Designing Universal Family Care: State-Based Social Insurance Programs for Early Child Care and Education, Paid Family and Medical Leave, and Long-Term Services and Supports

This report explores strategies that states could pursue to better support families in meeting evolving care needs over the lifespan. The first three chapters of the report explore the challenges families face in the realms of early child care and education (ECCE), paid family and medical leave (PFML), and long-term services and supports (LTSS). For each care domain, the panel identifies policy options along with the tradeoffs associated with specific policy choices; this is done within the context of assuring universal access, affordability, and financial stability through well-defined financing mechanisms. The concluding chapter explores how an integrated approach to care policy might be designed—one offering families a single point of access to ECCE, PFML, and LTSS benefits—under an umbrella program called Universal Family Care. Each chapter outlines challenges that states would need to navigate regarding how a new social insurance program would relate to existing federal and state care programs. Each chapter also addresses implementation considerations.

This analysis was developed over a year of deliberations by a Study Panel of 29 experts in care policy from a variety of perspectives. The report does not include recommendations but instead identifies the building blocks and tradeoffs associated with a range of options in the design of a state-based social insurance program. While there are other approaches for improving care supports, this report focuses specifically on social insurance solutions. As well, while there is nothing that precludes such approaches from being adopted at the national level, the focus of this analysis is on the potential for state action. Although addressed primarily to state policymakers, this analysis should be of interest to providers, advocacy organizations, insurers, administrators, and federal policymakers, as well as to any person interested in these issues.

See Fall 2019 events for further discussion.

Download the full report.

Read the press release.

Download infographics for each chapter:

• Early Child Care and Education
  • The Case for Action
  • States Leading the Way
  • Designing a State-Level Early Child Care and Education Program
• Paid Family and Medical Leave
  • The Case for Action
  • States Leading the Way
  • Designing a State-Level Paid Family and Medical Leave Program
• Long-Term Services and Supports
  • The Case for Action
  • Universal LTSS Could Support and Strengthen 21st Century Families
  • Core LTSS Decision Points for States
• Universal Family Care
  • One Integrated System of Family Supports
  • A Holistic, Integrated Approach to Care Policy
  • Designing a State-Based Universal Family Care Program: Four Illustrative Approaches

Explore Universal Family Care. (This link takes you to a site managed by Caring Across Generations.)

This project is being conducted in conjunction with the Academy’s “Leveraging Social Insurance to Combat Inequality” project, funded by the Ford Foundation. It also received support from Caring Across Generations, a campaign to transform how we care for our families at every stage of life.