The child care workforce holds demanding jobs that take a toll on their physical and mental health. Yet because of low wages and high rates of uninsurance, many cannot access essential health care benefits.

The District of Columbia’s HealthCare4ChildCare (HC4CC) initiative is a trailblazing public investment in health insurance affordability for early childhood education providers and their staff. HC4CC addresses a longstanding need for affordable health insurance among the child care workforce. It is one piece of a larger landmark compensation improvement initiative, the Early Childhood Educator Pay Equity Fund, which aims to promote competitive compensation for the early childhood workforce, including salaries and benefits, relative to DC public school teachers with equivalent roles and credentials.

About the Study

Funded by the Bainum Family Foundation, this study examines the design, implementation, and early outcomes of HC4CC. Using a sequential mixed-methods design, we highlight major opportunities, challenges, and participant trends.

Our case study includes information from the following:

• interviews with key informants, including leaders, advocates, and HealthCare4ChildCare implementation partners
• interviews with child care program directors
• analysis of administrative data from the initiative
• analysis of public Performance Oversight reports

Study publications describe the history of HC4CC, its implementation from January 2023 to June 2025, current participation patterns and experiences, perspectives on early outcomes, and future goals. Findings can inform DC and jurisdictions nationwide as they design and implement compensation improvements for the child care workforce.