State CCDF Policies and Child Care Access for Families of Children With Disabilities

In school year 2022-2023, the U.S. public school system served 7.5 million children ages 3 to 21 with an identified disability; nationally, 20 percent of children under age 18 (14.5 million children) have a special health care need. While a complex policy landscape supports the families of children with disabilities, the role of policy in improving child care^[1] access for these families is not well understood. The lived reality of many families of children with disabilities is that accessing high-quality child care can be challenging, despite the legal protections guaranteed by the Americans with Disabilities Act. These challenges can negatively impact the developmental trajectories for children with disabilities, as well as their family’s economic well-being.

The primary goal of the Child Care and Development Fund (CCDF) is to make child care subsidies available to eligible families, thereby supporting child care access, child development, and parents’[2] ability to work. Strengthening policymakers’ understanding of how CCDF can achieve this goal for families of children with disabilities stands to not only support this group, but to strengthen the subsidy and child care system as a whole. Furthermore, because of limited funding, states must often make tradeoffs when designing policy. Examining the degree to which state CCDF policies are effective in increasing access to child care for families with children who have disabilities not only informs states’ ongoing efforts to support children and families, but also provides insights into which policy levers could be prioritized to maximize the use of limited funds.

The 2016 CCDF Final Rule introduced a set of optional policies that states could adopt to support child care access for families of children with disabilities. This study examines two of those policy options: 1) prioritizing or guaranteeing a subsidy to these children (i.e., priority status) and 2) offering higher reimbursement rates to providers enrolling children with disabilities (i.e., differential reimbursement rates). We examine how these policies are associated with the use of paid child care, use of full-time child care, and weekly cost of care for families of children with disabilities with household incomes less than 200 percent of the federal poverty level (FPL). First, we employ a pre-post design that examines states that did not have these policies in 2012, comparing changes in outcomes in 2019 between states that implemented the policy following the 2016 Final Rule and those that did not. To provide additional context to the causal analyses, we also examine overall relationships between these two policies and outcomes among all states in 2012 and 2019.

This brief provides an overview of the disability policy landscape and child care, then reviews the methods used in the current study. We conclude with a discussion of the study findings and future research possibilities for the field.

Key findings

• This study did not find a causal relationship between either optional policy type—subsidy prioritization or differential reimbursement rates—and use of paid care or full-time paid care for children with disabilities in households with low incomes.
• Descriptive analyses did, however, identify the following:
• • Children with disabilities were more likely to use paid care than children without disabilities, particularly among children under age 5.
  • Differential reimbursement rates were associated with an increased likelihood of using paid care for children with and without disabilities. The increase was statistically significant for children ages 5 to 13, but not for children younger than age 5.
  • The weekly cost of care was higher for children with disabilities ages 5 to 13 than for children without disabilities. The differential reimbursement rate policy was associated with lower costs for care for this group of children, reducing the cost gap between children with and without disabilities. 

Footnotes

[1] For the purposes of these analyses, the term child care refers to all forms of paid nonparental child care and early education, including centers, home-based, and individual caregiving arrangements.

[2] Family structures vary; the term “parents” is intended to be inclusive of all primary caregivers.