1. Impact on Massachusetts Children's Access to Healthcare as a Result of the 2006 Massachusetts Health Reform Linda Jiang, B.S, MPH, jiang.l.linda@gmail.com Background and Overview Brief Background Providing children with healthcare services translate into a lifetime of health savings. In 2006, Massachusetts enacted a law that will provide near-universal coverage. Concerning children’s access to healthcare, MassHealth, the state’s combined Medicaid/State Children’s Health Insurance Program (SCHIP) was expanded to include children with family income levels from 200 percent of FPL to 300 percent of FPL. Commonwealth Choice, an insurance exchange of unsubsidized health plans, provided families above 300 percent FLP the opportunity purchase policies. Objectives Examine the impact of Massachusetts healthcare reform on children’s access pre- and post-reform using potential, blended, and realized access measures. Conceptual Framework Potential Access: Characteristics of the healthcare delivery system (provider availability) or population (insurance coverage, age, health status) Realized Access: Actual use measured by utilization rates and subjective descriptions of care Blended Access: Reflects the combination of probable and actual use of medical care Anderson and Aday Framework: Predisposing characteristics, enabling resources, and need for medical services are factors that influence utilization of health services. Data Sources and Methods Data Source The National Survey of Children’s Health (NSCH), a national telephone survey, for years 2003 and 2007. Methods NSCH data was evaluated using the following five access measures: Potential access measure: “What type of health insurance coverage, if any, did children have at the time of survey?” Blended access measure: “In general, how would you describe child’s health- excellent, very good, good, fair, or poor?” Realized access measures: “One or more preventive medical visits during the past 12 months”, “One or more preventive dental visits during the past 12 months”, and “Received mental health visits when needed during the past 12 months.” The two-proportion z-test (0.10 level) was used to compare the 2003 and 2007 measures. Results Access: Overall 1 year after the implementation of state reform, children in Massachusetts were: Significantly less likely to be uninsured (p=0.0797); Significantly less likely to be fair/poor health status (p=0.0611); Significantly more likely to have one or more preventive medical (p  0.00); and Significantly more likely to have one or more dental visits (p=0.0004) By Income The strongest gains were attained by children with family income between 200-399 % FPL.

2. Impact on Massachusetts Children's Access to Healthcare as a Result of the 2006 Massachusetts Health Reform Linda Jiang, B.S, MPH, jiang.l.linda@gmail.com Discussion Impact Of State Reform Findings are consistent with rise in MassHealth children eligibility levels, giving access to children with family income between 200-300% of FLP, and establishment of Commonwealth Choice plans. Effects possibly due to spillover of individual mandate and simplification of MassHealth enrollment policies by decreasing both administrative and organizational barriers in gaining entry to public assistance programs. Affordable Care Act (ACA) Implications ACA funds SCHIP through 2015. Will SCHIP be kept separate or moved into the new health insurance exchanges? In 2014, Medicaid eligibility levels will be increased to 133% of the FPL. Increased parental coverage may help children’s access due to spillover effects. Additionally, health insurance exchanges will provide premium subsidies on a sliding scale for families with incomes up to 400% of FPL. Massachusetts is not only a small and wealthy state but also the home to many academic research medical-centers. For states considerably similar to Massachusetts, lessons learned from the Massachusetts health reform can serve as a springboard for ideas in implementing the ACA with regard to children’s healthcare.