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Annual Roadmap Highlights State Policies to Support Infants & Toddlers

Resource November 3, 2023

The first three years of children’s lives 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 2023 Prenatal-to-3 State Policy Roadmap. The 2023 roadmap details actions that states can take to create environments that help infants and toddlers thrive. It includes a wide 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 state 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
– Child care subsidies
– Group prenatal care
– Community-based doulas
– Evidence-based home visiting programs
– Early Head Start
– Early Intervention services
* defined as approaches where the research supports clear legislative or regulatory action
**defined as approaches that research suggests support families with young children but does not provide clear guidance for legislative or regulatory action

As the Center’s Policy Clearinghouse explains, child care subsidies support families with young children by providing access to essential services, giving parents the ability to work, and ensuring that parents can afford sufficient household resources. Child care subsidies are financed by both federal and state dollars. The Child Care & Development Block Grant (CCDBG) is the primary federal program that supports states in providing child care assistance to families with young children, and states have significant flexibility to design their own subsidy programs within CCDBG’s established eligibility and quality requirements. 

The roadmap identifies three key policy levers that states can use to strengthen their child care subsidy systems. 

  • Set the income eligibility threshold at or above 85% of the state median income (SMI):
    • Income eligibility for subsidies varies substantially across states, with most states setting eligibility requirements well below the federal government’s cap of 85% of the SMI. Increasing income eligibility would alleviate the cost burden for more families. However, expanding eligibility should not come at the expense of serving families most in need. 
    • 16 states met this standard.
  • Limit copayments to 7% of family income or less for all families:
    • Capping copayments lowers out-of-pocket child care costs for families, which can improve family economic stability and expand their child care options. Many states have copayment rates that are unaffordable for families, making it difficult for them to access subsidized child care. 
    • 24 states met this standard. 
  • Set equitable infant and toddler reimbursement rates 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. Moreover, market rates often do not reflect the true costs of providing care. The result is often a substantial gap between how much providers are reimbursed and how much it costs to provide 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 critical for infants and toddlers, it is just one piece of the puzzle. The numerous state policies included in the roadmap demonstrate the wide range of supports that states can and should provide to support children’s growth and development. Find out more about the wellbeing of young children in your state and evidence-based solutions to support them here.

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