Objective: To determine how access to medical services for Medicaid clients is affected by the change from a fee-for-service system to a capitated, gatekeeper system. Health status and satisfaction with care will also be assessed. Significance: Across the United States, managed care systems are replacing fee-for-service systems for Medicaid populations. The effect of this switch on access is unclear. Previous studies have not measured access both before and after the switch. The results may help guide future health reform measures, and may lead to improvements in the Medicaid system. Design, Setting, and Sample: Quasi-experimental, using a pre- versus post- change comparison with a control group. A self-administered questionnaire will be mailed to 1500 AFDC-Medicaid client-families and 750 Basic Health Plan client-families in Pierce County, Washington, two months before the AFDC-Medicaid clients are switched to managed care. The subjects will be re-surveyed ten months after the switch to managed care. In the follow-up survey, a new random sample from each program will be included to make up for loss to follow-up. Main Outcome Measures: Individual and group changes in four dimensions of access, as measured by responses to a battery of questionnaire items. Any changes in specific components of access will also be described.