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This Care Workers Recognition Month, advocates across the country are calling for action on policies that support our paid and unpaid caregivers – including paid family and medical leave.

14 states, including the District of Columbia, have already stepped up to implement their own paid leave programs, but the remaining have yet to do so – exacerbating other economic and care challenges, including the rising cost of living, a scarcity of reproductive and maternal health care, and a rising number of aging loved ones to care for.

State-to-state divides on care supports are exacerbated by state abortion bans in the wake of the Dobbs decision overturning Roe v. Wade: States that have taken the lead on providing paid leave are also among the most protective of abortion rights, while no state that has banned or is likely to ban abortion provides paid leave to all workers (and many of the latter are also lagging or backsliding on voting rights and women’s political representation).

Paid and unpaid caregivers urgently need policymakers to invest in care policies – including paid leave – and to ensure we all have the freedom to determine what our family lives are like, from whether and when to have children, to how best to age with dignity. Which states have the most to gain from investments like paid leave? We crunched the numbers in our Paid Leave Means A Stronger Nation fact sheet series – a state-by-state look at the growing need for paid family and medical leave laws.

States with the Lowest Access to Employer Sponsored Paid Family Leave

Most working people in the United States – 73 percent, or 106 million people nationwide – do not have paid family leave through their jobs, but in some states this deficit is even more severe. On average, just 21 percent of civilian workers across the Great Plains (what the Census Bureau calls the West North Region) have employer-provided paid family leave. That includes Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota. Only Minnesota is closing the gap with a state paid leave program, which will go fully into effect in 2026. We hope the rest of the region is taking notes.

States with the Greatest Potential Economic Gains

If we had paid leave for all, far fewer women would be forced to leave the labor force to care for their families or health. In fact, if women participated in the U.S. labor force at the same rate as in Germany and Canada (countries that have paid leave and invest more in caregivers), our economy would benefit from more than $775 billion in additional economic activity each year. To put the power of the policy in perspective, if women in Texas participated in the labor force at the same rate as women in countries with paid leave, there would be an estimated 602,000 additional workers in the state and $19.1 billion more wages earned statewide. (Like so many things in Texas, labor force gains really are bigger there too!) Meanwhile, in Alaska, workers wouldn’t have to swallow the average of nearly $4,000 in wages lost during four weeks of unpaid leave – the highest of any state without paid leave.

States with the Most Breadwinning Mothers of Color

Women of color’s wages are supporting households across the country. The District of Columbia and Wisconsin have the largest share of Black breadwinning mothers, Massachusetts the largest share of Latina breadwinning mothers, and Hawai’i the largest share of AANHPI breadwinning mothers. Unfortunately state-level data for Native American mothers is limited, but nationally 64 percent of Native American mothers are breadwinners – and California, Arizona, and Oklahoma are the states with the largest populations of Native American women in the labor force. However, as a consequence of the United State’s systematic devaluation of their labor, women of color face wide gender wage gaps that make it even harder to take unpaid time off to care for themselves or their loved ones. While D.C., Massachusetts, and California have paid leave laws, women of color in Wisconsin, Hawai’i, Arizona and Oklahoma stand to gain much needed economic security from a program that allows them to afford leave and care for themselves and their loved ones.

States with Aging Populations and Shortages of Direct Care Workers

America’s elder care needs are increasing – by 2040, the number of Americans 65 years and older will grow by 23 percent, including more than two million in Florida, 1.9 million in Texas, nearly 700,000 in Arizona and nearly 600,000 in North Carolina. In addition to supporting unpaid caregivers, guaranteed paid leave would help shore up our direct care workforce by improving the quality of those jobs and allowing paid care workers to attend to their own health and families. State programs like the one in California – the state with the lowest share of nursing homes with care worker shortages – have already been proven to reduce nursing home utilization, and will help recruit and retain care workers. Meanwhile, the state with the most significant shortage of direct care workers in nursing homes, Wyoming, does not have a state paid leave program to help them shoulder the demands of an aging population.

If you’re curious how your state compares on care, check out the rest of our Paid Leave Means a Stronger Nation fact sheets.