Building Comprehensive Prenatal-to-3 Systems of Care in States

This guest post comes from Alyssa Rafa, policy manager, and Maria Spinetti, state policy analyst, with the Prenatal-to-3 Policy Impact Center. All views in guest posts are those of the authors. 

The science is clear that the prenatal to age three period profoundly affects a child’s future learning, behavior and well-being. However, these early years often bring substantial challenges for families — including trouble accessing high-quality and affordable child care, and difficulty locating needed services. These short-term challenges can have longer-term impacts on a child’s ability to enter a classroom ready to succeed and on a family’s capacity to support their child throughout their education journey.  

The Prenatal-to-3 Policy Impact Center regularly conducts comprehensive reviews of the most rigorous evidence available on dozens of state level policies. The Center recently released its fourth annual Prenatal-to-3 State Policy Roadmap, which includes a range of policy options state leaders can consider to support children and families in the earliest years of life — including three main areas that are closely tied to early care and education.  

Child Care Subsidies 

Child care subsidies provide financial assistance to reduce the cost of child care for families who have low incomes and who work or participate in education or training programs. Subsidy programs are funded through both federal and state funds, and states have considerable flexibility in program implementation. The Roadmap details three ways states can approach effective implementation of these programs, which are: 

  • Determining Eligibility: States have the flexibility to set the income level at which families are eligible for child care subsidies. Sixteen states set their income eligibility thresholds at or above 85% of their state’s median income. Over the past year, 18 states increased their thresholds. 
  • Reimbursing Child Care Providers: Twenty-three states reimburse providers at the federal target for equal access; 25 states increased reimbursement rates over the past year. Several states continue to move toward calculating reimbursement rates using cost estimation models, which may more accurately capture the true cost of providing high-quality child care. 
  • Determining Family Contribution Levels: To ensure affordability, the federal government suggests that families should pay no more than 7% of their income toward child care. Currently, 24 states limit copayments to align with this guidance, and five states decreased out-of-pocket costs for families over the last year.  

Although state leaders may choose to focus on one strategy at a time, a more comprehensive and systemic approach to change may have greater impacts. For example, Minnesota and Vermont increased their state investment and made changes to their subsidy programs this year that will eventually expand income eligibility, increase provider payments and reduce cost burden for families.  

Early Head Start 

Early Head Start provides pregnant people, infants, toddlers and families who have low incomes with support services in various settings. Although this is primarily a federal-to-local program, states play a crucial role in Early Head Start funding. Of the 23 states that provide this support:  

  • Six states layer Early Head Start funding with child care subsidy programs by serving as state Early Head Start-Child Care Partnership grantees. 
  • Fifteen states dedicate state funding directly to local programs. 
  • Five states have developed a state-specific program with similar standards to Early Head Start.  

This year, Colorado, Maine, Minnesota and Washington all increased Early Head Start funding with either general fund allocations or federal relief funds.  

Early Intervention Services 

Part C of the federal Individuals with Disabilities Education Act provides funds for states to establish Early Intervention programs, which offer services for infants and toddlers with disabilities or developmental delays regardless of family income. As states implement Early Intervention programs, they face several choices regarding eligibility and family fees. As of October 2023: 

  • In addition to thresholds for developmental delays, 17 states allow very low birthweight as a diagnosable or at-risk qualification for services, and children who are born prematurely qualify for services in 23 states. 
  • At least six states allow children to qualify based on a set of biological, environmental and/or social risk factors before they show signs of developmental delay. 
  • Research shows that implementing family fees for Early Intervention services may reduce participation for children in families with low incomes. Thirty-four states have eliminated family fees for children receiving Early Intervention services.  

When it comes to supporting young children and their families, state policymakers can consider taking a comprehensive approach to create strong systems of care. For more detailed information on evidence-based state policy choices that impact the Prenatal-to-3 period, visit our Roadmap! 

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