The first three years of a child’s life are a critical period for their development. State policy choices that impact young children and their families during pregnancy and these early years really matter. Last month, the Prenatal-to-3 Policy Impact Center hosted its annual Prenatal-to-3 Research-to-Policy Summit and released the state’s Prenatal-to-3 Policy Roadmap for 2023 The 2023 Roadmap details steps states can take to create environments where infants and toddlers can thrive. It includes a broad range of policies that impact children and families during these early years and focuses on those that reduce racial, ethnic, and socioeconomic disparities.
The roadmap outlines four policies and eight strategies state leaders can implement to create more equitable outcomes for infants, toddlers, and their caregivers:
| Effective public policies* | Effective state strategies** |
| – Expanded income eligibility for health insurance – Paid family leave programs of at least 6 weeks – State minimum wage of at least $10.00 – A refundable state EITC of at least 10% of the federal credit |
– Reduced administrative burden for SNAP – Comprehensive screening and connection programs – Childcare subsidies – Group prenatal care – Community doulas – Evidence-based home visiting programs – Early departure – Early intervention services |
| * defined as approaches where research supports clear legislative or regulatory action ** defined as approaches that research shows support families with young children but do not provide clear guidance for legislative or regulatory action | |
As the Centers Policy Clearinghouse explains, child care subsidies support families with young children by providing access to essential services, giving parents the opportunity to work, and ensuring that parents can afford resources sufficient family. Child care subsidies are funded by both federal and state dollars. The Child Care and Development Block Grant (CCDBG) is the primary federal program that helps states provide child care assistance to families with young children, and states have significant flexibility to design their own grant programs within the eligibility and quality requirements established by the CCDBG.
The roadmap identifies three key policy levers that states can use to strengthen their child care subsidy systems.
- Setting the income eligibility threshold at or above 85% of the State Median Income (SMI):
- Income eligibility for subsidies varies widely by state, with most setting eligibility requirements well below the federal government’s cap of 85% of SMI. Increasing eligible income would ease the financial burden on more families. However, expanding eligibility should not come at the expense of services to families most in need.
- 16 states met this standard.
- Limit co-pays to 7% of family income or less for all families:
- Capping copays reduces out-of-pocket child care costs for families, which can improve a family’s economic stability and expand their child care options. Many states have co-pay rates that are unaffordable for families, making it difficult to access subsidized child care.
- 24 states met this standard.
- Set fair reimbursement rates for infants and toddlers at or above the 75th percentile of the Market Rate Survey or set rates based on a cost estimation model:
- While the federal government recommends that states set provider reimbursement rates at the 75th percentile of the market rate, many states set rates much lower. Additionally, market rates often do not reflect the true costs of providing care. This often results in a significant gap between the amount reimbursed to providers and the cost of providing care. Failing to reimburse providers at a rate that actually covers the cost of care makes it difficult for providers to stay afloat and provide high-quality services, and discourages providers from participating in the subsidy system.
- 26 states met this standard.
Unfortunately, only seven states have implemented all three policy levers: Arkansas, Louisiana, New Mexico, New York, South Carolina, Utah, and Virginia.
While access to affordable, quality child care is essential for infants and toddlers, it is only one piece of the puzzle. The many state policies included in the Roadmap demonstrate the broad range of supports that states can and should provide to support children’s growth and development. Learn more about young child well-being in your state and evidence-based solutions to support them here.
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