Expanding access to high-quality early care and education for families with low income in Maryland through child care subsidy policies

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Documenting how federal and state child care policies increase equitable access to high-quality early care and education (ECE) for families with low- and moderate-incomes remains a challenge in part due to overlaps in policy enactment. This study used an interrupted time series analysis (ITSA) to describe changes to providers’ participation in Maryland's child care subsidy program following implementation of a constellation of child care policies enacted between January 5, 2015, and March 2, 2020 (i.e., prior to the COVID-19 pandemic). Findings indicate a marked increase in the percentage of licensed family child care (FCC) and center-based providers serving children with a subsidy following increases in household income eligibility levels and provider reimbursement rates in 2018. Provider participation rates varied by neighborhood income level, with participation expanding more in neighborhoods with lower poverty density relative to their starting level in 2015. Changes in child participation rates by income eligibility mirrored changes in state subsidy policy: children residing in income-eligible households above 200 % federal poverty level represented 4.4 % of the child sample in 2018, 13 % in 2019, and 18 % in 2020. The proportion of children with a subsidy who used higher-rated ECE increased significantly between January 2018 and January 2020 for all racial/ethnic groups, income eligibility levels, and urbanicity categories. The majority (62 %) of children who stayed in the subsidy program between 2018 and 2019 stayed with their same provider, many of which obtained their first rating or increased their quality rating during this time frame in accordance with a new requirement for providers to participate in the state's quality rating system to receive a subsidy reimbursement. Implications for future research, policy, and practice are discussed.