Child Care Professionals Need Health Care Access and Paid Leave.

Amanda McDougald Scott, Ph.D.
6 min readOct 1, 2021

Below is my testimony given September 30, 2021 to the Joint Citizens and Legislative Committee on Children (JCLCC)

During the 2020 JCLCC hearings, I shared about a Medicaid Waiver 1115 for child care workers. However, I know that Medicaid access up to 200% of the Federal Poverty Limit would benefit not only child care workers, but also other South Carolinians who are earning low wages. Research indicates that when caregivers for children have access to healthcare, they are able to provide a better environment in which children can thrive…this is applicable to child care workers, parents, guardians, grandparents, and others who care for children1–12.

Agnes, one of the child care professionals from my Participant Action Research study, summed up her thoughts on the importance of benefits, especially health insurance, as the most important thing we talked about and that others needed to know with a very simple statement: “I say the most important is helping ’em with insurance…” 7.

During the pandemic that we are still facing, 48% of South Carolinians remain unvaccinated. The Delta variant is much more contagious than the first variant, and more variants are on their way. As people continue to contract and become ill, hospitalized, or die from COVID, families are left struggling with medical bills. The burden upon the healthcare system is worsened as un-or under-insured patients seek treatment for COVID. Medicaid access would provide much-needed relief for patients, families, and healthcare systems. Children, who rely on adults to care for them and keep them safe, would have more stable environments in which to grow.

Among those un-or under-insured are the child care workers. Child care workers are likely to have caregiving responsibilities both at work and in their homes13. My analysis of the National Survey of Early Care and Education Project Team data showed that 24.3% of child care workers had children at home between 6–12 years of age, while 20.2% had children ages 5 and under at home14. These child care workers need child care while they work, or they cannot get to work, which is something I feel is often overlooked by society. An already-burdened workforce is facing continued resignation and decline in availability of safe child care during the pandemic — which only exacerbates a pre-existing shortage. Recent data from the Center for the Study of Child Care Employment indicates that at least 126,700 child care jobs have been lost since February 2020, and only 88% of the child care jobs that were available in February 2020 still exist. One of the top factors in child care worker retention — that my research and others has shown — is access to employer-sponsored health care7. Many child care centers cannot provide access to health care, which is why — for the sake of our children, families, and economy — Medicaid access must be provided for child care professionals15.

Another factor in child caregiving responsibilities is whether they are allowed to take paid leave. Child care professionals are often not afforded any leave…much less paid leave. Therefore, another critical solution to both providing access to health and retaining child care workers is to provide paid leave. Natalie, a nanny who participated in my study said,

It makes it harder…health insurance is a lot, especially not having like a little helpful stipend in there, or anything. And knowing that we are gonna go on vaca[tion] or if I need to take a sick day, like I’m not gonna get any kind of pay for that-… [I have to be] scheduling everything to make sure that I’ll be able to afford my bills if I need to take an afternoon off to go to the doctor or something.7

Child care workers should not have to choose between caring for others’ children and their own health, children, or basic needs.

During this legislative session, the committee endorsed legislation (H.3560 and S.11) that would provide paid parental leave for state employees and has done an outstanding job in moving it through the legislative process. In the upcoming year, we urge all on the committee to continue a strong push for passage. This is the first step towards what I would like to see — paid leave for all South Carolinians, which would include child care professionals. As you are all aware, paid leave has multiple positive effects on the mental and physical health of both parents and babies16. Research also shows that when we ensure workers have paid leave, we can reduce racial and ethnic disparities in maternal and child health17.

The pandemic has exacerbated pre-existing fractures in our society and system. We can start to make a change moving forward NOW by providing access to health care and safety at work through

1- Medicaid access up to 200% FPL

2- Requiring the provision of paid leave for all South Carolina employees

3- Following basic CDC-approved COVID precautions.

I appreciate your time and attention to these urgent matters, and welcome any questions.


1. Center on the Developing Child at Harvard University. 8 things to remember about child development. 2016.

2. Field T, Hernandez‐Reif M, Diego M, et al. Still‐face and separation effects on depressed mother‐infant interactions. Infant Mental Health Journal: Official Publication of The World Association for Infant Mental Health. 2007;28(3):314–323.

3. Field T, Healy B, Goldstein S, et al. Infants of depressed mothers show” depressed” behavior even with nondepressed adults. Child development. 1988:1569–1579.

4. Hamre BK, Pianta RC. Self-reported depression in nonfamilial caregivers: prevalence and associations with caregiver behavior in child-care settings. Early Childhood Research Quarterly. 2004;19(2):297–318.

5. Institute of Medicine, National Research Council. Transforming the workforce for children birth through age 8: A unifying foundation. Washington, DC: The National Academies Press; 2015.

6. Institute of Medicine. The early childhood care and education workforce: Challenges and opportunities: a workshop report. Washington, D.C.: National Academies Press; 2012.

7. McDougald Scott AM. Examining the Everyday Life of Child Care Workers: How Low Wages and the Lack of Benefits Affect Daily Life, Decisions about Employment, and What They Need You to Know (Unpublished doctoral dissertation). Clemson University, Clemson, South Carolina; 2021.

8. Otten JJ, Bradford VA, Stover B, et al. The culture of health in early care And education: Workers’ wages, health, And job characteristics. Health Affairs. 2019;38(5):709–720.

9. Russell SD, Lyons JD, Lowman BC. The early childhood system in Greenville, availability, quality, and affordability of child care in the year 2001. Chapel Hill, NC: Child Care Services Association; 2002 2001.

10. Whitaker RC, Becker BD, Herman AN, Gooze RA. The physical and mental health of Head Start staff: the Pennsylvania Head Start staff wellness survey, 2012. Prev Chronic Dis. 2013;10:E181.

11. Thomason S, Austin LJE, Bernhardt A, Dresser L, Jacobs K, Whitebook M. At the wage floor. Center for the Study of Child Care Employment (UC Berkeley)

Center for Labor Research and Education (UC Berkeley)

COWS (UW-Madison); May 22, 2018 2018.

12. Whitebook M, Phillips D, Howes C. Worthy work, STILL unlivable wages: the early childhood workforce 25 years after the National Child Care Staffing Study. University of California, Berkeley: Center for the Study of Child Care Employment; 2014 2014.

13. South Carolina Department of Social Services. COVID 19 Vaccination Dashboard. 2021; Accessed September 30, 2021.

14. National Survey of Early Care and Education Project Team. 2019 National Survey of Early Care and Education (NSECE) Preliminary 2019 Workforce data-file and documentation. In. Office of Planning R, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, trans. Washington, DC2020.

15. McDougald Scott AM. Benefits for Child Care Workers: How the State Could Help through a Medicaid Waiver. Journal of Working Class Studies. 2021;6(1).

16. Van Niel MS, Bhatia R, Riano NS, et al. The impact of paid maternity leave on the mental and physical health of mothers and children: A review of the literature and policy implications. Harvard Review of Psychiatry. 2020;28(2):113–126.

17. 1000 Days. Paid Leave: An Opportunity to Reduce Racial and Ethnic Disparities in Maternal and Child Health.1,000 Days.



Amanda McDougald Scott, Ph.D.

Advocate for social justice, mom to a 5-year-old, partner, friend. Political, child care, early childhood, psychology, and health care wonk.