United States Early Childhood Profile
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.
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. 4
- 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. 4
- 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. 4
- 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. 4
- 35 states provide lawfully residing immigrant children with Medicaid/CHIP coverage without 5-year waiting period 4
- 25 states provide lawfully residing pregnant immigrant women with Medicaid/CHIP coverage without 5-year waiting period 4
- 22 states provide temporary coverage to children under Medicaid or CHIP until eligibility can be formally determined 5
- 30 states provide temporary coverage to pregnant women under Medicaid until eligibility can be formally determined 6
- 28 states extend Medicaid coverage for family planning to otherwise ineligible low-income women 7
- 6 states include at-risk children in the definition of eligibility for IDEA Part C 8
- 33 states do not require redetermination of eligibility for Medicaid/CHIP more than once a year 4
- 39 states have adopted Medicaid expansion as part of the Affordable Care Act 9
- 27 states have an online dual-benefit form to apply for Medicaid and SNAP 4
- 43 states pay for maternal depression screening during pediatric/family medicine visits under the child's Medicaid 10
- 17 states have at least one Help Me Grow affiliate site that has fully implemented a centralized access point 11
EPSDT screening periodicity schedule meets recommendations of American Academy of Pediatrics [FY 2020]12
- 39 states require 7 screenings for children <1 year
- 51 states require 4 screenings for children 1-2 years
- 51 states require 3 screenings for children 3-5 years
- 48 states require 4 screenings for children 6-9 years
Early Care and Education Policies
- 17 states set the income eligibility limit for child care subsidies at or above 200% FPL 14
- 20 states use payment rate at or above the 75th percentile of current market rate for center-based care at the highest quality QRIS tier 14
- 45 states fund a pre-kindergarten program 15
- 13 states supplement Head Start 15
- 17 states require districts to offer full day kindergarten 16
- 14 states require one adult for every four 18-month-olds in child care centers 17
- 20 states require one adult for every ten 4-year-olds in child care centers 17
- 0 states require one teacher for every 12 students in kindergarten classrooms 16
- 31 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 17
- 43 states have implemented a statewide Quality Rating Improvement System (QRIS) 19
- 28 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 2020]22
- 36 states reduce the TANF work requirement to 20 hours or less for single parents with children under age 6 [FY 2020]22
- 10 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
- 18 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 [TY 2021]27
- 15 states offer a refundable state dependent care tax credit [TY 2022]29
- 25 states offer a refundable state Earned Income Tax Credit 28
- 9 states offer a refundable Child Tax Credit 30
- 33 states keep copayments for child care subsidies at or below 7% of family income for families of three at 150% FPL 14
- 20 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 2020]22
- 2 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
- Chase-Lansdale, P. L., & Brooks-Gunn, J. (2014). Two-generation programs in the twenty-first century. The Future of Children, 24(1), 13-39.
- Shonkoff, J. P., & Fisher, P. A. (2013). Rethinking evidence-based practice and two-generation programs to create the future of early childhood policy. Development and psychopathology, 25(4pt2), 1635-1653.
- 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., Osorio, A., Tolbert, J., Corallo, B., Ammula, M., & Moreno, S. (2022). Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2022: Findings from a 50-State Survey. Kaiser Commission on Medicaid and the Uninsured, The Henry J. Kaiser Family Foundation. https://files.kff.org (accessed July 7, 2022).
- U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2021). Presumptive Eligibility. https://www.medicaid.gov (accessed July 14, 2022).
- Brooks, T., Gardner, A., Osorio, A., Tolbert, J., Corallo, B., Ammula, M., & Moreno, S. (2022). Medicaid and CHIP Eligibility and Enrollment Policies as of January 2022: Findings from a 50-State Survey. Kaiser Commission on Medicaid and the Uninsured, The Henry J. Kaiser Family Foundation. https://files.kff.org (accessed Feburary 8, 2023).
- Guttmacher Institute. (2023). Medicaid Family Planning Eligibility Expansions. https://www.guttmacher.org (accessed February 15, 2023).
- The Early Childhood Technical Assistance Center. (n.d.). State and Jurisdictional Eligibility Definitions for Infants and Toddlers with Disabilities Under IDEA Part C. https://ectacenter.org (accessed February 15, 2023).
- Kaiser Commission on Medicaid and the Uninsured. (2022). Status of State Action on the Medicaid Expansion Decision. https://www.kff.org (accessed July 1, 2022).
- 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. (2022). Help Me Grow Network Affiliates. https://helpmegrownational.org Email correspondences from Cassandra Therriault on July 26, 2022.
- 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: 2018-2019 EI cumulative counts collected by the US Department of Education and 2011-2019 American Community Survey data. Estimates of the population of children under 3 were averages of single-year ACS data from 2011 to 2019. 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.
- Schulman, K. (2022). At the Crossroads: State Child Care Assistance Policies 2021. National Women's Law Center. https://nwlc.org (accessed July 5, 2022).
- Friedman-Krauss, A. H., Barnett, W. S., Garver, K. A., Hodges, K. S., Weisenfeld, G. G., Gardiner, B.A., & Jost, T. M. (2022). The State of Preschool 2021: State Preschool Yearbook. National Institute for Early Education Research. https://nieer.org (accessed November 22, 2022).
- Education Commission of the States. (2022). State Education Policy Tracking. https://www.ecs.org (accessed December 9, 2022). NCCP also referenced ECS's 2020 50-State Comparison: State Kindergarten-Through-Third-Grade Policies. https://internal-search.ecs.org (accessed December 9, 2022).
- NCCP's review of state child care licensing regulations as of July 13, 2022. Policies were retrieved from the National Database of Child Care Licensing Regulations. https://childcareta.acf.hhs.gov
- Zero to Three. (2021). The State of Child Care for Babies: The Need to Do Better for Our Youngest Children. https://stateofbabies.org (accessed December 1, 2022).
- The Quality Compendium. (2023). Individual State Profiles. The BUILD Initiative. https://qualitycompendium.org (accessed April 3, 2023).
- Collaborative for Academic, Social, and Emotional Learning (CASEL). (2022). SEL Policy at the State Level. https://casel.org (accessed July 13, 2022). CO data was obtained from CO DOE.
- 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).
- Dehry, I., Knowles, S., Shantz, K., Minton, S., & Giannarell, L. (2022). Welfare Rules Databook: State TANF Policies as of July 2020. OPRE Report 2021-147. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. https://www.acf.hhs.gov (accessed September 1, 2022).
- National Partnership for Women & Families. (2022). State Paid Family and Medical Leave Insurance Laws. https://www.nationalpartnership.org (accessed November 30, 2022).
- National Partnership for Women & Families. (2022). Paid Sick Days - State and District Statutes. https://www.nationalpartnership.org (accessed September 2, 2022).
- National Conference of State Legislatures. (2022). State Minimum Wages. http://www.ncsl.org (accessed May 4, 2022).
- Aussenberg, R.A., & Falk, G. (2022). The Supplemental Nutrition Assistance Program (SNAP): Categorical Eligibility. Congressional Research Service. https://sgp.fas.org (accessed December 15, 2022).
- Calculations derived from output generated by the National Bureau of Economic Research Internet TAXSIM Version 35, available at http://users.nber.org for the 2021 tax year. For a description of the TAXSIM model, see Feenberg, D. and Coutts, E. (1993). An Introduction to the TAXSIM Model. Journal of Policy Analysis and Management 12(1): 189-194.
- Urban Institute. (2022). State Earned Income Tax Credits. https://www.urban.org (accessed December 15, 2022). NCCP also referenced the Tax Policy Center's State EITC as Percentage of the Federal EITC. https://www.taxpolicycenter.org (accessed December 15, 2022).
- National Women's Law Center. (2023). States Can Make Care Less Taxing, Tax Year 2022. https://nwlc.org (accessed April 3, 2023).
- National Conference of State Legislatures. (2023). Child Tax Credit Overview. https://www.ncsl.org (accessed April 3, 2023).
- Center on Budget and Policy Priorities. (2022). Policy Basics: How Many Weeks of Unemployment Compensation Are Available? https://www.cbpp.org (accessed August 30, 2022).
- NCCP's review of state funded rental housing programs as of September 1, 2022. Programs were retrieved from the National Low Income Housing Coalition Database. https://reports.nlihc.org
- 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).