May Update: Prenatal-to-3 State Legislative Trends


2023 has seen great momentum to improve outcomes and equity for young children. Many state legislatures have taken action to support infants, toddlers, their families, and caregivers. This month, we tracked several bills to increase access to doula services and child care. And multiple states have enacted economic reforms to empower working parents with financial and material resources to provide for their families. This post covers a sampling of this prenatal-to-3 legislative action, including two exciting new laws in Maryland. 

Community-Based Doulas

The evidence is clear that, as a member of a comprehensive system of maternal care, community-based doulas can improve birth outcomes, foster nurturing relationships between new parents and babies, and increase attendance at medical appointments. We congratulate states who look to improve maternal and child health outcomes by supporting community-based doulas in their perinatal system of care.

A number of legislatures have introduced bills to cover services provided by doulas, including those in a community-based setting: 

  • Utah: Lawmakers enacted H.B. 415, which requires the state public insurance program to cover doula services as a part of pregnancy and childbirth care. 
  • Several states: Missouri (H.B. 1190), New Hampshire (S.B. 175), New York (S. 1190/A. 5958), and Texas (H.B. 3394), among others, proposed legislation to extend coverage for doula services to people participating in Medicaid. 
  • Louisiana: Legislators proposed requiring coverage for doulas as a part of maternity services offered in private health plans under H.B. 272
  • Nevada: A.B. 283 would increase the reimbursement rate for doula services in the perinatal period to at least $1,200. 
  • Minnesota: The Senate passed S.F. 2995, which would increase payments for certified doula services to $100 per prenatal or postpartum visit and to $1,400 for attending and providing doula services at birth. The payments are currently set at $47 per prenatal or postpartum visit and $488 for attending and providing doula services at a birth.
  • Tennessee: The legislature passed S.B. 394, which will create a doula advisory services committee to establish core competencies for doulas statewide and recommend Medicaid reimbursement rates for doula services.  

Many states’ legislation requires that doulas be certified to qualify to receive payment for covered services. This requirement may create barriers for the workforce and patients. Currently, many states do not have standardized certification requirements for doulas, and therefore training and certification varies among doula providers.  

The new certification requirements in the above bills could impose significant barriers for the doula workforce. As states implement policies that support the community-based doula workforce and increase access to care, certification requirements will be an important consideration for inclusivity and equity. 

Child Care Subsidies  

Many states are focused on increasing access to child care—either by expanding eligibility for child care subsidies or by removing policies that limit participation. This legislative session, we also see a trend of states introducing bills to expand subsidy access to specific populations:

  • Massachusetts: Through H. 147, the Department of Transitional Assistance would provide immediate access to subsidies for families experiencing homelessness and receiving cash assistance.  
  • Washington: The legislature passed H.B. 1525, which will provide child care assistance without a work requirement to parents participating in state-registered apprenticeships.  
  • Oklahoma: H.B. 2770 would expand eligibility for child care subsidies to include all state employees.  
  • Kentucky: The legislature adjourned without enacting H.B. 305, which would have expanded subsidy eligibility to health care personnel, child care workers, social workers, and long-term care personnel regardless of income level. We will watch closely next year to see if the bill pops up again. 

As legislation to expand access to child care subsidies programs is introduced, states should also look for long-term, sustainable funding sources to support changes. Without additional funds, changes to subsidy programs may increase access on paper, but lead to longer wait lists. 

States can also promote access to child care by removing or adjusting current policies that make benefits difficult to access:

  • New York: Legislators proposed two bills this legislative cycle to remove barriers to child care subsidies. S.B. 4522 would prohibit the state from denying subsidy access based on immigration status, and S.B. 5327 would provide access to full-time care regardless of the hours spent working or in education or training.

Economic Supports for Working Parents 

Financial hardship in early childhood can disrupt healthy brain development and compromise long-term learning, behavior, and health. According to our comprehensive reviews of rigorous research, states have several effective options to increase household resources. This year, several states have introduced or passed legislation to support the economic wellbeing of families through expanded tax credits, higher minimum wages, and improved paid family leave:

  • New Mexico: Last month, Governor Michelle Lujan Grisham signed a tax package into law (H.B. 547). One of the provisions will expand the state child tax credit (CTC) to up to $600 per child for eligible families. 
  • California: A.B. 1128 would expand the state’s Young Child Tax Credit to all eligible dependents in households receiving the EITC. The bill continues to move through committees. 
  • Louisiana: Governor John Bel Edwards proposed increasing the state minimum wage to $10.00 per hour in his budget proposal, which lawmakers included in legislation introduced in both chambers (S.B. 149/H.B. 374). 
  • Rhode Island: As a result of prior legislation, the number of weeks of paid family leave benefits available in the statewide program increased this year to 6 weeks. And legislators introduced several pieces of legislation targeted at increasing the number of weeks of benefits, raising the wage replacement rate, and making the statewide program more equitable.   

Maryland has passed two exciting laws this year to put money into the pockets of working families: 

  • Last month, Maryland enacted the Family Prosperity Act of 2023 (S.B. 552), which permanently increases the value of the refundable state earned income tax credit (EITC) to 45% of the federal credit. Without this action, the state EITC would have returned to 28% of the federal EITC this tax year. S.B. 552 also raises the qualifying income threshold for the $500 refundable state CTC, meaning more families have extra money to support their families.  
  • Maryland also enacted the Fair Wage Act of 2023 (S.B. 555), which accelerates previously scheduled minimum wage increases. The state minimum wage in Maryland will reach $15.00 per hour on January 1, 2024, rather than in 2025. 

Final Update Coming in June 

At this point in the year, more than a third of state legislatures have adjourned sine die. By the end of this month, nearly two-thirds will have wrapped their sessions for the year. The Prenatal-to-3 Policy Impact Center will publish our last legislative update for 2023 in June. Would you like to know as soon as the post goes live? Subscribe to our blog updates!  


Cynthia Osborne discusses the work of the Prenatal-to-3 Policy Impact Center, which focuses on building the evidence base for effective state policies to improve outcomes for infants, toddlers, and their families. Read the full article
Vanderbilt University’s Prenatal-to-3 Policy Impact Center (PN-3) just issued its annual State Policy Roadmap, exploring ways that the states (and D.C.) can improve conditions so infants and toddlers can thrive. The Roadmap focuses on 12 solutions shown
Paid family leave is one of 12 evidence-based policies in our 2023 Prenatal-to-3 State Policy Roadmap, which details states’ progress toward adopting and implementing policies that effectively improve child and family wellbeing . As of