Last month, Stanford Center on Early Childhood released its four-year anniversary report on findings of its RAPID Survey Project. The report detailed the top concerns and stressors felt by parents and providers of young children across the country. The leading concerns? Child care, housing, and health care.

The RAPID Survey Project began in response to the COVID-19 pandemic to collect and measure “essential information on the needs, health promoting behaviors, and well-being of young children and their caregivers.” The survey asks parents and providers across the U.S., “What do you want elected officials and policymakers to know about how your family is doing and what you need?” This framing allows for not only important detail on the day-to-day perspectives of young families but also points to actionable and solution-oriented recommendations to their most urgent challenges.

Young families’ top concern – across all demographics, locations, and incomes – revolves around child care challenges: affordability, quality, and reliability. The rising cost of child care coupled with limited public support contributes to an overwhelming conundrum – parents are unable to meet the high costs of safe and quality child care, but providers are not being paid enough, which then exacerbates the shortage in quality child care. Both parents and child care providers surveyed said that elected officials need to do more to support child care for parents, particularly those looking to return to the workforce.

Families with young children also pointed to the challenges of affording essential services like basic housing, health care, and household needs. The report lists specific efforts like food assistance, stimulus checks, and expansion of the Child Tax Credit as ways to meet the increasing challenges facing families. The RAPID Survey Project’s Pandemic Financial Relief Policy fact sheet reveals the impact of such policies on hardship, housing, and food insecurity. Families have more readily pointed to added stress caused by lack of household supplies and affordable housing since the expiration of many family support policies, such as the child tax credit, put into place by the American Rescue Plan. Survey respondents touched upon the many ways these helped mitigate the rising costs of these essential services. Families’ responses suggest that a return to these policies could ease families’ growing financial burden and ultimately prevent heightened emotional distress on both parent and child.

Both stable housing and consistent health care are essential to the success of early childhood development. Additionally, financial and care-related strains on parents heighten stress levels, which in turn impacts the emotions of young children, particularly when these strains impact day-to-day functioning of a family and household.

Health coverage itself is not only important to get needed care – it also supports families’ financial security. Medicaid coverage has long been associated with improved family financial stability in the short and long runs. But that means eligible children and family members need to remain enrolled to access financial protections. The unwinding has underscored the need to ensure children have stable, continuous coverage without added red tape at renewal that can disenroll children for procedural reasons. This is one reason we have seen a dozen states move to adopt up to five years of continuous eligibility for young children in Medicaid. States can also opt to lessen the economic and red-tape burdens on families by removing premiums and co-pays and increasing income eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) for children and pregnant women. States that have not yet expanded Medicaid to low-income adults under the Affordable Care Act (ACA) have the biggest opportunity to remove stress from young families– most non-expansion states do not provide health coverage for parents at very high-income levels. Parent coverage helps kids by improving economic security and keeping parents healthy– removing sources of family stress.

Beyond the importance of ensuring all children and families are connected to available health coverage, states are also considering Medicaid’s potential to address health-related social needs (HRSN), including housing and nutrition. Our new paper, State Use of Section 1115 Waivers to Support the Health-Related Social Needs of Pregnant and Postpartum Women, Infants, and Young Children, outlines the ways some states are using waivers to help support targeted housing and nutrition services to pregnant women and young children who meet certain criteria. Delaware and Tennessee recently became the first states to cover diapers for young children via Section 1115 demonstration project approvals, aiming to relieve another cost burden on families for a necessary expense. But the opportunity to support HRSN doesn’t stop at Section 1115 projects– the new Medicaid managed care rules open the door for states to use managed care organizations (MCOs) to help support HRSN, as our colleague Leo Cuello recently blogged. With costs of housing and material necessities rising, these HRSN housing and nutrition strategies present a targeted way for states to ease the stressful burdens on parents and ensure the healthy and stable development of infants and young children.

The RAPID survey’s years of listening to families and caregivers of young children details the main stressors they face: high quality child care, financial stability, and ability to attain basic household and health care – all needs that are of critical importance to the success of a child’s development, particularly in the first few years of life. Medicaid is a foundational support for children and families, but states can do more to ensure it works as intended by ensuring all eligible children and families are covered, addressing timely access to care, and doing more to connect families with the services and supports they need to thrive.