Our brief on the critical role Medicaid plays for the early childhood education workforce has been re-published with new 2024 data, resources, and implications from the past year of federal actions, with the help of our partners, the Center for Law and Social Policy (CLASP), the National Association for the Education of Young Children (NAEYC), and the National Association for Family Child Care (NAFCC). These updates reveal that Medicaid continues to support early childhood educators in a significant way, covering over 26 percent of child care workers in 2024. State-by-state data shows this share growing to a third or more in twelve states (CA, IN, LA, MT, NJ, NM, NY, OR, RI, SD, VT, WV).
Readers who are familiar with the child care landscape in the US may not be surprised that the field faces challenges from many angles– cost is unaffordable for young families while providers and educators still do not receive adequate pay nor benefits, contributing to major access challenges for working families. Responses from the Stanford University’s Center on Early Childhood’s RAPID survey project found that 74% of families (with children under age six) had difficulty finding a spot for their child in a center or home-based program. And of these families, 81% said it impacted their ability to work.
The child care crisis is caused by a multitude of factors, including workforce shortage caused by burn out and low wages, lack of affordability, waitlists, limited hours, and safety concerns. NAEYC’s annual workforce survey found that nearly half of surveyed educators reported feeling more burned out this year, with 22 percent indicating they were considering leaving the field. About 43 percent of early educator families rely on one or more public safety net program such as Medicaid or SNAP. These are not new problems, but here are a few reasons that we must pay attention now more than ever.
More than 1 in 10 child care workers across the country are uninsured; among the 10 states that have not expanded Medicaid, this rate nearly doubles. The Affordable Care Act’s (ACA’s) Medicaid expansion has made a significant impact on health coverage rates for this workforce, as well as for parents and other caregivers for young children. Moreover, data shows that when parents are covered, their children are more likely to be covered due to what we refer to as the “welcome mat” effect. The ACA policy changes, most notably the Medicaid expansion, boosted coverage for adults and helped usher in historic improvements in child uninsured rates: between 2013 (the year before the ACA went into effect) and 2016, the child uninsured rate dropped by 2.8 percent, reaching the lowest rate ever recorded.
As we said last year, federal cuts that target the Medicaid expansion population, such as work reporting requirements (WRR), will certainly impact child care professionals and the young families they support. Anticipated losses (5.3 million adults from the WRR alone) are compounded by cuts and restrictions to SNAP eligibility and the expiration of enhanced premium tax credits for the Marketplace– two public benefits that work alongside Medicaid to support the health and wellbeing of this workforce. With CMS’ Interim Final Rule on Work Reporting Requirements now available, it is clear that the requirement’s burdensome red tape will be further exacerbated by the rule’s added hoops and hurdles.
NAFCC’s member survey found that health care is the third highest challenge reported by family child care educator respondents. Results also showed that 71 percent of the surveyed group reported working more than 50 hours per week. Yet as experts have pointed out, WRR will be particularly complicated for home-based providers. In 2027, the first year of WRR, states may choose to accept a statement – “self-attestation”– by enrollees for verification of compliance with the rule. Starting in 2028, though, states will require documentation to determine compliance. Many of these educators are self-employed, which means traditional documentation like pay stubs or state proof of income data is rare. It’s critical that decisionmakers at the state and federal levels implement this requirement in a way that protects Medicaid coverage for home-based child care providers, early childhood educators in smaller centers, and all child care workers in expansion states who will be navigating complex administrative obstacles from H.R. 1 on top of already challenging conditions.
Many of H.R. 1’s sweeping changes are not isolated to educators in expansion states, either, and these health care cuts come at a time when the Trump Administration’s actions have already taken a toll on the child care workforce. First, the Department of Health and Human Services (HHS) is paring back recommended vaccines for children. By increasing the likelihood of exposure to what were previously manageable or even preventable illnesses and diseases, the changes threaten not only children’s health, but also the health of professional educators who work with young children every day– many of whom will now also experience unstable access to health coverage.
More aggressive immigration enforcement and rollbacks on benefits for immigrants also strain early childhood educators, given that at least 21 percent of this workforce are immigrants. On October 1st, Medicaid eligibility will be restricted to only cover Lawful Permanent Residents, Cuban and Haitian entrants, and COFA migrants, eliminating health coverage for all other lawfully present immigrants. On top of narrowed eligibility, the Administration has also changed the Public Charge Ground of Inadmissibility rules in a way that could allow immigration officers to consider utilization, or likelihood of future utilization, of public benefits when reviewing applications for permanent residency. So even immigrant workers and families who are eligible for Medicaid may be deterred from seeking necessary care, coverage, and supports, due to concerns of it harming their immigration status. Lastly, heightening this environment of fear and its chilling effect are constant threats of Immigration and Customs Enforcement (ICE) raids and the HHS’ sharing of Medicaid data with ICE. It’s important to note that these targeted changes have widespread and lasting consequences for the one in four children in mixed status families, too.
These are just a few of the strains on those caring for young children that will translate to negative impacts on kids and families. Loss of health care coverage for providers could shrink the workforce and cause even higher costs and access issues for families, who themselves will be facing red tape to maintain their health care through WRR exemptions, six-month reverification, and more. It’s critical that policymakers and advocates pay special attention to the child care workforce in the current health care landscape and work to mitigate the harm caused by these and related policies through intentional outreach and implementation, flexibility where possible, and reliable data tracking. Read more about Medicaid for this population in the updated brief here and see how your state covers this vital workforce.