PROGRESS ACROSS STATES SINCE THE 2020 PRENATAL-TO-3 STATE POLICY ROADMAP
The Prenatal-to-3 State Policy Roadmap provides state policy leaders with clear guidance on 12 policies and strategies that have a strong evidence base of positively impacting the lives of infants, toddlers, and their parents. First released in 2020 and most recently in 2024, the Roadmap details state level investments in the 12 effective solutions, which include a combination of broad-based economic and family supports, as well as targeted interventions to support families’ health, economic security, and early development. The findings of each Roadmap have illustrated how state policy choices vary considerably, which leads to a patchwork of benefits and resources for families across the country.
This section of our report, 5 Years of Progress on the Prenatal-to-3 State Policy Roadmap, provides a summary of the substantial investments that many states have made since 2020 across each of the 12 effective solutions, the impact of these investments on family resources through the tale of two contrasting states, and highlights system-wide changes that states have made. Beyond this summary, a detailed profile of the progress states have made on each effective Roadmap policy and strategy is also available, in addition to a summary of each state’s specific progress.
WHAT PROGRESS HAVE STATES MADE SINCE THE 2020 ROADMAP TO ADOPT AND IMPLEMENT EFFECTIVE ROADMAP POLICIES?
Since the 2020 State Policy Roadmap, 21 states newly implemented 26 Roadmap policies, representing significant policy change and impacting the lives of millions of infants, toddlers, and families. Of the 21 states that newly implemented a Roadmap policy, five states (Michigan, Missouri, Montana, South Dakota, and Virginia) implemented two policies.
States have also taken other important steps, beyond expanding Medicaid under the ACA, to improve access to health insurance.
- Since the passage of the American Rescue Plan Act of 2021, all states except Arkansas and Wisconsin have extended Medicaid coverage to 12 months postpartum.
- Three states (New Mexico, Oregon, and Washington) implemented continuous Medicaid coverage from birth to age 6, with 10 more states in the process of developing multi-year continuous coverage for children.
- Several states have taken action to extend Medicaid coverage to populations typically ineligible, such as those who are undocumented or are incarcerated.
Learn more about states’ progress implementing Medicaid expansion since 2020 in our Medicaid expansion progress profile, including insights into states that have taken steps to enact Medicaid expansion, implement work reporting requirements, and expand access to Medicaid coverage.
The five states newly implementing a statewide paid and family medical leave program of at least 6 weeks to all parents joined California, the District of Columbia, New Jersey, New York, and Washington in offering this benefit to families. In addition to these 10 states, several other states have taken additional steps to improve access to and benefits of statewide paid family and medical leave programs since the 2020 Roadmap.
- Four more states (Delaware, Maine, Maryland, and Minnesota) will implement statewide paid family and medical leave programs in 2026.
- States continue to increase the generosity of their paid family and medical leave benefits.
- Since the 2020 Roadmap, the District of Columbia, Rhode Island, and New York increased the number of weeks of leave available to parents with a new child.
- New York increased the generosity of the wage replacement benefit while on family leave, and California enacted legislation to increase the generosity of benefits beginning in January 2025.
Learn more about states’ progress implementing paid family and medical leave since 2020 in our paid family and medical leave progress profile, including incremental progress states have made toward passing statewide programs, how states consider equity in policy design, and the path forward for paid family and medical leave in states without a statewide program.
States have made considerable progress in other ways, beyond passing the $10.00 threshold, to increase the generosity of their state minimum wage.
- In total, 30 states, including those with minimum wages already at least $10.00 per hour in 2020, increased their minimum wage (at any level).
- Virginia had the largest increase (of $4.75 per hour) and was the only state to increase its wage among those states with minimum wages equal to the federal minimum in 2020 ($7.25 per hour).
- As of December 2024, eight states (California, Connecticut, the District of Columbia, Maryland, Massachusetts, New Jersey, New York, and Washington) have a minimum wage of $15.00 or greater, up from only the District of Columbia in October 2020. An additional six states are scheduled to reach at least $15.00 per hour by 2026.
- States also took action to eliminate subminimum wages for workers with disabilities and for tipped workers.
Learn more about states’ progress on the minimum wage since 2020 in our state minimum wage progress profile, including changes in wages across all 51 states, the impact of wage increases, and the need to monitor the value and equity of state minimum wages in the future.
Beyond progress related to the Roadmap threshold, states have also taken important steps to increase the generosity of state EITCs – both in the value of the credit and in the populations eligible for the credit.
- In total, 17 states made their EITC more generous. Changes in generosity vary, but the largest increases were in Colorado and Hawaii. Both state increases were equivalent to a $1,685 increase in the maximum benefit for a household with one child, but were accomplished in different ways. In Colorado, the state’s refundable EITC increased by 40 percentage points (from 10% to 50%), and in Hawaii, the nonrefundable 20% credit was made refundable and its generosity was increased by 20 percentage points.
- The District of Columbia has the most generous refundable state EITC, set at 70% of the federal credit for families with children and the credit is scheduled to increase to 100% of the federal credit by tax year 2026.
- Four states made their nonrefundable EITCs refundable, varying in generosity.
- States extended the EITC to additional populations, including individuals with nonresident children or with an Individual Taxpayer Identification Number (ITIN, who have a legal work status but are ineligible for a Social Security number).
Learn more about states’ progress on the earned income tax credit since 2020 in our state EITC progress profile, including changes in EITCs across all 51 states, the impact of increases, and changes in the broader tax system to support families (such as the state child tax credit).
WHAT PROGRESS HAVE STATES MADE SINCE THE 2020 ROADMAP TO INCREASE ACCESS TO EFFECTIVE ROADMAP STRATEGIES?
In addition to progress on effective policies, states made progress on effective strategies by implementing policy levers that increase access. Since the 2020 Roadmap, states have made the most significant investments in their child care subsidy programs and in increasing access to community-based doulas.
IT TAKES A SYSTEM TO SUPPORT FAMILIES
Since the release of our first annual Prenatal-to-3 State Policy Roadmap in October 2020, every state, including the District of Columbia, has increased their investments in at least one of the 12 effective Roadmap policies and strategies. These efforts should be recognized and celebrated! Investing in infants, toddlers, and their parents promotes healthy development in the short term and has huge benefits to individuals and society in the long term.
However, the amount that states invested since 2020 varies considerably, as does which policies or strategies states chose to support. This variation in state policy choices has led to widening inequality in family resources across states. Some states have invested heavily in several effective solutions, leaving families with substantially more resources and greater access to benefits and services; whereas some states have invested very little, and families are not as well off today as they were in 2020.
In the section above, we illustrated the investments states made in each of the 12 Roadmap policies and strategies, and we showed that millions of families with young children are benefiting from state policy choices. Families, however, benefit most when states center the wellbeing of parents and young children and develop a strong system of support for their health, economic, and early learning needs.
To foster this system of support, states may consider how their policy choices interact to provide a base level of resources for families, and how new policy choices alter families’ resources over time. Our Policy Impact Calculator illustrates the minimum level of resources that a full-time, working, single mother with an infant and toddler has to care for her family. We consider a state’s minimum wage, the availability of a statewide paid family and medical leave program, out-of-pocket child care expenses, taxes and tax credits, as well as federal nutrition benefits.
State variation in earnings and benefits is substantial. Policy choices lead to approximately $40,000 or more in earnings and benefits in roughly one-third of states, another third of states falling between approximately $30,000 and $40,000 in total resources, and a final third in which working families have less than $30,000 in resources.
Importantly, the Policy Impact Calculator does not account for additional state investments in Roadmap policies (e.g. Medicaid expansion) and strategies (e.g. investing in Early Head Start) that are harder to quantify at the family level. Colorado and Idaho provide an interesting comparison.
The policy choices of these two states lead to our simulated family having the highest and lowest level of resources in 2024, respectively. In 2024, if the simulated family described above lives in Colorado, they have $54,330 in annual earnings and benefits, whereas if the same family lives in Idaho, they have only $20,873 in earnings and benefits, less than half what the family in Colorado has.
Although it is about 11% more expensive to live in Colorado than Idaho, the Colorado family has more than 2.6 times the resources than the Idaho family does. This difference of nearly $33,500 in annual resources is driven entirely by state policy choices, namely a higher minimum wage in Colorado, paid family and medical leave, lower out-of-pocket child care expenses, and state tax credits for Colorado families with children.
These two states have also experienced the largest (an increase of $21,617) and smallest (a decline of $2,874) gains in family resources since 2020. In 2020, the family in Colorado had access to $32,703 in earnings and benefits; since that time, changes to state policies have led to an increase of $21,301 in resources, and expansions in federal nutrition benefits and cost of living adjustments to the federal EITC have led to an additional increase of $326 in federal benefits. The Colorado family has $21,617 more in 2024 than in 2020, an increase of 66%.
By contrast, in Idaho, the family has fewer resources in 2024 than they had in 2020. In 2020, the family had $23,747 in earnings and benefits, which is 14% more than the $20,873 they have in 2024. The loss of $2,874 is due to a huge increase in out-of-pocket child care expenses. Although the actual reimbursement rates to providers increased modestly, the price of child care increased much more, leaving the family with higher out-of-pocket costs to purchase the same quality of care.
Based on state policy choices alone, the Idaho family would have had $5,232 less in 2024 than in 2020; increases in federal benefits of $2,358 partially offset the state losses, but the family remains worse off today than 5 years ago.
HOW HAVE STATES INVESTED IN A PRENATAL-TO-3 SYSTEM OF CARE FOR FAMILIES?
Spotlight: 10 States That Transformed Their System of Care and Increased Family Resources
Ten states stand out as making transformational investments in state policies and strategies to support families with young children. Although the type and generosity of investments varied across these 10 states, each state’s policy choices led to an increase in household resources, enhanced the health and wellbeing of parents and children, and increased access to affordable child care and learning supports.
Limiting the selection to only 10 states is difficult because most states made substantial investments. The focus of this report, however, is on states that made policy progress across their entire early childhood system since the October 2020 Roadmap. Some states had relatively generous policies in place prior to the first Roadmap, but saw limited investments since that time and are not highlighted here. Other states made substantial investments in one policy area, but did not invest systemwide, and are therefore not spotlighted.
In addition to the difficulty of spotlighting only 10 states, ranking within these 10 stand-out states proved nearly impossible, because the states’ investments varied among different dimensions of family supports, and it isn’t clear how to determine if one investment is more valuable to families than another. Below we highlight three ways the 10 states enhanced their systems of support for families with young children.
Making Work Pay
Each of the 10 states increased its minimum wage quite substantially since October 2020; ranging from $4,680 in additional earnings for a minimum wage worker in Massachusetts to nearly $8,600 in New Jersey. Additionally, several of the 10 states increased the generosity of their states’ earned income tax credit and expanded access to the credit to additional populations, including workers without a Social Security number, younger parents, and nonresident parents. Six of the 10 states also newly implemented child tax credits, which provide between $440 (Massachusetts) to $4,400 (Colorado) in annual benefits to families with low incomes.
Protecting Earnings
The 10 states are also protecting workers’ earnings by implementing paid family and medical leave programs. Three of the 10 states – the District of Columbia, New Jersey, and Washington – had a paid leave program prior to the release of the October 2020 Roadmap, and the District of Columbia and New Jersey have made their programs more generous since that time. Four of the 10 states – Colorado, Connecticut, Massachusetts, and Oregon – newly implemented a statewide paid family and medical leave program, and Delaware and Maryland will do so in 2026. New Mexico came close to enacting a paid leave program this past legislative session and will likely reintroduce legislation in 2025.
The states are also protecting earnings by expanding access to affordable child care and limiting out-of-pocket child care expenses. Each state increased its reimbursement rate to providers, and half of the 10 states reduced their copayment rates or expanded their income eligibility limits. Colorado, New Mexico, and Washington invested in each of these strategies to increase access to affordable care.
Increasing Access to Health Care and Perinatal Resources
All 10 states expanded Medicaid prior to October 2020, but since that time Colorado, Connecticut, and the District of Columbia have taken steps to make health insurance available to additional populations and individuals with higher levels of income. Additionally, each of the 10 states is actively using or in the process of using (New Mexico and Washington) Medicaid to reimburse for community-based doula services. Finally, Colorado, Connecticut, Oregon, and New Jersey have all begun implementing Family Connects statewide to assess families’ needs and connect them to services.
Spotlight: States That Made Relatively Few Investments in Families with Young Children
In contrast to the large, system-wide investments made by the 10 states discussed above, several states made relatively few investments in effective policies and strategies to support infants and toddlers in the earliest years. Determining which states to spotlight, however, is difficult because every state made some sort of investment in families with young children.
We offer three approaches to spotlight states that made relatively few investments since the 2020 Roadmap:
- The eight states that have not implemented any of the four effective Roadmap policies,
- The 10 states in which state resources to families declined or stayed the same, and
- The five states that only invested in child care since the 2020 Roadmap.
8 States Have Not Implemented Any of the Four Effective Roadmap Policies
In 2020, 13 states had not implemented any of the effective Roadmap policies. Since 2020, five states moved out of this bottom tier: Oklahoma, North Carolina, Missouri, and South Dakota expanded Medicaid, and the state minimum wage in Missouri, South Dakota, and Florida passed the $10.00 threshold.
Among the eight remaining states in the bottom tier, none has seen an increase in its state minimum wage, enacted a statewide paid family and medical leave program, nor implemented a refundable state earned income tax credit since 2020. Any changes to the minimum level of resources to a working family come from changes in out-of-pocket child expenses or the expansion of federal nutrition benefits and tax credits.
Although these eight states have not implemented any of the four effective Roadmap policies, several made progress toward supporting families with young children in other ways.
- Three of the states made incremental progress on increasing access to Medicaid:
- Georgia began offering Medicaid to individuals with incomes up to 100% of the federal poverty level (FPL), but instituted a work requirement that is limiting enrollment;
- Tennessee expanded its income eligibility threshold for parents to 105% of the FPL, and they were the first state to use Medicaid to buy diapers for families;
- And Mississippi’s legislature seriously considered Medicaid expansion this past legislative session.
- Four of the states (Georgia, South Carolina, Tennessee, and Texas) began offering paid family leave to eligible state employees; South Carolina and Tennessee both covered public school teachers beginning in 2023.
- Each state made some policy changes to increase access to child care subsidies, by expanding income eligibility, reducing family copayments and fees, and/or increasing provider reimbursement rates.
- States also made investments in other Roadmap strategies, for example:
- Georgia increased its certification period for SNAP from 6 to 12 months and now provides an enhanced reimbursement rate for group prenatal care.
- Mississippi and South Carolina expanded their investments in comprehensive screening and connection programs.
- Texas and Wyoming increased access to Early Intervention services.
State Resources to Families Declined or Stayed the Same in 10 States
Based on calculations by the Policy Impact Calculator, families led by a full-time, minimum wage worker experienced a decline in state resources in eight states, ranging from a loss of $142 in West Virginia to $5,232 in Idaho. In two additional states – Iowa and Mississippi – families had the same level of resources in 2020 as 2024, based on state policy choices.
With the exception of Hawaii, which invested in its refundable state EITC, none of the states listed above implemented any of the four Roadmap policies since the 2020 Roadmap. Therefore, the decline in resources based on state policy choices is driven by an increase in out-of-pocket child care costs. Each of the 10 states increased their reimbursement rates to child care providers, but the rates did not keep pace with increases in the market rate price, making it more expensive for families to access the same quality of care.
Family resources are a function of state and federal policy choices, however. With the exception of Idaho and Wisconsin, increases in federal nutrition benefits and tax credits since 2020 offset the loss of state benefits among this group of states, leaving families in these states with more resources overall in 2024 than in 2020. In Idaho and Wisconsin, the minimum level of resources available to working families was $2,874 and $547 lower, respectively, in 2024 than in 2020.
Four of these 10 states (Idaho, Mississippi, New Hampshire, and Utah) made investments in other effective Roadmap strategies, but the generosity and reach of those investments varied.
Five States Only Invested in Child Care Since the 2020 Roadmap
Five states only invested in child care since the 2020 Roadmap and did not make major new investments in any other effective Roadmap policies or strategies. Child care is certainly an important resource for families with young children, but it is only one element of a system of care. These five states maintained their investments in several Roadmap policies and strategies, but did not enhance their supports for families.
It’s not important to name the best or worst state for families, especially when the goals we set for our states may be even higher than any state is currently achieving. However, the substantial variation in states’ level of investments leads to a widening gap in benefits and resources based on where the family lives – which has significant implications for the wellbeing of children and families. All states can do more to support families, but some need to get started.
WHAT OPPORTUNITIES AND CHALLENGES DO STATES FACE IN THE FUTURE?
Since the 2020 Roadmap, families have faced unprecedented challenges. The global pandemic exposed and exacerbated how fragile our systems of support for families with young children are. Our child care providers struggled to retain a workforce and keep their doors open. Our health care systems were forced to develop innovative approaches to serving families and caring for young children. And families struggled with the loss of employment and rising costs, making it increasingly difficult to afford basic necessities.
The federal government provided families with unprecedented financial support, both directly through cash payments and enhanced child tax credits, and indirectly through increased funding to states and programs administered at the state level. This assistance had a huge impact on families; for example, the child tax credit lifted 2.1 million children out of poverty. Funding for evidence-based home visiting programs doubled and increased significantly for Head Start/Early Head Start, which allowed states to increase access to services. And the federal government provided states with multiple rounds of stabilization dollars for child care, which states used to shore up the fragile market.
Unfortunately, most of the federal investments were temporary, and states now must determine whether and how to sustain supports for families. As we illustrated above and throughout this report, many states have made unprecedented investments in policies and programs to support families with young children since 2020. Importantly, several states are generating new funding streams to sustain their investments, and other states are prioritizing general revenue toward these effective policies. However, as other states fail to sustain or make investments in early childhood, the variation in state investments is widening the gap between the benefits and services available to families based on where they live and raise their children.
Investing in Effective Solutions and Comprehensive Systems, Centering the Family
The research is clear that investments in children’s earliest years have long-term financial and social benefits for the individual, families, communities, and society as a whole. Our Prenatal-to-3 State Policy Roadmap provides state leaders with a guide on how to invest wisely to impact child and family wellbeing.
Investments in families with young children will be more effective, however, if states center the families’ needs and construct a system of support that includes broad-based economic and family supports, as well as comprehensive screenings and targeted interventions to meet identified needs. Moreover, an effective and efficient system will reduce administrative barriers to accessing programs for which families are eligible.
An effective system of support will also break down silos across programs and issue areas, and integrate health, economic, and early learning systems to better meet the needs of families. State leaders who focus on one particular area (e.g., parent and child health) would benefit from working more collaboratively with state leaders in other areas (e.g., economic policy or child care policy).
For example, access to health insurance (e.g., Medicaid) has been linked to increasing access to health services, but it also reduces poverty, increases financial stability, improves birth outcomes, and reduces child maltreatment. Similarly, state minimum wages are often considered only an economic or labor issue. Higher minimum wages do reduce poverty and increase incomes, but higher minimum wages also reduce adverse birth outcomes and child maltreatment. Child care subsidies are one of the most important employment policies states can implement. Working across sectors will build broader coalitions and stronger systems of support for families.
Our Policy Impact Calculator also illustrates the importance of considering how policies interact to support families with young children. For example, states may make large investments in tax credits or increase their state minimum wage, but if their child care subsidy reimbursement rates fail to remain on par with market prices, families will be no better off than they were prior to the economic policy change.
Opportunities to Build and Sustain Comprehensive Systems of Care
Since we released our first Roadmap in 2020, many states have made considerable progress in building comprehensive systems of support. Policy is a long game, however, and an ever-changing landscape as well. As state leaders move forward in new state and federal political environments, states that have made significant progress will need to determine how to maintain the investments made thus far and equitably implement the policies and programs they have adopted. States that have made relatively few investments will need to prioritize the goals they have for children and families and push toward adopting effective policies and strategies.
Based on our engagement with the early childhood field and input from state policy leaders, we offer a few specific areas of opportunity for continued momentum and learning. The issues noted below are not exhaustive but are key issues that many states are currently grappling with.
Opportunities in Parent and Child Health
In the area of parent and child health, states are determining how to build comprehensive perinatal support systems, especially to reduce disparities in birth outcomes. States are also developing strategies to implement the extension of postpartum Medicaid coverage to 12 months after the end of pregnancy, including identifying how best to serve individuals in this period. Several states are also exploring how to provide continuous Medicaid coverage for children in the earliest years and extend Medicaid to additional adult populations. And there remains an ongoing effort to enhance access to resources for mental health services for parents and children.
Opportunities in Economic Security and Family Supports
In the area of economic security and family supports, states continue to explore how tax credits can support families with young children. As states introduce new credits, it is important to consider how taxes interact in a system, including state EITCs, as well as state CTCs, state income and other taxes, and payroll taxes. Benefits cliffs are also a pressing issue for many states. Given that 14 states will implement a state minimum wage of $15.00 per hour or greater by 2026, states will need to determine how to ensure that working families benefit overall from higher wages, and not lose eligibility for critical benefits (e.g., SNAP) that would end up making them worse off. Another key issue in states is reducing administrative burden and coordinating across systems and programs to better allow families to access the programs they are eligible for.
Opportunities in Early Learning and Care
In the area of early learning and care, states are considering how to build sustainable funding systems to maintain progress to support early learning and care and increase access to high quality affordable care for more families. States are also developing strategies to support the early care and learning workforce through adequate wages and professional development. State leaders are also recognizing that the market rate approach to setting reimbursement rates to providers leaves providers with inadequate funding. States are applying cost modeling to better understand the true cost of care and learning to use that information to better support the early learning field. Finally, state leaders understand that home-based child care is an essential part of the child care landscape, especially for infants and toddlers. It will be important for states to develop strategies to enhance the viability and quality of home-based providers to increase access to care.
Building the Evidence Base and Moving Forward
Overall, it is important for state policy and program leaders to work closely with researchers to evaluate existing and new investments. The existing evidence base is relatively small and provides little understanding of how our policies and programs address issues of equity. We also know too little about the impact of specific policy levers (e.g., the optimal number of weeks of paid family leave), or how policies interact to affect families. More research will inform better policy making.
State policy choices matter. Millions of families with young children have benefited from the investments states have made since 2020. Moving forward, we will continue to monitor states’ progress toward the adoption and implementation of effective policies and strategies that help all children thrive from the start.
