Two-generational state policies that promote health, education, and strong families can help the early development and school readiness of America’s youngest citizens. These two-generation state policies are especially important to low-income families whose young children lack access to the kinds of supports and opportunities that their more affluent peers receive.
A two-generation framework for policy design reflects extensive research that identifies the critical supports young children need over time to thrive1, 2. Most two-generation supports for young children and families are created through the collective impact of multiple policies. An example is investment in prekindergarten programs and an effective quality improvement system that promotes children’s access to high quality early care and education programs along with state policies such as the Earned Income Tax credit and minimum wage that raise the incomes of low-income working families; another is policies that ensure mental health screenings and access to quality health care for both children and parents.
This national profile aggregates the two-generation policy choices of the 50 states and the District of Columbia, showing the number of states meeting benchmarks that are favorable to the well-being of children and their families (see policy definitions for an explanation of benchmarks). The national profile includes policies that are key elements of a two-generation approach to supporting the well-being and life opportunities of young children and their parents, in the areas of health, early care and education, and parenting and economic support.
Complete source citations and endnotes are included with this profile. For easy reference, the year of the data appears in brackets. To show the range of variation among states, some graphs identify the states with the highest and lowest percentages alongside the national average. Data tables also allow for comparisons across states on each policy choice.
Users who wish to examine additional policies specific to their state, within a two-generation framework, can find suggestions in State Policies through a Two-Generation Lens: Strengthening the Collective Impact of Policies that Affect the Life Course of Young Children and their Parents.
Young children (under age 6)1: 22,655,483
Young children by income, 2019
Young children by race/ethnicity, 2019
Exposure to multiple risk factors among young children, 2019*
*This graph includes all possible risk factors: poor, single parent, teen mother, low parental education, nonemployed parents, residential mobility, households without English speakers, and large family size.
Health and Development Policies
49 states set the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL) for children age less than 1 year 2
49 states set the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL) for children ages 1 to 5 years 2
49 states set the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL) for children ages 6 to 18 years 2
35 states set the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL) for pregnant women 2
35 states provide lawfully residing immigrant children with Medicaid/CHIP coverage without 5-year waiting period 2
25 states provide lawfully residing pregnant immigrant women with Medicaid/CHIP coverage without 5-year waiting period 2
20 states provide temporary coverage to children under Medicaid or CHIP until eligibility can be formally determined 3
30 states provide temporary coverage to pregnant women under Medicaid until eligibility can be formally determined 3
21 states provide 12-month continuous eligibility for both Medicaid and CHIP (for child) 4
13 states provide 12 months of postpartum Medicaid coverage for all eligible women 5
30 states extend Medicaid coverage for family planning to otherwise ineligible low-income women 6
6 states include at-risk children in the definition of eligibility for IDEA Part C 7
32 states do not require redetermination of eligibility for Medicaid/CHIP more than once a year 3
39 states have adopted Medicaid expansion as part of the Affordable Care Act 8
25 states have an online dual-benefit form to apply for Medicaid and SNAP 3
43 states pay for maternal depression screening during pediatric/family medicine visits under the child’s Medicaid 9
18 states have at least one Help Me Grow affiliate site that has fully implemented a centralized access point 10
EPSDT screening periodicity schedule meets recommendations of American Academy of Pediatrics [FY 2019]
28 states require 7 screenings for children <1 year [FY 2019]11
51 states require 4 screenings for children 1-2 years [FY 2019]11
51 states require 3 screenings for children 3-5 years [FY 2019]11
45 states require 4 screenings for children 6-9 years [FY 2019]11
Early Care and Education Policies
16 states set the income eligibility limit for child care subsidies at or above 200% FPL 13
19 states use payment rate at or above the 75th percentile of current market rate for center-based care at the highest quality QRIS tier 13
45 states fund a pre-kindergarten program 14
14 states supplement Head Start 14
17 states require districts to offer full day kindergarten 15
14 states require one adult for every four 18-month-olds in child care centers 16
20 states require one adult for every ten 4-year-olds in child care centers 16
0 states require one teacher for every 12 students in kindergarten classrooms 17
32 states have an infant/toddler credential or certificate 18
39 states require that infants and toddlers in child care centers be assigned a consistent primary caregiver 16
43 states have implemented a statewide Quality Rating Improvement System (QRIS) 19
21 states have comprehensive, free-standing standards for social emotional learning at the K-12 level 20
0 states require a minimum of a bachelor’s degree for lead teachers in public pre-K programs and licensed child care centers 21
Parenting and Economic Supports Policies
26 states exempt single parents on TANF from work requirements until the youngest child reaches age 1 [FY 2019]22
37 states reduce the TANF work requirement to 20 hours or less for single parents with children under age 6 [FY 2019]22
7 states have paid family leave for a minimum of 6 weeks with partial replacement of wages 23
14 states offer accrual of at least five paid sick days 24
15 states established a state minimum wage that meets or exceeds $12.00/hr and is indexed to inflation for a family of three 25
16 states set gross income eligibility limit at 200% FPL and do not have asset limits for SNAP 26
43 states do not charge personal income tax for single-parent families of three below the federal poverty level 27
15 states offer a refundable state dependent care tax credit 28
23 states offer a refundable state Earned Income Tax Credit 29
2 states offer a refundable Child Tax Credit 30
28 states keep copayments for child care subsidies at or below 7% of family income for families of three at 150% FPL 13
19 states offer exemptions and/or extensions of the TANF benefit time limit for women who are pregnant or caring for a child under 6 months of age [FY 2019]22
1 state offers a minimum of 28 weeks of Unemployment Insurance benefits 31
6 states fund a housing program that provides rental assistance to low-income families with children to avoid eviction or homelessness 32
Data Notes and Sources
- State data were calculated from the 2016-2020 American Community Survey, representing information from the years 2016 to 2020. National data were calculated from the 2019 American Community Survey, representing information from 2019. We did not use the 2020 American Community Survey data for the U.S. due to the dataset's experimental nature and caution about its reliability.
- Brooks, T., Gardner, A., Tolbert, J., Dolan, R., & Pham, O. (2021). Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2021: Findings from a 50-State Survey. Kaiser Commission on Medicaid and the Uninsured, The Henry J. Kaiser Family Foundation. https://files.kff.org (accessed June 25, 2021).
- Brooks, T., Roygardner, L., Artiga, S., Pham, O., & Dolan, R. (2020). Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey. Kaiser Commission on Medicaid and the Uninsured, The Henry J. Kaiser Family Foundation. http://files.kff.org (accessed July 7, 2020).
- U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2021). Continuous Eligibility for Medicaid and CHIP Coverage. https://www.medicaid.gov (accessed April 21, 2022).
- Kaiser Family Foundation. (2022). Medicaid Postpartum Coverage Extension Tracker. https://www.kff.org (accessed April 28, 2022).
- Guttmacher Institute. (2022). Medicaid Family Planning Eligibility Expansions. https://www.guttmacher.org (accessed April 25, 2022).
- The Early Childhood Technical Assistance Center. (2021). State and Jurisdictional Eligibility Definitions for Infants and Toddlers with Disabilities Under IDEA Part C. https://ectacenter.org (accessed March 10, 2021).
- Kaiser Commission on Medicaid and the Uninsured. (2021). Status of State Action on the Medicaid Expansion Decision. https://www.kff.org (accessed June 25, 2021).
- National Academy for State Health Policy. (2021). Medicaid Policies for Maternal Depression Screening During Well-Child Visits, by State. https://healthychild.nashp.org (accessed February 26, 2021).
- Help Me Grow National Center. (2020). Help Me Grow Network Affiliates. https://helpmegrownational.org Email correspondences from Cassandra Therriault on August 3, 2021.
- U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2019). The Annual EPSDT Report (Form CMS-416) for FY 2019. https://www.medicaid.gov (accessed January 25, 2021).
- Early Intervention (EI) rates were calculated by using data from two sources: 2019-2020 EI cumulative counts collected by the US Department of Education and 2016-2020 American Community Survey data. EI rates are not displayed where cell size for the numerator (number of children in EI) is missing, or cell size for the denominator (total number of children) is less than 200. To access EI data, please go to IDEA Section 618 Data Products: Table 11 Cumulative count of infants and toddlers birth through age 2 receiving early intervention services under IDEA, Part C, by race/ethnicity and state 2019-2020. https://data.ed.gov . To access ACS data, please visit the US Census Bureau data tool. https://data.census.gov
- Schulman, K. (2020). On the Precipice: State Child Care Assistance Policies 2020. National Women's Law Center. https://nwlc.org (accessed July 15, 2021).
- Friedman-Krauss, A. H., Barnett, W. S., Garver, K. A., Hodges, K. S., Weisenfeld, G. G., & Gardiner, B.A. (2021). The State of Preschool 2020: State Preschool Yearbook. National Institute for Early Education Research. https://nieer.org (accessed April 25, 2022).
- Education Commission of the States. (2020). 50-State Comparison: State Kindergarten-Through-Third-Grade Policies. https://internal-search.ecs.org (accessed January 25, 2021).
- NCCP's review of state child care licensing regulations as of August 12, 2021. Policies were retrieved from the National Database of Child Care Licensing Regulations. https://childcareta.acf.hhs.gov
- Kelley, B., Weyer, M., McCann, M., Broom, S., & Keily, T. (2020). 50-State Comparison: State Kindergarten-Through-Third-Grade Policies. Education Commission of the States. https://reports.ecs.org (accessed August 10, 2021).
- Administration for Children & Families, National Center on Early Childhood Development, Teaching, and Learning. (2018). State/Territory Infant/Toddler Credential Overview, May 2018. https://childcareta.acf.hhs.gov (accessed December 3, 2018).
- The Quality Compendium. (2021). Individual State Profiles. The BUILD Initiative. https://qualitycompendium.org (accessed February 17, 2022).
- The Collaborative for Academic, Social, and Emotional Learning (CASEL). (2021). State Scan Scorecard Project. https://casel.org (accessed July 27, 2021).
- McLean, C., Austin, L.J.E., Whitebook, M., & Olson, K.L. (2021). Early Childhood Workforce Index 2020. Berkeley, CA: Center for the Study of Child Care Employment, University of California, Berkeley. https://cscce.berkeley.edu (accessed March 10, 2021).
- Shantz, K., Dehry, I., Knowles, S., Minton, S., & Giannarelli, L. (2020). Welfare Rules Databook: State TANF Policies as of July 2019. OPRE Report 2020-141. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://wrd.urban.org (accessed February 2, 2021).
- National Partnership for Women & Families. (2022). State Paid Family and Medical Leave Insurance Laws. https://www.nationalpartnership.org (accessed May 4, 2022).
- National Partnership for Women & Families. (2021). Paid Sick Days - State and District Statutes. https://www.nationalpartnership.org (accessed July 27, 2021).
- National Conference of State Legislatures. (2022). State Minimum Wages. http://www.ncsl.org (accessed May 4, 2022).
- National Center for Children in Poverty (2021). 50-State Policy Tracker. https://www.nccp.org (accessed April 28, 2022).
- National Center for Children in Poverty (NCCP). (2018). 50-State Data, Income Tax Liability. Obtained internally through email correspondence with Seth Hartig dated on July 21, 2020.
- National Women's Law Center. (2022). Making Care Less Taxing: State Child and Dependent Care Tax Provisions, Tax Year 2021. https://nwlc.org (accessed April 5, 2022).
- Waxman, S., & Legendre, J. (2021). States Can Adopt or Expand Earned Income Tax Credits to Build Equitable, Inclusive Communities and Economies. Center on Budget and Policy Priorities. https://www.cbpp.org (accessed July 28, 2021).
- Tax Credits for Workers and Their Families. (2021). State Tax Credits Maps. http://www.taxcreditsforworkersandfamilies.org (accessed July 6, 2021).
- Center on Budget and Policy Priorities. (2021). Policy Basics: How Many Weeks of Unemployment Compensation Are Available? https://www.cbpp.org (accessed July 9, 2021).
- NCCP's review of state funded rental housing programs as of August 10, 2021. Programs were retrieved from the National Low Income Housing Coalition Database. https://reports.nlihc.org
- Safawi, A. & Reyes, C. (2021). States Must Continue Recent Momentum to Further Improve TANF Benefit Levels. Center on Budget and Policy Priorities. https://www.cbpp.org (accessed February 24, 2022).