Early Childhood Profiles Policy Definitions

Health and Development

Sets the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL). Federal Medicaid law requires states to provide coverage for pregnant women and children under age six when household income is at or below 133% FPL. States are allowed to set income eligibility for Medicaid above 133% FPL. A state’s Children’s Health Insurance Program (CHIP) extends coverage to low-income uninsured children, typically when their family income exceeds the Medicaid eligibility level and private coverage is not available. States have the option to administer CHIP through a Medicaid expansion program (M-CHIP), which provides full Medicaid benefits; a separate state program (S-CHIP); or a combination of the two.

Provides lawfully residing immigrant children with Medicaid/CHIP coverage without 5-year waiting period. Provides lawfully residing pregnant immigrant women with Medicaid/CHIP coverage without 5-year waiting period. States have the option to provide Medicaid/CHIP coverage for immigrant children and pregnant women who have been lawfully residing in the U.S. for less than five years, otherwise known as the Immigrant Children’s Health Improvement Act (ICHIA) option. According to guidance from the Centers for Medicare and Medicaid Services (CMS), a lawfully residing immigrant includes legal permanent residents (i.e., green card holders), refugees, and asylees, as well as other groups. Legal permanent residents cannot use Medicaid until they have been in the U.S. for five years, unless a state expands Medicaid to include them. Refugees and asylees don’t have to wait five years.

Provides temporary coverage to pregnant women under Medicaid until eligibility can be formally determined. Provides temporary coverage to children under Medicaid/CHIP until eligibility can be formally determined. Some states provide immediate temporary coverage and health services to pregnant women and children until eligibility has been determined through verification of income and other requirements.

Provides 12-month continuous eligibility for both Medicaid and CHIP (for child). Continuous eligibility for children is a long-established policy option in Medicaid and CHIP that allows states to cover children for up to a year unless the child ages out, moves out of state, requests voluntary disenrollment, or is disenrolled due to nonpayment of premium. Currently, many states still have short-term continuous coverage in Medicaid and CHIP.

Provides 12 months of postpartum Medicaid coverage for all eligible women. Providing postpartum Medicaid coverage ensures that new mothers have access to care for the first year after delivery. Currently, federal law mandates Medicaid coverage for only 60 days post-delivery. States can improve maternal and infant health outcomes by expanding Medicaid coverage to 12 months postpartum.

Extends Medicaid coverage for family planning to otherwise ineligible low-income women. States can secure approval from the Centers for Medicare and Medicaid Services to extend coverage for family planning services to any woman who would otherwise lose coverage after the postpartum period. States can also expand family planning coverage to all low-income women.

Includes at-risk children in the definition of eligibility for IDEA Part C. Part C of the Individuals with Disabilities Education Act (IDEA) requires participating states and jurisdictions to provide early intervention services to eligible children from birth to age three who may be experiencing disabilities and developmental delays. States may also provide services to children who are at-risk for disabilities. The Office of Special Education Programs in the U.S. Department of Education developed a rubric to categorize state eligibility policies for Part C services. In general, states with broad eligibility definitions serve children who have less serious delays.

Has adopted Medicaid expansion as part of the Affordable Care Act. Medicaid requires coverage for certain groups of individuals: low-income children and some of their parents; poor pregnant woman; certain low-income seniors; and some individuals with disabilities who are under the age of 65. Beginning in 2012, the Affordable Care Act gave states have the option to extend eligibility to adults with incomes up to 138 percent of the federal poverty level. States that use this option are often called “Medicaid expansion states.”

Has an online dual-benefit application for Medicaid and SNAP. One on-line application allows users to apply for both Medicaid and SNAP. Using one online system to apply for two key benefits simplifies an applicant’s enrollment experience and may increase use of these benefits.

Requires or recommends maternal depression screening as part of well-child visits under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. Research shows that maternal depression is a risk factor for the child and maternal depression screening in a well-child visit is a best practice. In May 2016 the U.S. Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin (IB) explaining that states can cover maternal depression screenings under Medicaid’s EPSDT benefit.

Has at least one Help Me Grow affiliate site that has fully implemented a centralized access point. Help Me Grow (HMG) is a national model that helps communities identify vulnerable children and connect families to community-based programs and services through four core components: 1) child health care provider outreach; 2) family and community outreach; 3) a centralized access point; 4) ongoing data collection and analysis. An HMG affiliate site that has fully implemented a centralized access point is conducting all key activities necessary to connect children and their families to community-based services and programs, and coordinate care. The activities include having a specialized child development line such as 2-1-1, linkage and follow-up, researching resources, and real-time directory maintenance. According to HMG National Center, most state affiliates receive public funding for their HMG programs.

EPSDT screening periodicity schedule meets recommendations of American Academy of Pediatrics. Early Periodic Screening, Diagnosis and Treatment (EPSDT) is Medicaid’s comprehensive and preventive child health program for individuals under the age of 21, and provides health examinations and follow-up care to Medicare eligible children, including periodic screening, vision, dental, and hearing services to assure that the health problems found are diagnosed and treated early, before becoming more complex and their treatment more costly.

Early Care and Education

Sets the income eligibility limit for child care subsidies at or above 85% of the State Median Income (SMI). States subsidize child care costs for eligible families with a combination of state and federal funds, and set the family income level for eligibility. States with higher eligibility levels serve families who are above the federal poverty level, but still low-income.

Uses payment rate at or above the 75th percentile of current market rate for center-based care at the highest quality QRIS tier. CCDF rules recommend that states set child care reimbursements to child care providers at 75% of the market rate or higher. States are also encouraged to provide tiered payment with a sufficient rate difference between tiers to promote higher quality. A state is considered to have rates that are based on current market prices if the provider market survey used to set rates was conducted no more than two years earlier (for example, rates used in 2016 are considered current if set at the 75th percentile of 2014 or more recent market rates).

Provides families with at least 12 months of continuous eligibility for child care subsidies. CCDF rules require lead agencies to provide at least 12 months of continuous eligibility for child care subsidies, except when family income exceeds the federal threshold of 85% of State Median Income. For more information see the FAQ on the Child Care and Development Fund Final Rule from the Administration for Children and Families (ACF).

Funds a pre-kindergarten program. Supplements Head Start. States serve mostly 4 year olds and smaller numbers of 3 year olds in state-funded pre-kindergarten programs and Head Start programs that receive supplemental state funding.

Requires districts to offer full-day kindergarten. While full-day kindergarten is optional in some states, others require that every district provides full-day kindergarten, a policy that informed by research on the educational benefits of the full-day experience for kindergarteners. For additional information, see Effects of Full-Day Kindergarten on Academic Achievement and Social Development (2010) by Cooper, H., Allen, A. B., Patall, E. A., & Dent, A. L.

Requires one adult for every four 18-month-olds in child care centers. Requires one adult for every ten 4-year-olds in child care centers. Requires one teacher for every 12 students in kindergarten classrooms. The American Academy of Pediatrics, American Public Health Association, National Research Center for Health and Safety in Child Care, National Research Council, and National Association for the Education of Young Children make different recommendations on ratios and class size, but they generally do not exceed these ratios. NCCP established these benchmarks using ratios provided by the National Association for the Education of Young Children (NAEYC).

Requires that infants and toddlers in child care centers be assigned a consistent primary caregiver. Some states require, through licensure and regulation, that very young children in subsidized child care are assigned a “primary caregiver,” (i.e., a single, consistent caregiver) in order to promote nurturing, high quality care within a secure adult-child relationship.

Has implemented a statewide Quality Rating Improvement System (QRIS). A Quality Rating and Improvement System (QRIS) has components that assess and support the quality of early care and education (ECE) programs, and communicate the level of quality through ratings. State QRIS are designed to help increase the quality of ECE programs through professional development and monetary incentives, and increase parents’ understanding of and demand for higher quality programs. For more information, see the Build Initiative.

Has comprehensive, free-standing standards for social emotional learning at the K-12 level. States with free-standing standards for SEL at the K-12 level describe expected social-emotional competencies that students should have at different grade levels within a separate standard. These competencies include positive social behaviors (e.g., sharing, taking turns), managing emotions, and showing an understanding of others emotions or ideas that differ from yours.

Requires a minimum of a bachelor’s degree for lead teachers in public pre-K programs and licensed child care centers. States require that lead teachers in public pre-K programs and licensed child care centers have at least a bachelor’s degree. This benchmark is based on recommendations in the National Academy of Sciences 2015 report “Transforming the Workforce for Chidlren Birth Through Age 8: A Unifying Foundation.” The report suggests that workforce preparations for early childhood teachers should be on par with those for elementary school teachers in order to raise the quality of early care and education programs.

Parenting and Economic Supports

Exempts single parents on TANF from work requirements until the youngest child reaches age 1. Reduces the TANF work requirement to 20 hours or less for single parents with children under age 6. The Temporary Assistance for Needy Families (TANF) program provides cash benefits to eligible, very low-income families. State TANF programs have established minimum work requirements and time-limited cash benefits, and have some flexibility in establishing the hours of work required and who is exempt from these requirements.

Allows TANF participants to receive benefits for a maximum of 60 months in their lifetime without limits on continuous coverage. Federal funds of TANF allow participants to receive cash assistance benefits for a total of 60 months in their lifetime. However, states may restrict months of benefits with discretionary time limits on total months of benefit coverage and/or continuous benefit coverage.

Has paid family leave for a minimum of 6 weeks with partial replacement of wages. Some states have established laws to allow employees to take paid time off to care for sick or disabled family members or a new child. The states currently providing paid family leave (CA, NJ, and RI) are funded through employee-paid payroll taxes and are administered through their respective disability programs.

Offers accrual of at least five paid sick days. Employees can typically use paid sick days to recover from their own illness, care for an ill family member or seek medical care. Establishing state-wide laws on paid sick time off promotes a healthy work environment and gives workers the ability to care for themselves and their families without the fear of losing income.

Established a state minimum wage that meets or exceeds $14.00/hr and is indexed to inflation for a family of three. State minimum wage rates set above the federal minimum wage ($7.25) increase income, helping workers to provide the basic necessities for their families. NCCP create this benchmark by calculating the hourly wage a family of three with two children would need to escape poverty in a given year. We use the federal poverty guidelines and calculate the hourly wage based on a 40-hour work week. For example, in 2023, a family of three would have an annual gross income of $27,346, or 110% FPL, working 40 hours per week with an hourly wage of $13.00.

Sets gross income eligibility limit at 200% FPL and does not have asset limits for SNAP. Supplemental Nutrition Assistance Program (SNAP) offers nutrition assistance to low-income individuals and families. To get SNAP benefits, households must meet certain tests, including resource and income tests. States have flexibility in administering their SNAP programs and can set their own income and asset limits.

Does not charge personal income tax for single-parent families of three below the federal poverty level. States that do not require families with income below the FPL to pay state income tax help increase the income of these families.

Offers a refundable state Earned Income Tax Credit. The Earned Income Tax Credit (EITC) reduces the amount of income tax low- to moderate-income working families are required to pay, and provides a wage supplement to some families. For families with income so low that they do not pay taxes, states have the option to make their EITC refundable (like the federal credit), thereby increasing family income. State policy choices include whether or not to offer a state EITC, what percentage of the federal EITC to credit, and whether or not to make it refundable to families that have no tax burden.

Offers a refundable state dependent care tax credit. The child and dependent care tax credit reduces the amount of taxes working families with child care expenses are required to pay. To be eligible, a family must incur expenses for the care of a child under the age of 13 (or of an older dependent who is unable to care for him or herself) in order to work or look for work. States make choices about whether to establish a credit, a deduction, or both; where to set the income eligibility for the benefit; and whether or not to make the credit refundable.

Offers a refundable Child Tax Credit. The Child Tax Credit is intended to offset the expenses of raising children for low and middle-income families with qualifying children. States can offer their own Child Tax Credit to complement the federal credits, set their own eligibility requirements and decide whether or not to make the credit refundable.

Keeps copayments for child care subsidies at or below 7% of family income for families of three at 150% FPL. CCDF guidance directs states to set copayments for child care subsidies at or below 7% of family income. This benchmark was made in an effort to keep copayments affordable for families. Guidance also eliminates copayments for families with very low incomes, and gradually increases the copayment as incomes rise. For more information, see the final rule on the CCDF program from the Children and Families Administration.

Offers exemption and/or extension of TANF benefit time limit for recipients who are pregnant. Offers exemption and/or extension of TANF benefit time limit for recipients caring for a child under 6 months of age. Pregnant women and parents caring for young children of a specified age can receive TANF benefits for longer periods in certain states. For these parents, states can exempt (not count) an amount of time towards the time limit for receiving TANF benefits. States can also extend the TANF benefit time.

Offers a minimum of 28 weeks of Unemployment Insurance benefits. Unemployment insurance is a joint state-federal program that temporarily replaces part of the wages of people who have lost their jobs through no fault of their own. States may set their own additional requirements for eligibility, benefit amounts and length of time benefits can be paid.

Funds a housing program that provides rental assistance to low-income families with children at 80% AMI/200% FPL or less to avoid eviction or homelessness. States can protect low-income families with children from facing homelessness or eviction by providing rental assistance. During the COVID-19 pandemic, rental assistance programs were expanded through the federal Emergency Rental Assistance Program