10/27/2025
The Drawbacks of Government-Funded Monopolies: A Case Study in Disability Services
In theory, public funding should empower choice, equity, and accountability. But when government dollars flow into a closed system—where a single agency controls access and a handful of providers dominate the landscape—monopoly dynamics emerge. Nowhere is this more evident than in the Massachusetts Department of Developmental Services (DDS), where individuals with intellectual and developmental disabilities (IDD) are assigned placements without meaningful input or realistic alternatives. The result is a system that stifles innovation, erodes dignity, and traps families in substandard care.
Lack of Consumer Choice
In most sectors, competition drives quality. If a restaurant serves bad food, customers leave. If a school fails its students, families seek alternatives. But in the DDS system, individuals with IDD are placed by the state, not by preference or informed consent. Families cannot “shop around” for better care, and residents cannot opt out of poorly run programs. This absence of choice breeds stagnation. Providers have little incentive to improve when their funding is guaranteed and their clients are captive.
Private Nonprofits as De Facto Monopolies
While the state technically contracts with multiple nonprofits, the reality is that a few organizations dominate entire regions. These nonprofits receive public funds but operate with limited transparency. Their boards are often insular, their oversight minimal, and their responsiveness to families inconsistent. Families are further limited in their choices because they can only visit or consider programs that are specifically referred to them by DDS, restricting their ability to explore broader options independently. Without competition or exit options, these entities become monopolistic in function—controlling access, shaping narratives, and resisting reform.
Accountability Gaps
Government-funded monopolies blur the lines of responsibility. When a resident is neglected or a family’s concerns are ignored, who is accountable? The nonprofit? The state agency? The legislature? This diffusion of responsibility allows systemic failures to persist. Oversight mechanisms—such as audits, ombudsman reviews, or family councils—are often toothless. And because families cannot leave, their leverage is diminished.
Misaligned Incentives
In a monopolized system, funding follows placement—not outcomes. Providers are paid regardless of whether they deliver high quality care, uphold residents’ rights, or foster community inclusion. This misalignment incentivizes cost-cutting and compliance over compassion. It also discourages the development of specialized programs for individuals with profound needs, who are often seen as “too expensive” or “too complex” to serve.
The Path Forward: Restoring Choice and Equity
To dismantle monopoly dynamics, Massachusetts must reimagine its IDD system around person-centered planning and informed consent. Families should have access to a range of providers—including state-run options like Wrentham and Hogan—and the ability to change placements when care falls short. Funding should be tied to quality metrics, not occupancy rates. And nonprofits receiving public dollars must be subject to rigorous transparency standards, including public board meetings, independent audits, and family representation.
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Please consider joining the Saving Wrentham and Hogan Alliance page at: Saving Wrentham and Hogan ICF/IID Facilities in Massachusetts | Facebook
The Saving Wrentham and Hogan Alliance, Inc. is a newly formed 501c3 nonprofit organization. Please consider sending a donation to: Saving Wrentham and Hogan Alliance, Inc., PO Box 741, Norwood, MA 02062
