We are asked a lot about the ways states can do more for young children in Medicaid—and we have a lot to say! Young children’s healthy development is influenced by their interactions and relationships with parents and other adults. So naturally, for the 17 states holding out, we start by raising Medicaid expansion. While we talk a lot about the importance of parent coverage for children’s development, we know there are many others who interact with children every day—namely, caregivers in formal or informal child care and preschool settings. Medicaid expansion could help many of them, too.

Don’t just take it from me. Child care workforce experts agree. The Early Childhood Workforce Index 2018 assesses states on early childhood employment conditions and policies. A state’s Medicaid expansion status contributes to progress on the health and well-being of the state early childhood workforce. Expansion, along with statewide paid family leave and paid sick leave, informs whether states are classified as stalled, progressing, or making headway.

Edging forward for health and well-being in 2018: Arizona, Connecticut, Maryland, Massachusetts, New York, Oregon, Vermont—expansion states all. (See here for the full report, an interactive map, and state profiles, all chock full of helpful data!)

Why would Medicaid expansion help? Let’s start with a bit on the early childhood workforce from the report’s executive summary:

Across almost all settings in the country, early educators are in economic distress, and available data suggests that this reality falls disproportionately on women of color, who comprise about 40 percent of this workforce, and on those working with the youngest children.

Among other challenges, lower pay among early childhood workers translates to higher use of public programs—more than double the rate for workers across all occupations. But like others in the coverage gap, early childhood educators in non-expansion states can’t enroll in Medicaid.

They don’t make enough to access financial support to purchase Marketplace coverage, and don’t qualify for Medicaid (or, if they are parents, the make too much to qualify).

The characteristics of this workforce reflect much of what we know about those in the coverage gap today: They work part – or full – time but earn less on average, many work for small employers (under 50 employees) that can’t afford to offer insurance, and are disproportionately people of color.  

While it’s not a silver bullet, Medicaid expansion has helped improve economic security for adults, in addition to improving their access to care. Providing some additional peace of mind for early childhood educators can help them—just like any of us—go to work less stressed and, in turn, better able to engage with and help guide young children during a critical time in their development. Why would we settle for anything less?