talk to a designated supporter despite a valid HIPAA release on file, the problem is the provider's HIPAA compliance, not the SDM agreement.

If a financial institution refuses to honor a durable power of attorney that accompanies the SDM agreement, the issue may be the POA's drafting (missing durability language) or, for a real-estate transaction, missing notarization or recording rather than the SDM concept itself.

SDM vs. Guardianship: The Practical Difference

The core distinction is who holds legal authority:

For adults who can understand the SDM agreement and participate in decisions with support, SDM preserves dignity and autonomy without court supervision. For adults who cannot understand delegation at all — who cannot meaningfully participate even with support — guardianship may be the appropriate tool.

The Massachusetts Adult Guardianship & Alternatives Guide walks through this comparison with diagnostic worksheets that help families assess which approach matches their child's actual functional capacity.

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