The Best and Worst States for Family Care Policies

The report excerpted below was originally published by The Century Foundation. Read the full analysis here.

In 2021, the Century Foundation published its first care policy report card, “Care Matters,” which graded each state on a number of supportive family policies and worker rights and protections, such as paid sick and paid family leave, pregnant worker fairness, and the domestic worker bill of rights. The 2021 report card revealed the tremendous gaps in state care policies and a fragmented and insufficient system of care workers and families in most states.

This year’s update, co-authored with Caring Across Generations, takes another look at how states are doing.

Since 2021, the federal government invested unprecedented resources in care infrastructure through the American Rescue Plan Act (ARPA), which supported states to innovate and improve their policies, serve more families, and pay higher wages. Although they were short-term, the ARPA funds were a lifeline across the care economy and made clear what is possible when the federal government comes together with families, states, workers, employers, communities, and others to build the care infrastructure America needs. The historic lack of investment in care infrastructure means that even temporary investments make a big difference.

At the same time, the historic lack of investment means even with progress, states still have a long way to go. Some of the progress made as a result of ARPA and related funding is not yet reflected in the grades due to lagging data.

The goal of this care report card is to show the status of essential care policies in the states. Grades don’t reflect the efforts of advocates and policymakers who have long fought for stronger care policies in their states, but rather the political realities faced and the overarching need for federal and state investments. Substantial federal investment—on top of state and local prioritization—is needed to fuel economies, improve the well-being of children and families, create millions of good jobs, promote equity, and support disabled people and older adults to live independently with safety and dignity.

State Care Report Card Grades

To date, 13 states and the District of Columbia have passed paid family and medical leave, and 15 states and the District of Columbia have passed paid sick days policies. These states are some of the highest scoring.

Historically, the District of Columbia was the most advanced in terms of childcare and early learning policies. The ARPA funds supported other states to make improvements in affordability, stabilize childcare supply, and expand pre-K, and even invest additional state dollars into childcare and pre-K. However, lagging data means those changes won’t fully show up in the grades. Similarly, ARPA funds supported HCBS expansions in every state, and leveraged additional state dollars, but does not yet fully show up in the grades, including in terms of care worker wages.

Top Five States

The five highest-scoring states in this report card, in order, are:

  • Oregon
  • Massachusetts
  • California
  • Colorado
  • Minnesota.

Oregon received the highest grade on the report card, a “B+,” while Massachusetts, California, Colorado and Minnesota were the only states to earn a “B.” Oregon’s strong performance on childcare and paid family and medical leave propelled it to the top of the care report card.

Minnesota made significant investments in paid family leave and paid sick days.

Massachusetts earned a B in large part due to its improvements in childcare.

California’s progress on childcare, paid sick days, and paid family leave policies helped them score a B.

Colorado’s strong paid family medical leave program, and comparative strength in home and community-based services helped it secure a spot in the top five best states.

At the same time, the fact that no state received an A shows that critical improvements in care policies are possible and needed even among the highest-scoring states.

For example, California can also maintain its leading edge on care by investing in home and community-based services, implementing a state public long-term care benefit similar to Washington state’s program, and establishing statewide collective bargaining rights for in-home supportive services (IHSS) workers, the largest direct-care workforce in the country.

In Oregon, lawmakers failed to pass a bill that would have required the state’s labor agency to adopt the recommended compensation schedule for long-term care workers.

And in Massachusetts, paid family and medical leave currently can’t be taken to care for what are known as “chosen” family members (loved ones that the leave taker isn’t biologically or legally related to).

These leading states must continue to take steps to ensure inclusive and equitable investments in care.

Worst Five States

Unfortunately, there are still many states that lack comprehensive care policies. The five lowest-scoring states all had either a D—or an F grade.

The lowest-scoring states are:

  • Alabama
  • West Virginia
  • Florida
  • Wyoming
  • Idaho

Many of these states lack even basic policies and protections. None of the worst five states have a statewide paid sick day policy or paid family medical leave policy. 

Florida has a list of over 77,000 people waiting to receive home and community-based services.

Alabama and West Virginia’s median hourly wages for direct care workers were $12.15 and $12.56 in 2022, respectively, far below the national median of $15.43.

Many of these states have failed to make progress on affordable childcare that’s available to families when and where they need it.

For example, in West Virginia there is only one childcare slot for every eight children under the age of 6 with all their parents in the workforce, and childcare is unaffordable for the typical family.

The Historic Undervaluing of Care

Care is, and has always been, woven into the fabric of daily life—from women doing a majority of unpaid care work at home, to the Black, Brown and immigrant women supporting families in their homes through domestic work, and those providing care and support to children, older adults, and disabled people in their homes and communities. Despite the essential nature of the services that care workers provide, care work continues to be undervalued and underpaid.

The devaluing of care work can be traced back to the use of chattel slavery in the United States, when Black women were enslaved and forced to care for the families of their white enslavers.

The persistence of historical and present-day oppressions are embedded in the lack of commonsense public policies on care and the working conditions for care workers today. That’s why progress on building a care infrastructure does not just materially help those impacted, but also helps dismantle the legacies of racism, slavery, xenophobia, sexism, ageism and ableism that have devalued care.

What You Should Know

  • Care policies impact everyone. Transformative investments in robust childcare and early learning, as well as in home and community-based services and comprehensive paid family and medical leave are critical for families and communities. Together with paid sick and safe days and support for both the family caregivers and paid care workforce, these priorities help ensure gender, racial, and economic equity and a thriving economy.

  • This report, in partnership with Caring Across Generations, grades states on their care policies across multiple issues—childcare and early learning, home and community-based services, paid family and medical leave, paid sick and safe days, fair working conditions for care workers, and family-supporting tax policies.

  • Despite tireless work from advocates throughout the country, the combination of limited financial resources, entrenched well-funded opposition, and a lack of political will have long stymied state progress on care policies.

  • The COVID-19 pandemic and pandemic-relief investments, including the American Rescue Plan Act, not only lifted the invisibility cloak that had hidden the nationwide need to invest in care, but also supported states to innovate and take action. The historic underinvestment in care, however, means that even those measures were not enough for any state to receive an A.

Explore the full “Care Matters: A 2024 Report Card for Policies in the States report, including recent changes to federal policy, scoring, methodology and more.

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About , , , and

Laura Valle Gutierrez is a fellow at The Century Foundation, where she works on economic policy and research to promote economic, disability, racial and gender justice.
Julie Kashen is director of women’s economic justice and a senior fellow at The Century Foundation, a leading progressive think tank. She is one of the nation’s leading experts on the issues affecting working families, having authored numerous studies on childcare, paid leave, equal pay and other topics.
Faith Jalango is a student at American University pursuing a bachelor's degree in political science and a master's in political communication.
Kathy Mendes is a policy associate at Caring Across Generations and a researcher and advocate based in Philadelphia.
Jaimie Worker is director of public policy at Caring Across Generations.