Care matters. How are the states measuring up? 


March 28, 2024

A new report grades all states plus Washington, D.C. on a range of care policies – and while many are improving, not a single state walked away with an ‘A.’ 

The report, Care Matters: A 2024 Report Card for Policies in the States, was researched, written, and published by The Century Foundation and Caring Across Generations. It assessed states’ performances across multiple issue areas – child care and early learning, home- and community-based services, paid family and medical leave, paid sick 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 report found. 

The states that earned the highest grades were Oregon (B+), followed by Massachusetts, California, Colorado, and Minnesota, all of whom earned a B. The states with the lowest grades were Alabama, West Virginia, and Florida, all of whom earned an F, and Wyoming and Idaho, with each garnering a D-minus. 

The report noted that COVID-19 relief programs, particularly the American Rescue Plan, helped states invest in care, and even experiment with innovative approaches to care programs. But money is running out, the report noted, and the “historic underinvestment in care…means that even those measures were not enough for any state to receive an A.” 

The report lists reasons why states scored as high – or as low – as they did. 

“Oregon’s strong performance on child care and paid family and medical leave propelled it to the top of the care report card,” the report states. “Minnesota made significant investments in paid family leave and paid sick days. Massachusetts earned a B in large part due to its improvements in child care. California’s progress on child care, 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.” 

Conversely, the report found, none of the five worst-performing states have a 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,” the report states. “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.” 

And many of the failing states have not made progress on affordable child care that’s available to families when and where they need it. 

“For example, in West Virginia, there is only one child care slot for every eight children under the age of 6 with all their parents in the workforce, and child care is unavailable for the typical family,” the report found. 

Even for states with the highest grades, the report offered advice on how they can improve. 

For example, the report said, California could invest more in home- and community-based services, “implementing a state public 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, the report noted, state legislators failed to pass a bill that would have required the state’s labor agency to adopt a recommended compensation schedule for long-term care workers. And in Massachusetts, paid family and medical leave under current law cannot be taken to care for what are called “chosen” family members – loved ones that the leave taker isn’t biologically or legally related to. 

Want to see your state’s grade? Go here and scroll down. 

A number of Coalition on Human Needs members and allies are involved in events next month via Care Can’t Wait and Care Can’t Wait Action – offering a chance to lift up policies that will help move forward policies to “make the grade.” The groups are celebrating the one-year anniversary of a sweeping set of executive orders from President Biden aimed at improving the lives of care workers and the families they serve.


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