Guide to Evaluating Paid Family and Medical Leave Policies - Background

Paid family and medical leave (PFML) policies allow workers to attend to a range of family and caregiver responsibilities without losing needed income. For example, an individual might take advantage of PFML to care for a newborn or recently adopted child, care for a sick family member, address their own health conditions, or manage family needs related to military deployment or experiences of domestic or sexual violence.

The benefits of PFML are well-documented and include improved health outcomes for workers and their children (e.g., decreased infant mortality, decreased maternal and infant rehospitalizations, decreased parental psychological distress) and improved economic outcomes for families (e.g., decreased risk of poverty and food insecurity, increased labor force participation for mothers), with few documented downsides for employers.[1] Despite these benefits, though, the United States is one of only six countries in the world without any kind of national paid parental leave policy, and one of a few high-income countries with no national paid policy for family caregiving leave.

As of 2023, approximately one quarter (27%) of U.S. workers access PFML through their employers, and access varies by job type and worker characteristics. In 2021, 6 percent of workers in the lowest-wage jobs had access to paid family leave benefits[2] through their employers and just 19 percent had access to paid medical leave through short-term disability insurance[3]—compared to 43 and 64 percent, respectively, among workers in the highest-wage jobs. Access to PFML also varies by race and is significantly lower among Asian, Black, and Hispanic workers than among White workers, even after accounting for occupational disparities.

While the federal government offers no guaranteed PFML, multiple states have expanded access to it. As of 2024, 13 states and the District of Columbia have passed mandatory PFML policies and nine states have passed voluntary ones.[4] These policies are in various stages of implementation, with five slated to come into full effect in 2025 and 2026. There is continued bipartisan interest in expanding access to PFML at the state and federal levels.

In states that have enacted PFML policies, public officials who make early and ongoing plans to evaluate PFML implementation and outcomes will gain insights that can inform future policy design and implementation. These insights can benefit individual states, helping policymakers and administrators improve their PFML programs over time. They can also contribute to a growing body of evidence on which other states and the federal government can draw when enacting PFML policies in the future.

Footnotes

[1] We describe these outcomes in further detail in this brief.

[2] Here, “workers in the lowest-wage jobs” refers to private industry workers whose hourly wages fall in the lowest 10 percent of the total income distribution across the population, and “workers in the highest-wage jobs” refers to private industry workers whose hourly wages are in the highest 10 percent.

[3] Here, “workers in the lowest-wage jobs” refers to private industry workers whose wages are in the bottom quartile and “workers in the highest-wage jobs” refers to private industry workers whose wages are in the top quartile.

[4] States with voluntary PFML policies do not require that employers provide PFML and instead allow the private insurance market to sell paid family leave insurance, which employers can elect to purchase for their employees and/or which individuals can purchase independently. Approaches to voluntary PFML policies vary. For example, Texas strictly clarifies that private insurers are permitted to sell PFML plans, while New Hampshire contracts with insurance carriers that provide a base plan in the state and purchases coverage for state employees to support the private market. We discuss some of the implications of voluntary versus mandatory PFML policies in this brief.