Benefits for Child Care Workers: How the State Could Help through a Medicaid Waiver


  • Amanda McDougald Scott



Childcare workers, child care, Medicaid, health insurance, health care, low-income workers


Child care is expensive, and many parents struggle to afford care; furthermore, even though child care costs are high, child care providers in the United States (US) are not making a living wage. Child care professionals (ages 0-5 in child care homes or centers) earn less income than Kindergarten teachers, pre-K teachers, non-farm animal caretakers, and the US estimate of all workers’ annual median salary (Bureau of Labor Statistics, 2020a, 2020b). Workers in comparable professions are also usually offered benefits for their labor, which child care professionals are not (Kwon, 2019; National Survey of Early Care and Education Project Team, 2020; Otten et al., 2019; Whitebook, McLean, Austin, & Edwards, 2018).  This often necessitates use of public assistance.  Because many child care workers are not provided access to health insurance or other health-related benefits through their employers, they must seek access to health care in other ways.  Additionally, turnover rates among child care workers are high, and wages and benefits are a large part of the reason why child care professionals leave their jobs (McDougald Scott, 2021a). This policy analysis (a) reviewed the current struggle (as of May 2021) that child care workers in the United States (in general) and South Carolina (in particular) experience compared with employees in other fields; and (b) explore options (particularly a Medicaid waiver option) that might improve the situation.  South Carolina (SC) is one of the 13 states that have not expanded Medicaid; most of the 13 states are in Southern United States (US) region, which makes an extrapolation of SC research reasonable.  Lessons learned from SC childcare data should reflect closely what may be found in other non-expansion states, but research from the literature review will not be SC-specific. Relevant peer-reviewed, government documents, state and national data, and grey literature were reviewed and analyzed. There have been ongoing efforts (although insufficient even in more successful efforts) with mixed results to improve the pay for child care workers for decades.  Progress for earning a living wage will require a systems overhaul for early education, but child care providers cannot wait for workforce environmental improvements.  Action must be taken now to augment the shortage of healthcare access for child care providers.  In SC, Medicaid helps some child care workers receive access to health care, but expansion through Medicaid waiver 1115 would include many more child care workers who do not currently have access.