The District of Columbia (DC) is leading the nation in advancing compensation reform for the early childhood workforce. HealthCare4ChildCare (HC4CC) is a key component of these efforts that addresses a critical gap in benefits by offering free or low-cost health insurance to the child care workforce and their families. This report describes the history of HC4CC, its implementation successes and challenges, current participation patterns and experiences, perspectives on early outcomes, and future goals.

Why This Matters

The child care workforce performs essential, physically demanding work and faces daily health risks, yet many lack access to affordable health care. HC4CC is a groundbreaking public investment by DC to expand health insurance coverage for early childhood education providers and their staff.

What We Found

Interview and administrative data analysis document how HC4CC provided a critical benefit to the early childhood workforce in its early years of implementation. Key insights from this mixed-methods case study include the following:

• The DC Health Benefit Exchange Authority overcame initial mistrust, common for any new initiative, to quickly design and implement HC4CC. They conducted extensive outreach and engagement to build understanding and collaborated with other government agencies and community-based organizations to secure trust in the program. Interviewees praised their customer service approach and commitment to continuous improvement.
• HC4CC enrolled 2,331 individuals in its first two years, including early childhood education staff, their spouses, and children. Revenue from a tax on DC’s highest earners funded the bulk of enrollees’ health insurance premiums, with smaller contributions from employers, employees, and federal advance premium tax credits, depending on the enrollment pathway. Most individuals enrolled through a group plan offered by their employer, and most participating employers did not offer health insurance before HC4CC. Four out of five eligible facilities (79 percent) enrolled in HC4CC.
• Key informants and child care providers shared positive perspectives on the early outcomes of HC4CC. They reported that the initiative improved health insurance affordability, enhanced enrollees’ health and well-being and professional identity, empowered employers, and demonstrated positive impact to the DC government.
• HC4CC is funded through FY 2026 but continues to face uncertainty because of budget questions in DC and potential federal policy changes, including changes to the Affordable Care Act and Medicaid. Future research could continue tracking the initiative’s viability and highlight adaptations.

How We Did It

Urban Institute researchers conducted a mixed-method case study of HC4CC. Urban researchers analyzed administrative data and Public Oversight reports and conducted interviews with key informants and child care program directors to describe the early implementation of HC4CC, participation trends, and initial outcomes.