Child care, its cost and its availability are issues that are pertinent to many families in Massachusetts. As a health care professional, are you familiar with the availability of child care in this state? Are you able to tell your patients how to access child care, or to help determine a family's eligibility? Read on to learn more about child care and subsidies available to families in Massachusetts.

What is subsidized child care?
Subsidized child care is child care that is purchased by the state for income-eligible families. An "income-eligible" family is one that meets or falls below 50% of the State Median Income Guideline for Families with Children. See accompanying chart.

The Office of Child Care Services (OCCS) is the State agency that is responsible for the monitoring, enforcement, and technical assistance oversight of all licensed child care programs in Massachusetts. Additionally, OCCS is responsible for administering child care subsidies that are available to low income families, teen parents, parents transitioning off welfare, families who are involved with the Department of Social Services, and families in which a parent or child might have a disability.

There are two processes under which a parent can access subsidized child care: contracted child care slots and child care vouchers. A contracted slot provides payment directly from OCCS to the child care provider- who agrees to offer a certain number of spaces. Vouchers are written to the parent and allow the parent to present it to any agency of their choice that accepts vouchers for care. In most cases the parent will have a co-pay that is established according to their ability to pay. Some would say that a voucher which is issued to a parent has more flexibility as the parent can seek out their own provider who is willing to accept the voucher and will sign an agreement to do so with the R&R. The upside to contracts is that if a mother has a second child she can gain access to care immediately where the voucher client must wait for a second voucher. Per one source for this article, this will be changing in the upcoming year when continuity will be offered to voucher clients as well. OCCS is currently designing an improved delivery system that may move parents with vouchers at a contracted provider may be switched into a contracted slot to free up the voucher which will allow that voucher to be put back into circulation and available to someone on the waitlist. This planned new system will better align the two systems and offer the best of each.

OCCS contracts with Child Care Resource and Referral Agencies (R&R) who collect information about OCCS licensed child care and programs. This information is updated regularly and is used to provide parents with referrals, as well as counseling on how to identify and select quality child care that best meets their child's needs. R&Rs refer parents to a variety of child care options that include group day care, family child care, in home/relative care, school age care and part time care. Additionally, R&Rs can provide information to families about financial assistance, available subsidies and income eligibility. (Also listed in IRis under keyword: Child Care/I & R)

Who is eligible for subsidized child care?
Contracted slots:

• Income eligible families - including families who are low-income, 'welfare to work' participants, and families who are transitioning off of welfare
• Teen parents
• Parents in trial court - child care is provided for parents while they conduct court business. These centers are located on the courthouse premises
• Families in need of 'Supportive' situations - child care for families with open DSS cases. This type of child care may include mental health and/or other related services

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