The Massachusetts Children's Medical Security Plan (CMSP) was created in response to the national focus on health care reform. Another driving force behind the formation of the plan was an interest in reducing infant mortality in Massachusetts. Massachusetts was the first state to offer prenatal care up to 200% of the FPL, and CMSP evolved out of this initiative. The program initially began as a program for preschoolers age 0-6, but was subsequently expanded to include children up to age 13, and then up to age 18. Currently, the program is open to families up to 400% of the poverty level. CMSP provides premium-free services to children up to the age of 18 under 200% FPL, with families between 201-400% FPL charged a reduced premium rate based on income and family size. There are three sources of funding for the program: tobacco taxes; general funds; and family contributions.