Explainer: Paid and Unpaid Leave Policies in the United States

State paid leave programs are or will soon pay benefits to virtually all workers in 13 states—California, Colorado, Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, and Washington—and the District of Columbia when a qualifying need arises. [1] 2024 will be the first full year of operation for programs in Oregon and Colorado.

More detail about the benefits available and funding streams for comprehensive state paid leave programs can be found in our companion piece: Paid Leave Benefits and Funding in the United States.

The COVID-19 pandemic proved the value of state paid family and medical leave programs, which cover a comprehensive range of personal and family medical and care needs. And it demonstrated the massive shortcoming in current U.S. federal policy, the Family and Medical Leave Act of 1993 (FMLA), which guarantees job-protected but only unpaid leave to a limited share of the workforce.

In 2020, Congress enacted limited, temporary (and now expired) paid sick and family leave measures to address COVID-19 related illness and care needs for some workers. The nation’s first-ever permanent comprehensive paid family and medical leave program was included in the Build Back Better Act, which passed the House of Representatives in November 2021, but negotiations over this landmark legislation—which also included child care and home- and community-based care investments—stalled in the Senate. As 2024 begins, federal lawmakers have yet to enact a permanent national paid family and medical leave policy despite overwhelming public support and the country’s enduring need, but states have created new programs and more states are likely to continue to innovate.

Since 1993, the Family and Medical Leave Act (FMLA) has guaranteed eligible workers up to 12 weeks away from their jobs to care for a seriously ill or injured parent, spouse, or child; to address their own serious health issue; or to care for a newborn, newly adopted, or newly placed foster child. [2] In the late 2000s, Congress amended the FMLA to cover two types of military caregiving leave: up to 26 weeks to care for a wounded service member by a parent, child, spouse or next of kin, and up to 12 weeks for circumstances related to the deployment of a parent, spouse, or child. Despite proposals to expand access to the FMLA, Congress has not expanded the law since 2009.

The FMLA only provides unpaid leave to about 56 percent of the workforce due to exclusions based on business size and worker tenure; many workers’ inability to take leave without pay further limits eligible workers’ access. Workers who are paid low wages, single parents, rural workers, and Latine workers are less likely to be eligible for FMLA leave than other workers. But even with these barriers, as of the beginning of 2022, the FMLA was estimated to have been used more than 300 million times in its 29 years.

According to the U.S. Department of Labor’s most recent FMLA usage survey, 15.3 percent of the workforce takes leave for an FMLA-qualifying reason annually. Based on workers’ experiences in 2018, about half of all leaves workers take each year are for a serious personal medical issue (51 percent), one-fourth of all leaves are to care for a new child or address pregnancy-related needs (25 percent), one-fifth (19 percent) are to care for a seriously ill, injured, or disabled parent, spouse, or child or due to the deployment of a service member in the family, and 5 percent are to care for a family member not currently covered by the FMLA (for example, a grandparent, grandchild, sibling, or other extended family members).

The share of workers who need FMLA-type leaves far exceeds the share who are actually able to take leave to provide or receive care. In 2018, 6.9 percent of workers said they needed an FMLA-type leave but did not take it. This is a significant increase from 2012 when 4.6 percent of workers reported forgoing a needed leave. In each year, the most common reason people cited for not taking a FMLA-type leave they needed was their inability to afford unpaid leave (66 percent in 2018; 46 percent in 2012).

To build on the FMLA, 13 states plus the District of Columbia (DC) have or will soon have paid family and medical leave programs in place, which offer partial wage replacement to workers in businesses of all sizes. Each use of paid family and medical leave represents a parent who was able to care for a new child, a person who could get care for their own serious health issue without losing all of their pay, or a working family member able to care for a loved one.

Programs in nine of these states (California, Colorado, Connecticut, Massachusetts, New Jersey, New York, Oregon, Rhode Island, and Washington) and DC are fully implemented and paying benefits now, and have collectively been used millions of times.

Programs in Delaware, Maine, Maryland, and Minnesota will begin collecting taxes in 2024 (Maryland) or 2025 (the others); Delaware, Maryland, and Minnesota will begin paying benefits in January 2026 and Maine will follow in May 2026.

Legislation in California (passed in 2002, implemented in 2004), New Jersey (passed in 2008, implemented in 2009), Rhode Island (passed in 2013, implemented in 2014), and New York (passed in 2016, implemented in stages from 2018 through 2021) each added paid family leave benefits as a complement to long-standing temporary disability insurance that workers could use for wage replacement during a leave from work to address their own serious health condition, including pregnancy. Each of these programs’ laws have been updated one or more times since initial passage to better reflect workers’ needs.

In 2017, Washington state and DC each passed new programs that were implemented in 2020. Despite launching during a global pandemic, each of these programs’ have successfully served workers and have expanded their reach since initial passage.

In 2018, Massachusetts passed a program that went into effect in two stages in 2021: Massachusetts began making available benefits for personal medical needs, military leave, and caring for new children on January 1; and family caregiving benefits became available on July 1.

In 2019, Connecticut and Oregon adopted new programs. Connecticut’s program began collecting premiums in January 2021, accepting applications in December 2021, and paying benefits in January 2022. Oregon’s program began collecting premiums on January 1, 2023, and began paying benefits on September 3, 2023.

In 2020, Colorado became the first state to pass a paid leave program at the ballot by voter initiative. Premium collection began on January 1, 2023, and benefits became available on January 1, 2024.

In 2022, both Maryland and Delaware adopted new programs. Maryland’s program will begin collecting revenue in October 2024 and paying benefits in January 2026. Delaware’s program will begin collecting revenue in January 2025 and paying benefits in January 2026. [3]

In May 2023, Minnesota adopted a new program. Minnesota’s program will begin collecting revenue and paying benefits on January 1, 2026. Minnesota will be able to start benefits at the same time as the state begins collecting payroll contribution premiums, rather than collecting premiums first, by making general revenues available for benefits for a limited period of time.

In July 2023, Maine adopted a new program; the program was passed as part of a budget agreement and start-up funds will become available in October 2023. Maine’s program will begin collecting revenue in January 2025 and paying benefits in May 2026.

Reasons for Using State Paid Leave Programs

In most states, as with the federal unpaid leave program, personal medical leave is the most common reason workers use state paid leave programs, followed by caring for a new child through birth, adoption, or foster placement and caring for a family member.

In California, New Jersey, and Rhode Island, where temporary disability insurance programs that provide paid medical leave have been in place for decades, between two-thirds and 80+ percent of all leave claims are filed for personal medical needs, including pregnancy and recovery from childbirth. In states that created programs from scratch, personal medical leave tends to be between 53 and 63 percent of all claims, with the exception of DC, where medical leave utilization has been lower. Bonding with a new child accounts for between just over 10 percent of all claims (Rhode Island) and two-thirds of filed claims (DC), with one-quarter to one-third most typical. [4]

Family care leave is underutilized, relative to expected need and to the FMLA; this may be because of waiting periods in some states, workers’ lack of awareness, the use of leave in short enough increments that the paperwork of applying for state paid leave may seem onerous, or other practical reasons.

The COVID-19 pandemic shows the utility of paid leave programs in a crisis. An Urban Institute analysis of California and Rhode Island state paid leave claim data from the first months of the COVID-19 pandemic concludes that these states’ programs were able to absorb a surge of new claims, making financial relief available to working families quickly and without unexpected costs on working people or their employers. Researchers from Stanford University, Columbia University, and the University of Virginia studying business impacts during the pandemic found increased support among small businesses for public paid leave programs.

State Paid Leave Utilization Rates

Program data show that a small share of workers use state paid leave programs each year, negating any concerns often raised about overuse. Even in the midst and aftermath of a global pandemic, leave-taking rates ranged from less than 3 percent of workers to just over 5 percent of the workforce in all but one state (Rhode Island), where disability claims drive higher overall workforce leave-taking rates. [5] This is consistent with American Enterprise Institute-Brookings Institution utilization rate estimates in the three longest-standing paid leave states, California, New Jersey, and Rhode Island in 2016 to 2017.

Moreover, a growing body of research shows that paid family and medical leave is associated with greater workforce retention for new mothers; women providing care to loved ones, including new research related to caregiving for spouses; and workers with their own serious health issues such as cancer.

State Paid Leave Duration

State paid family and medical leave programs offer workers time away from their jobs for a period of weeks or months. With the exception of new parents, especially women, who do tend make full use of the time available to bond with a new child, most workers do not take the full amount of time available to them—rather, they use the period of time they need to address their particular family or medical need and return to work expeditiously.

In California, New Jersey, New York, and Rhode Island, paid leave types are separated into two “buckets”: state temporary disability insurance (TDI) for personal medical leave; and paid family leave (PFL) for new child and family care. These states’ TDI programs have been in effect for decades. They provide between 26 weeks (New Jersey and New York) and 52 weeks (California) for people who need time away from their jobs to address a serious personal health issue, including pregnancy. Workers who use TDI typically use about one-third or less of the time available: between 10 and 16 weeks. PFL programs in these four states complement TDI and offer PFL for between six weeks (Rhode Island—an increase in 2023 from an original four weeks, and five weeks in 2022), eight weeks (California—an increase from the state’s original provision of six weeks), and 12 weeks (New York, which scaled its duration over time as the program phased in, and New Jersey, which originally offered six weeks).

Washington was the first state to build a new program. Washington provides 12 weeks for parental leave or family care and 12 weeks for personal medical leave, with an additional two to four weeks available to people who have complications related to pregnancy, up to 16 or 18 combined weeks for all purposes in one year. Washington also allows parents grieving the loss of a pregnancy to take seven days of leave without a waiting period, as of January 1, 2023.

The District of Columbia also built and implemented a new program, which began providing benefits on July 1, 2020, but only for a limited number of weeks (eight weeks for new parents, six weeks for family caregivers, and two weeks for a worker to address their own serious health condition). The duration of leave available through DC’s program has been expanded twice since and, since October 1, 2022, DC provides up to 12 weeks for workers caring for a new child, a seriously ill or injured loved one, or their own serious health issue, with an additional two weeks for prenatal care.

Massachusetts’ program, effective in 2021, provides workers up to 26 weeks per year, which can be combined across multiple needs. Uses include up to 20 weeks for workers who need to address their own serious health issue; up to 12 weeks for leave to care for a family member or a newborn, newly adopted, or newly placed foster child; and up to 26 weeks for leaves related to care needs arising from a loved one’s military deployment. Beginning in late 2023, an amendment to the Massachusetts law means the commonwealth joins most other states in permitting employees to use their employer-provided paid leave benefits to “top off” their state provided paid leave benefits.

Connecticut’s program began providing benefits on January 1, 2022. It offers workers’ benefits for up to 12 weeks (with two additional weeks available for people with pregnancy complications) to care for a new child, a loved one with a serious health issue, their own serious health issue, a family or personal domestic violence situation, or circumstances related to a loved one’s military deployment.

Oregon’s program began paying benefits in September 2023. It offers workers’ benefits for up to 12 weeks (with two additional weeks available for people with pregnancy complications) to care for a new child, a loved one with a serious health issue, their own serious health issue, or a personal domestic violence situation.

Colorado’s program began providing benefits on January 1, 2024. It offers workers’ benefits for up to 12 weeks (with two additional weeks available for people with pregnancy complications) to care for a new child, a loved one with a serious health issue, their own serious health issue, a family or personal domestic violence situation, or circumstances related to a loved one’s military deployment.

New programs in Maine, Maryland, and Minnesota will provide a base level of 12 weeks of paid leave. Colorado and Oregon allow extra time for pregnancy-related health issues; Maryland and Minnesota each allow workers who have both a personal health need and a family care need in a single year to access additional time, up to a maximum combined 24 and 20 weeks per year, respectively. In Delaware, new parents will be able to access up to 12 weeks of paid parental leave; people with family caregiving needs or personal health issues have six weeks available in a 24-month period.

State Paid Leave Family Caregiving Coverage

Each state program except one recognizes a wide range of family members for whom workers may take leave to provide care and expands substantially on the FMLA’s parent, spouse, and child limitations on family caregiving. All but one includes grandparents; all but two include siblings; all but three include adult children and grandchildren. Parents-in-law are also included in all but three. Five of the newest laws and an expansion to New Jersey’s law include people who are related to the worker by blood or affinity, or “a significant personal bond,” (commonly referred to as “chosen family”)—a provision of particular importance to LGBTQ+ people, Black and Latine families, and people with disabilities and their caregivers. Minnesota includes similar language, allowing family caregiving to be provided by “an individual selected by the incapacitated person.”

In sum, state paid family and medical leave programs expand substantially on FMLA by providing pay, additional coverage for caregivers and, in some cases, longer leave durations. State programs, which are run in a sustainable, affordable way, provide strong models as federal lawmakers consider crafting a permanent national paid family and medical leave program.

New America’s Naomi Morduch Toubman assisted with the creation of graphics for this brief. Former Better Life Lab staff, including Haley Swenson, Jahdziah St. Julien, and former intern, Leah Crowder, assisted with the development of an earlier version of this explainer.

[1] Two other states, New Hampshire and Virginia, created voluntary programs beginning in 2023. New Hampshire’s program covers state employees and gives private employers the opportunity to purchase private insurance at insurer-set rates to cover six weeks of paid family and medical leave at 60 percent of a worker’s usual pay; workers whose employers do not choose to purchase insurance are able to buy a private insurance product on their own for no more than $5 per week. Employer enrollment in the program’s first year was extremely low; a second year of practice will provide more insights into the effectiveness and reach of this approach. Vermont launched a similar program in July 2023 for state workers; in July 2024, the Vermont program will also enroll private employers who choose to participate and individuals will be allowed to enroll on their own in July 2025.

In addition, in 2022, Virginia authorized its State Corporation Commission’s Bureau of Insurance to approve the sale of family leave insurance products in the state; as of this writing in December 2023, only one insurer has applied to offer a family leave insurance product. In 2023, five states, Alabama, Arkansas, Florida, Tennessee, and Texas, passed similar laws based on an insurance industry model bill. These approaches are discussed in slightly more detail at the end of our companion piece: Paid Leave Benefits and Funding in the United States.

[2] Leave for one’s own serious health issue leave requires hospitalization or an incapacity lasting three or more days and continuing care by a health provider.

[3] Maryland’s program was initially set to begin collecting contributions in October 2023 and begin paying benefits in January 2025; the bill had passed in a veto override vote in 2022 and the outgoing administration did not make as much progress as was needed to meet this timeline. In May 2023, Governor Wes Moore signed legislation making some adjustments to the program and providing for a longer implementation timeline. See Maryland SB 828. This explainer presents the details of the program as amended.

[4] Program claims data used for these calculations are for the most recent full year where available, or the most recently available year, based on approved claims (for New Jersey, this is 2021; for Rhode Island, this is 2022; for DC, this is FY 2022, which ran from October 2021 through September 2022). New York does not report TDI take up for personal medical issues. Sources used are:

• California (Paid Family Leave and Disability Insurance)
• New Jersey
• Rhode Island
• New York
• Washington
• District of Columbia (Q.140 Chart)
• Massachusetts
• Connecticut

[5] Estimated share of the workforce using paid family and medical leave is based on the number of approved claims from sources cited in Note 3 divided by the number of employed people in the civilian workforce, where programs cover some public sector workers, or the private sector, where programs only cover private sector workers. Employment data for some states (California, New Jersey, Rhode Island, Massachusetts, and Connecticut) is likely to slightly overestimate the number of employed covered workers because of only partial or inconsistent coverage of public sector workers. In addition, the lack of wage or eligibility information for employed workers adds some additional amount of uncertainty to these estimates. Employment estimates were taken from the midpoint of the time period for paid leave claims, with sources and dates as follows:

• California: January 2023 (Note: non-farm civilian labor force currently employed, likely overestimate of covered workers due to inconsistent coverage of public sector)
• New Jersey: July 2021 (Note: employed people, likely an overestimate due to inconsistent coverage in the public sector, also during the pandemic)
• Rhode Island: July 2022 (Note: overestimate of covered workers due to inconsistent coverage of public sector workers for TDI)
• New York (Note: covered workers included in the PFL report, slide 3)
• Washington: January 2023
• District of Columbia: March 2022 (Note: estimate of private sector employment since no public sector workers are covered by the program)
• Massachusetts: January 2023 (Note: likely overestimate due to inconsistent coverage of public sector workers)
• Connecticut: January 2023 (Note: non-farm civilian labor force; likely overestimate due to inconsistent coverage of public sector workers)