Child care subsidies can contribute to employability and economic success and the improvement of maternal and child health for many low-income families. However, overall access to subsidies is low, and the amount and length of subsidy receipt depend on the generosity of the child care system that each state operates, which could affect access to quality care and thus potential children’s health outcomes. Although some studies examined the relationships between subsidy receipt and child developmental outcomes, they measured subsidy receipt as a single indicator and did not address the generosity of subsidy policies that might play a role in parental capacity in choosing quality child care. The current study explores how subsidy take-up affects child health and whether the state subsidy rules, individually and collectively, moderate the relationship between subsidy take-up and child health.
The study used a merged data set, combining individual-level information on subsidy take-up and child health status from two waves (2012 and 2016) of the National Household Education Survey (NHES)-Early Childhood Program Participation (ECPP) and state-level subsidy rules data from the Child Care and Development Fund (CCDF) Policies Database. Our sample focused on families with income at or below 200% of the poverty threshold and at least one child age six or younger in families (N = 5,889). Subsidy take-up was measured as receiving child care assistance from social service, welfare, or child care agency, and a parents-reported general health status of children was used to measure children’s health outcome (1= poor/fair/good and 0 = very good/excellent). Seven key subsidy rules included in the analysis were income eligibility limit, family copayment, state reimbursement rate, workhour requirement, in-person interview requirement for initial application, whether to have job search eligibility, whether to allow providers to charge families for the difference between reimbursement and private-pay rates. With these rules, we created an indicator for each policy and combined them to create a continuous state-level generosity index, ranged from 1 to 7. We then created a categorical generosity measure based on the distribution of the combined score (1= generous, 2= moderate, 3= restrictive). We employed multi-level logistic regression models with rich individual and state-level control variables. The cross-level interaction analysis was conducted to explore whether the generosity index moderates the association between subsidy take-up and child health.
About 6 percent of the sample received subsidies. Multivariate results found that subsidy receipt was associated with poor child health (Odds Ratio = 1.42, p<.05). The interaction result revealed that subsidy receipt was strongly associated with poor child health particularly in states with restrictive subsidy program rules, while it was not associated with child health in states with generous rules.
Preliminary findings suggest that subsidy receipt may be associated with poor child health particularly in states with restrictive subsidy policy rules. Our future analysis will explore ways to cluster states based on their policy rules. The study will discuss policy implications that can advance health outcomes for low-income families with young children.