Guide to Evaluating Paid Family and Medical Leave Policies

Outreach and communication plans

• Tailored messaging and outreach strategies to reach select populations• Outreach in languages aligned with community needs• Collaboration/coordination with advocacy groups, employers, community leaders, and other interested parties• Plans to communicate policy updates and changes

Consider urban/rural residence: A 2023 scoping review found that people living in rural areas face multiple barriers when seeking public benefits information, including limited internet access, low digital literacy, and transportation challenges.

Budget allocation for outreach and communication

Information and documentation required to apply

• Documentation for need for leave• Documentation of wages

Time required to complete the application

Application accessibility• Options for submission using physical and electronic forms• Accessibility on mobile phones, tablets, and computers• Integration of instructions into application• Availability of translation for application materials, including instructions• Alignment with Accessibility Guidelines (i.e., accessibility features for visual impairment, hearing impairments, mobility or dexterity impairments, cognitive or neurological disabilities, and photosensitive seizure disorders)• Reading level of application materials, including instructions

Consider disability status: A 2021 study found that approximately half (48%) of the most popular federal websites failed an accessibility test on at least one of their three most popular pages.

Extent to which the application process is integrated with other benefits

Customer support available for people applying for this benefit

• Availability via different modalities (e.g., phone, email, chatbot)• Availability in languages aligned with community needs

Information and documentation required for workers to contest eligibility determinations

Time required to complete appeal process

• Time required to submit appeal• State response time

Appeals process accessibility

• Options for submission using physical and electronic forms• Accessibility on mobile phones, tablets, and computers• Integration of instructions into appeal documentation• Availability of translation for appeal materials, including instructions• Alignment with Accessibility Guidelines (i.e., accessibility features for visual impairment, hearing impairments, mobility or dexterity impairments, cognitive or neurological disabilities, and photosensitive seizure disorders)• Reading level of appeal materials, including instructions

Customer support available for people submitting appeals

• Availability via different modalities (e.g., phone, email, chatbot)• Availability in languages aligned with community needs

Disbursement method(s)

• Availability of disbursement method(s) (e.g., paper check, direct deposit, other)• Option for beneficiaries to select preferred disbursement method

Consider banking status: A 2023 study found that 4.2 percent of U.S. households were “unbanked” (i.e., no one in the household had a checking or savings account).

Payment processing time

Customer support available for people receiving this benefit

• Availability via different modalities (e.g., phone, email, chatbot)• Availability in languages aligned with community needs

Outreach and communication plans

• Tailored messaging and outreach strategies to reach employers across a range of geographic locations and industries• Outreach in languages aligned with community needs• Collaboration/coordination with advocacy groups, community leaders, and other interested parties• Plans to communicate policy updates and changes

Consider urban/rural location: A 2023 scoping review found that people living in rural areas face multiple barriers when seeking public benefits information, including limited internet access, low digital literacy, and transportation challenges.  While this review examined barriers experienced by potential beneficiaries, these challenges may apply to employers, too.

Budget allocation for outreach and communication

Administrative requirements for employers (e.g., notify employees of policy using state-provided materials, withhold payroll deductions, submit contributions, verify employee claim information)

Time required to complete administrative requirements

Consider employer size: A 2012 assessment of the impact of paid family leave on New Jersey businesses found that small businesses were more likely to report increased administrative costs as a result of the policy.

Customer support available for employers

• Availability via different modalities (e.g., phone, email, chatbot)• Availability in languages aligned with community needs

Evaluation plan

• Logic model or theory of change• Data sources• Timeline

Budget allocation for evaluation

Groups engaged in decision making on policy implementation

Consider access to employer-provided PFML: Engaging groups with limited access to employer-provided PFML (e.g., low-wage workers; Black and Indigenous workers and workers of color) in making decisions about policy implementation is one way to identify obstacles preventing communities from accessing PFML and ensuring that their needs will be met.

Ways in which interested parties have been engaged (i.e., ignored, informed, consulted, involved, collaborated with, deferred to)

Extent to which interested party feedback has been incorporated into decision making

Extent to which interested parties believe the policy addresses their needs and interests

Adherence to outreach and communication plans

Adjustments to outreach and communications strategies to better reach specific populations

Estimated reach of communication efforts

• Number of views (e.g., ads on social media, print, TV, etc.)• Number of listeners (e.g., ads on radio or streaming services)• Number of in-person contacts (e.g., at community events)• Number of employers that shared materials with employees• Number of downloads of communication resources (e.g., communication toolkits)

Number/percent of people aware of the policy

Number/percent of people with knowledge of the policy’s eligibility requirements and application process

Aspects of the policy that are clear or easy to understand

Aspects of the policy that are confusing or hard to understand

Consider income: A study in California found that only 38 percent of workers who earned less than $15 per hour were aware of the state’s paid family leave policy, compared to 63 percent of workers who earned more than $15 per hour.  Similarly, a survey of mothers in San Francisco found that less than 2 percent of those covered by Medicaid had accurate information about the policy.

Number/percent of employers aware of the policy

Number/percent of employers with knowledge of the policy’s requirements for employers and how to support their employees in accessing the benefit

Number/percent of employers that have shared information about the policy with employees

Aspects of the policy that are clear or easy to understand

Aspects of the policy that are confusing or hard to understand

Number of people estimated to be eligible for the benefit

Number of people who applied for the benefit

Percentage of estimated eligible people who have applied for the benefit

Consider income: A study in California found that, among survey respondents who were aware of the state’s PFML policy but did not apply, nearly one third (31%) reported concerns about low rates of wage replacement.

Consider English language proficiency: Research on the Medicaid redetermination process found that people with limited English proficiency[1] experience challenges reading and completing necessary documentation.

Consider employment type: In 2023, uptake rates of PFML were low among self-employed workers with access to paid leave policies, ranging from 0.1 to 7 percent across five states and the District of Columbia.

[1] The federal Office of Civil Rights defines people with limited English proficiency (LEP) as “Individuals who do not speak English as their primary language and who have a limited ability to read, write, speak, or understand English ...” Source

Number of people who received the benefit

Percentage of estimated eligible people who received the benefit

Percentage of applicants who received the benefit

Length of time for which people receive the benefit

Consider income: The US Bureau of Labor Statistics reported that, in 2021, only 6 percent of workers in the lowest-wage jobs had access to paid leave through their employer.

Reasons applications for the benefit are denied

Percentage of appeals that are successful

Consider sexual orientation and gender identity: A survey conducted with lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in New York City found that one quarter (24%) of respondents experienced challenges with public benefits in the past year. Of those, nearly half (46%) reported challenges applying for benefits, and 40 percent do not think they are receiving the accurate amount of benefits. LGBTQ people face numerous barriers to accessing PFML, including fear of discrimination and leave policies that are not inclusive of LGBTQ families.

Reasons eligible people do not apply for the new benefit

Feedback on the process (e.g., application, eligibility determination, receipt of benefit)

• Facilitators of access/uptake• Barriers to access/uptake

Consider industry: The Rural Health Information Hub reports that migrant and seasonal farm workers face numerous barriers to accessing health care insurance coverage and services. These include language barriers, lack of information on available services, and challenges understanding eligibility requirements.

Consider English language proficiency: Approximately one quarter (24%) of Spanish-speaking adults in immigrant families who applied for a safety net program were never or only sometimes able to find information in their preferred language.

Feedback on the process (e.g., providing information, managing leave administration)

• Facilitators of ensuring access to this benefit• Barriers to ensuring access to this benefit

Consider employer size: A 2012 assessment of the impact of paid family leave on New Jersey businesses found variation in employers’ reported difficulty complying with legal requirements by business size.

Feedback on the administration process (e.g., application review, benefit disbursement, outreach, data management)

• Facilitators of administration• Barriers to administration

Infant mortality rate

(Low) birth weight

Preterm birth rate

Rates of infant rehospitalization

Consider race/ethnicity: The Centers for Disease Control and Prevention (CDC) reports that infant mortality rates are twice as high for Black infants as for White infants.

Adherence to vaccine schedules

Attendance at well-child visits

Cognitive development

General health status

Consider insurance type: 2022 National Immunization Survey data showed that children with private health insurance had vaccination coverage 2.4-38 percentage points higher than those with Medicaid, other insurance, or no insurance.

Consider parental education level: Data from the Medical Expenditure Panel Survey shows that well-child visit adherence is lower for children whose parents have a high school degree or less, compared to those whose parents attended college.

Attendance at postpartum visits

Rehospitalization after birth

Postpartum mood disorders

Blood pressure

Exercise behaviors

Smoking behaviors

Consider race/ethnicity: The CDC reports that Black women and American Indian and Alaska Native women experience the highest rates of hypertensive disorders in pregnancy among racial/ethnic groups.

Consider income: A 2024 study on the relationship between parental leave and postpartum care found that people with lower incomes were at greater risk of not attending a postpartum visit regardless of the length of their parental leave.

Percentage of people initiating breastfeeding

Duration of breastfeeding:

• Average duration of breastfeeding• Percentage of people continuing to breastfeed at 3 months, 6 months, and 12 months

Barriers and facilitators to breastfeeding

Consider race/ethnicity: The CDC reports that fewer non-Hispanic Black infants are breastfed compared with Asian, non-Hispanic White, and Hispanic infants. A 2023 examination of data from the Pregnancy Risk Assessment Monitoring System (PRAMS) found that more than half of American Indian and one quarter of Black women reported not breastfeeding or discontinuing breastfeeding due to concerns about returning to school or work.

Depressive symptoms

Stress

Psychological distress

Ability to cope

Self-esteem

Abusive behaviors

Intimate partner violence

Consider race/ethnicity: A 2005 meta-analysis found that Hispanic and Asian-American caregivers were more depressed than non-Hispanic White caregivers.

Percentage of families experiencing poverty

Percentage of families experiencing food insecurity

Household income

Utilization of public benefits (e.g., Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]; Supplemental Nutrition Assistance Program [SNAP]; Medicaid; Children’s Health Insurance Program [CHIP]; Temporary Assistance for Needy Families [TANF])

Employment:

• Caregiver employment status• Length of employment• Changes to employment (e.g., wages, benefits, schedule)• Use of unemployment benefits

Consider education level: A 2024 study found that New York’s paid family leave policy led to a greater reduction in food insecurity among heads of household with lower education levels than among those with higher education levels.

Consider marital status: A 2019 study using American Community Survey data found that California’s paid leave policy was associated with decreased risk of poverty and increased household income in the year following the birth of a child, particularly for single mothers with lower incomes and less education.

Percentage of families using child care:

• Ages of children (infant, toddler, preschooler)• Type of care (center, home-based)

Consider income: In 2023, the average price for center-based child care for an infant ranged from 7 percent (South Dakota) to 18 percent (Hawaii) of median income for a married couple, and from 23 percent (South Dakota) to 53 percent (Hawaii) of median income for a single-parent.

Families’ experiences accessing child care that meets their needs

Labor force participation of caregivers

Consider gender: The Bureau of Labor Statistics reported that, in 2023, two-thirds (69%) of women with children younger than age 6 participated in the labor force, compared to nearly all (95%) men with similarly aged children.

Implementation costs of state PFML for employers, compared to projected costs of managing leave without the policy

Employee metrics:

• Job satisfaction• Job retention/turnover• Productivity

Employers’ experiences in implementing these policies:

• Benefits• Challenges• Differences for smaller versus larger employers

Consider employer size: A 2012 assessment of the impact of paid family leave on New Jersey businesses and a 2011 article on PFML in California showed some variation in employer experiences by workforce size.

Consider job quality: A study in California found that 83 percent of workers in lower-quality jobs[1] who used paid leave returned to their employer after taking leave, compared to 74 percent of those who did not use the program.

[1] This study defined “high quality” jobs as those that paid more than $20 an hour and provided employer-paid health insurance. “Low quality” jobs were those that did not.