A growing number of states and localities are adopting paid sick leave laws, a trend that has accelerated during the COVID-19 pandemic. However, proposals to enact permanent federal paid sick leave often run into concerns over costs to small businesses and staffing disruptions. As a result, many existing laws and proposals exempt small employers, leaving out 20 percent of more of the workforce. However, research suggests access to paid sick leave carries a host of important benefits for individuals, employers, public health, the economy and government spending. To address cost concerns, we offer a modified version of the reimbursement mechanism used in the Families First Coronavirus Response Act to allow employers to anticipate their paid sick leave costs and access federal reimbursement quickly for above-average costs.