As state lawmakers gear up to decide how much Massachusetts should spend on health and human services next year, they’re also looking to improve how the health care system works.

Health and Human Services Secretary Kate Walsh testified before state representatives and senators Monday on the more than $30 billion that Gov. Maura Healey’s budget proposal for next year steers to departments and agencies under her purview.

In tight financial times, Walsh said, “the people we serve get hit the most, because they need services the most.

“So we have to be really assiduous about the unit cost and the efficacy of every dollar we spend,” she added.

Walsh made that point in response to lawmakers’ questions about Healey's recommended approach to MassHealth's personal care attendant program for people with disabilities. Healey’s budget would set a cap on the number of hours authorized for meal prep and make some eligibility changes.

“I'll just say we did not come to those cuts easily,” Walsh said. “They are cuts. But I'm convinced that we have to just be stewards of these resources in a way that protects the people who need them the most, the people for whom other programs are not an option.”

Sen. Cindy Friedman, an Arlington Democrat, asked Walsh to hold a briefing for lawmakers who want to better understand the PCA changes and what alternatives are available for people who might lose access to services.

Friedman, who co-chairs the Health Care Financing Committee, also asked Walsh to identify what lawmakers “need to do to shore up the health care system, which is in very dire straits.”

“Is there some kind of statute that can help you to increase the workforce?” Friedman said. “Do we need protections from predatory spending in health care, and what can we do about that?”

Lawmakers repeatedly brought up workforce shortages during the hearing. Walsh said it’s an issue across the continuum of care, causing capacity constraints and emergency room crowding when there are no staffed beds in other facilities where a patient can be transferred.

Rep. Meg Kilcoyne, a Clinton Democrat, said she was concerned about the vitality of community hospitals and “making sure our hospitals are equipped to stay open.”

Walsh said keeping smaller, community hospitals open is a challenge nationally. She said health care leaders and officials need to think about “the best way to organize services in regions so that residents can benefit.”

The money allocated to health and human services accounts for more than half of the $58 billion Healey is proposing to spend across state government, roughly the same proportion as this year. It would finance investments in the MassHealth insurance program, services for older adults and people with disabilities, the Department of Children and Families, as well as efforts to combat the opioid crisis and improve maternal health outcomes. Overall, Healey’s plan would boost funding for the Executive Office of Health and Human Services by 4% from the prior year’s appropriations.

The House and Senate will rewrite Healey’s budget and debate their own versions, facing the added challenge of a revenue squeeze. State tax collections have fallen below projections for seven straight months, and budget-writers expect essentially flat revenue growth next year.