North Carolina Early Childhood Profile
The Early Childhood Two-Generation State Policy Profile shows which state policies meet benchmarks that are favorable to the well-being of children and their families. The 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.
A two-generation framework for policy design reflects extensive research that identifies the critical supports young children need over time to thrive. 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.
A brief overview of policies in the EC Two-Generation State Policy Profile is provided below (see policy definitions for an explanation of benchmarks). The Profile is limited to policies for which 50-state data are available. 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.
Health and Development
States can support young children’s development by making key policy choices in early health and development. This section of ITO highlights states’ policy choices for supporting young children’s well-being: 1) Access to and continuity of health care, including state Medicaid/CHIP eligibility levels and coverage of legal immigrant children; 2) Parents’ access to health care, including for low-income pregnant women, and access to a medical home for young children; and 3) Preventive screening and assessment, including adherence to recommended schedules for well-child visits.
Early Care and Education
States make important decisions about the early care and education services they provide to young children and families. This section of ITO highlights states’ key policy choices that affect children’s development and parents’ ability to work: 1) Access to childcare, including subsidy eligibility levels and reimbursement rates; and 2) States’ investment in Head Start, Early Head Start, pre-kindergarten, child care centers’ class size and student-teacher ratios and investment in infant/toddler specialist networks and credentials and Quality Rating Improvement Systems.
Parenting and Economic Supports
States make critical policy choices that help low-income parents effectively support young children’s healthy development. This section of ITO spotlights states’ policy choices related to important economic supports for low-income families with young children: 1) TANF requirements for parents of young children; and 2) Income support policies including tax relief, earned income and dependent care tax credits, as well as child support disregards.
Young children (under age 6)1: 706,913
Young children by income, 2020
Young children by race/ethnicity, 2020
Exposure to multiple risk factors among young children, 2020*
*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
Sets the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL) 
Children <1 year 2
Sets eligibility at 216% (S-CHIP) and 215% (Medicaid and M-CHIP)
Children 1-5 years 2
Sets eligibility at 216% (S-CHIP) and 215% (Medicaid and M-CHIP)
Children 6-18 years 2
Sets eligibility at 216% (S-CHIP) and 138% (Medicaid and M-CHIP)
Pregnant women 2
Sets eligibility at 201% (Medicaid)
Provides lawfully residing immigrant children with Medicaid/CHIP coverage without 5-year waiting period 2
Provides lawfully residing pregnant immigrant women with Medicaid/CHIP coverage without 5-year waiting period 2
Provides temporary coverage to children under Medicaid or CHIP until eligibility can be formally determined 3
Provides temporary coverage to pregnant women under Medicaid until eligibility can be formally determined 3
Provides 12-month continuous eligibility for both Medicaid and CHIP (for child) 4
Provides 12 months of postpartum Medicaid coverage for all eligible women 5
North Carolina's postpartum coverage extension went into effect on April 1, 2022.
Extends Medicaid coverage for family planning to otherwise ineligible low-income women 6
Eligibility based on income up to 200% FPL, includes men and individuals younger than 19 years of age.
Has adopted Medicaid expansion as part of the Affordable Care Act 7
Includes at-risk children in the definition of eligibility for IDEA Part C 8
The relationship between being an at-risk state and the number of children served varies. Some non-at-risk states have higher than average percentages of children being served in Early Intervention (EI). See graphs for the state EI data.
Does not require redetermination of eligibility for Medicaid/CHIP more than once a year 3
Has an online dual-benefit form to apply for Medicaid and SNAP 3
Medicaid pays for maternal depression screening during pediatric/family medicine visits under the child's Medicaid 9
Has at least one Help Me Grow affiliate site that has fully implemented a centralized access point 10
Help Me Grow North Carolina is working toward fully implementing a centralized access point.
EPSDT screening periodicity schedule meets recommendations of American Academy of Pediatrics [FY 2019]
7 screenings for children <1 year [FY 2019]11
State requires 5 screens. 100% of eligible screens were completed in 2019.
4 screenings for children 1-2 years [FY 2019]11
State requires 4 screens. 100% of eligible screens were completed in 2019.
3 screenings for children 3-5 years [FY 2019]11
State requires 3 screens. 82% of eligible screens were completed in 2019.
4 screenings for children 6-9 years [FY 2019]11
State requires 4 screens. 53% of eligible screens were completed in 2019.
Young children under age 6 who lack health insurance, 2020
Percent of children under age 3 receiving Early Intervention services in 2019-2020
Percent of children under age 3 receiving Early Intervention services by race/ethnicity in 2019-2020*
*EI rates are not displayed where the cell size is small as the data are not reliable.
Percent of eligible children who received at least one EPSDT screening, by age, FY 2019
Early Care and Education Policies
Sets the income eligibility limit for child care subsidies at or above 200% FPL 13
A family of three qualifies for assistance with a maximum income at $42,660 or 196% FPL. This reflects an increase from 191% FPL in 2019.
Uses payment rate at or above the 75th percentile of current market rate for center-based care at the highest quality QRIS tier 13
The reimbursement rate for center care for a four-year-old in Mecklenburg county at the highest quality tier was 117% higher than the rate at the lowest quality tier.
Funds a pre-kindergarten program 14
$166,326,635 in 2020
Supplements Head Start 14
Requires districts to offer full day kindergarten 15
Requires one adult for every four 18-month-olds in child care centers 16
Child care regulations require one adult for every 6 children.
Requires one adult for every ten 4-year-olds in child care centers 16
Child care regulations require one adult for every 12 children between the ages of 4-5, but require one adult for every 10 children between the ages of 3-4.
Requires one teacher for every 12 students in kindergarten classrooms 17
Requires one teacher for every 18 students
Has an infant/toddler credential or certificate 18
Requires that infants and toddlers in child care centers be assigned a consistent primary caregiver 16
Has implemented a statewide Quality Rating Improvement System (QRIS) 19
Has comprehensive, free-standing standards for social emotional learning at the K-12 level 20
Requires a minimum of a bachelor's degree for lead teachers in public pre-K programs and licensed child care centers 21
Only lead teachers in public pre-K programs are required to have a minimum of a bachelor's degree.
Parenting and Economic Supports Policies
Exempts single parents on TANF from work requirements until the youngest child reaches age 1 [FY 2019]23
Exemption limited to 12 cumulative months in the recipient's lifetime.
Reduces the TANF work requirement to 20 hours or less for single parents with children under age 6 [FY 2019]23
Has paid family leave for a minimum of 6 weeks with partial replacement of wages 24
Offers accrual of at least five paid sick days 25
Established a state minimum wage that meets or exceeds $12.00/hr and is indexed to inflation for a family of three 26
Sets gross income eligibility limit at 200% FPL and does not have asset limits for SNAP 27
Does not charge personal income tax for single-parent families of three below the federal poverty level 28
Offers a refundable state Earned Income Tax Credit 29
Offers a refundable state dependent care tax credit 30
Offers a refundable Child Tax Credit 31
North Carolina offers non-refundable Child Tax Credit named Credit for Children. Reductions vary by income and marital status.
Keeps copayments for child care subsidies at or below 7% of family income for families of three at 150% FPL 13
Copayments set at 10% of income.
Offers 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]23
Parents caring for a child under 12 months old are exempt from the benefit waiting period time limit.
Offers a minimum of 28 weeks of Unemployment Insurance benefits 32
State provides up to 16 weeks of regular state-funded UI.
Funds a housing program that provides rental assistance to low-income families with children to avoid eviction or homelessness 33
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).
- 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).
- 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).
- 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).
- U.S. Department of Education, Institute of Education Sciences, National Center for Education Statistics. (2019). National Assessment of Educational Progress (NAEP), 2019 Math and Reading Assessment. https://nces.ed.gov (accessed June 30, 2020).
- 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.
- 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).
- 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).
- 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).