title: Massachusetts health reform and access for children with special health care needs.
abstract: OBJECTIVE
  Children with special health care needs (CSHCN) face unique challenges in accessing affordable health care. Massachusetts implemented major health reform in 2006; little is known about the impact of this state's health reform on uninsurance, access to care, and financial protection for privately and publicly insured CSHCN.
  
  
  METHODS
  We used a difference-in-differences (DD) approach to compare uninsurance, access to primary and specialty care, and financial protection in Massachusetts versus other states and Washington, DC before and after Massachusetts health reform. Parent-reported data were used from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs and adjusted for age, gender, race/ethnicity, non-English language at home, and functional difficulties.
  
  
  RESULTS
  Postreform, living in Massachusetts was not associated with significant decreases in uninsurance or increases in access to primary care for CSHCN. For privately insured CSHCN, Massachusetts was associated with increased access to specialists (DD = 6.0%; P ≤ .001) postreform. For publicly insured CSHCN, however, there was a significant decrease in access to prescription medications (DD = -7.2%; P = .003) postreform. Living in Massachusetts postreform was not associated with significant changes in financial protection compared with privately or publicly insured CSHCN in other states.
  
  
  CONCLUSIONS
  Massachusetts health reform likely improved access to specialists for privately insured CSHCN but did not decrease instances of uninsurance, increase access to primary care, or improve financial protection for CSHCN in general. Comparable provisions within the Affordable Care Act may produce similarly modest outcomes for CSHCN.
authors.affiliation: Harvard Medical School, Boston, Massachusetts; and anna_smith@hms.harvard.edu.
authors.forename: Anna Jo
authors.initials: AJ
authors.lastname: Smith
authors.affiliation: Harvard Medical School, Boston, Massachusetts; andDivision of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
mesh_terms: D002648:Child; D019988:Children with Disabilities; D005260:Female; D018166:Health Care Reform / Q000331:legislation & jurisprudence / Q000458:organization & administration; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008404:Massachusetts; D017057:Medically Uninsured / Q000706:statistics & numerical data; D020380:Needs Assessment; D013038:Specialization
keywords: community pediatrics; legislation