How Do State Subsidy Policies Affect Child Care Access for Families of Children with Disabilities?

Background and Purpose: Families of children with disabilities often experience barriers to accessing affordable and appropriate care for their children, affecting children’s development and parental employment. These families disproportionately live with low incomes that further limits their child care access. Child care subsidies provided by the Child Care Development Fund (CCDF) play a crucial role in addressing unequal child care access for these families. The CCDF Final Rule identify children with disabilities as one of the priority populations and outlines policy approaches states can adopt to support equitable child care access for children with disabilities. However, there is a gap in literature on how these policies affect access for children with disabilities. The current study examines two specific policies: 1) prioritizing/guaranteeing subsidies for eligible children with disabilities; and 2) differentiating provider payment rates for caring for children with disabilities. We hypothesize that implementing these policies will result in increased enrollment in paid care and the number of hours in care. Additionally, we expect the weekly out-of-pocket cost of care will decrease for children with disabilities.

Methods: The study uses data from the National Survey of Early and Education (NSECE) merged with the CCDF Policies Database from 2012 and 2019. The sample consists of children under 13 years from low-income families (i.e., income below 200% of the federal poverty level); 9% of children in the sample have a disability (i.e., having a physical, emotional, developmental, or behavioral condition that affects the way care is provided). We first conduct multiple regression to assess the associations between the focal CCDF policies and child care outcomes. Difference-in-difference-in-differences will be employed to estimate the effects of the focal CCDF policies on child care outcomes for low-income children with disabilities. We disaggregate the sample for analysis by child age – 0-5 years and school-age.

Results: Among 0 through 5-year-olds, children with disabilities were in any child care at a higher rate (36.14%) than children without disabilities (27.65%; p<0.05). The rates among school-aged children were similar regardless of disabilities (14.34% and14.89%). The average weekly cost of care for children aged 0-5 with disabilities ($44.82) was lower, compared to $59.40 for children without disabilities (difference was at the marginal level, p=0.10). By contrast, the average weekly cost of care for school-aged children with disabilities ($38.84) was higher than the average cost for those without disabilities ($28.34; p=0.09). In terms of the focal CCDF policies, in 2012, 26 states prioritized/guaranteed subsidies for children with disabilities, and 31 states provided differential payments for providers caring for children with disabilities. In 2019, the numbers of states increased to 29 and 36, respectively. Our next steps will estimate the effects of the focal CCDF policies on utilization of paid care and full-time care and on the weekly cost.

Conclusions and Implications: As states consider how to best support the underserved population of children with disabilities, findings from the current study provide insights into how CCDF policies can improve access to affordable and appropriate child care for families of children with disabilities.