Explainer: Paid and Unpaid Leave Policies in the United States
Federal FMLA and State Paid Leave Program Purposes, Utilization, Duration and Family Care Coverage
May 25, 2023
**This document has been updated multiple times since its original publication in June 2021 to reflect newly passed state paid leave programs, new data on state programs and modified duration and family caregiving coverage. It will continue to be updated periodically as new information is available.**
State paid leave programs are or will soon pay benefits to virtually all workers in 12 states—California, Colorado, Connecticut, Delaware, Maryland, Massachusetts, Minnesota, New Jersey, New York, Oregon, Rhode Island, and Washington—and the District of Columbia when a qualifying need arises. Minnesota's program is the most recently enacted program in May 2023. 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. An 2023 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. More states are likely to continue to innovate in 2023.
Family and Medical Leave Act
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. 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 a 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).
State Paid Family and Medical Leave Programs
To build on the FMLA, 12 states plus the District of Columbia (D.C.) 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. Programs that are currently fully implemented and paying benefits in the seven states and D.C. have been used millions of times. Each use 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.
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, the state of Washington and D.C. 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; 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 will begin paying benefits in September 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 will become 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.
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.
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 70 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 50 and 60 percent of all claims, with the exception of D.C., where medical leave utilization in the program's first 18 months was much lower (possibly because of the COVID-19 pandemic). Bonding with a new child accounts for between one-sixth (Rhode Island) and two-thirds of filed claims (D.C.), with one-quarter to one-third most typical.
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 studied 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 of a global pandemic, leave-taking rates in states where full-year, comprehensive data is available show that workers' leave-taking rates range from less than 3 percent of workers to about 6 percent of the workforce across states. 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 2016-2017.
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, 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 originally, and five weeks in 2022 ), eight (California—an increase from the state's original provision of six weeks), and 12 (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-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 D.C.'s program has been expanded twice since and, since October 1, 2022, D.C. 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 pre-natal 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.
Connecticut's program began providing benefits on January 1, 2022. It offers 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 Colorado, Oregon, 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 6 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 four. Three of the newest laws and an expansion to New Jersey's law include people who are related to the worker by blood or affinity (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.
 Two other states, New Hampshire and Virginia, have created voluntary programs that may make it easier for employers to offer paid leave 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 provide 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. Whether and how this meets New Hampshire workers' and employers' needs remains to be seen. Vermont is slated to launch a similar program beginning later in 2023.
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 May 2023, only one insurer has applied to offer a family leave insurance product. In 2023, three states (Arkansas, Florida, and Tennessee) have passed similar laws based on an insurance industry model bill, and Texas has sent a bill to the governor. These approaches are discussed in slightly more detail at the end of our companion piece: Paid Leave Benefits and Funding in the United States.
 Leave for one’s own serious health issue leave requires hospitalization or an incapacity lasting 3 or more days and continuing care by a health provider.
 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 history here: https://mgaleg.maryland.gov/mgawebsite/Legislation/Details/SB0828. This explainer presents the details of the program as amended.
 Program claims data used for these calculations are for the most recent full year (except in Connecticut, which started in 2022). New York does not report TDI take up for personal medical issues. Additionally, not every state reports approved claims by reason for leave; where this data was unavailable, filed claim data is used instead. Sources used are:
- Calif.: https://edd.ca.gov/siteassets/files/about_edd/pdf/qsdi_di_program_statistics.pdf & https://edd.ca.gov/siteassets/files/about_edd/pdf/qspfl_pfl_program_statistics.pdf
- N.J.: https://nj.gov/labor/myleavebenefits/assets/pdfs/TDI%20Summary%20Report%20for%202020.pdf & https://nj.gov/labor/myleavebenefits/assets/pdfs/FLI%20Summary%20Report%20for%202020.pdf
- R.I.: https://dlt.ri.gov/media/15961/download?language=en
- N.Y.: https://www.dfs.ny.gov/reports_and_publications/pfl
- Wash.: https://esd.wa.gov/labormarketinfo/paidleave/claims-data (calculations from this dataset)
- D.C.: https://dccouncil.gov/wp-content/uploads/2022/02/DOES-POH-2022-Submission-1-Workforce-and-PFL-Attachments-retry.pdf
- Mass.: https://www.mass.gov/doc/fy2022-dfml-annual-report/download
- Conn.: http://www.cbia.com/wp-content/uploads/2022/07/CTPL-Annual-Report.pdf.
 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 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 (CA, NJ, RI, MA and CT) is likely to slightly overestimate the number of employed covered workers because of only partial/inconsistent coverage of public sector workers. In addition, the lack of wage/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:
- Calif.: https://edd.ca.gov/en/about_edd/news_releases_and_announcements/unemployment-january-2022 (Jan. 2022, non-farm civilian labor force) (likely overestimate of covered workers due to inconsistent coverage of public sector)
- N.J.: https://data.bls.gov/timeseries/LASST340000000000005?amp%253bdata_tool=XGtable&output_view=data&include_graphs=true (July 2020) (likely overestimate of covered workers due to only partial coverage for public sector workers for TDI)
- R.I.: https://data.bls.gov/timeseries/LASST440000000000005?amp%253bdata_tool=XGtable&output_view=data&include_graphs=true (July 2021)
- N.Y.: https://www.dfs.ny.gov/reports_and_publications/pfl (covered workers included in the NY PFL report)
- Wash.: https://media.esd.wa.gov/esdwa/Default/ESDWAGOV/labor-market-info/Libraries/Economic-reports/MER/MER%202022/MER-2022-01.pdf (January 2022)
- D.C.: https://does.dc.gov/sites/default/files/dc/sites/does/page_content/attachments/DC%20Labor%20Market%20Indicators_March2021.pdf (estimate of private sector employment since no public sector workers are covered, March 2021)
- Mass.: https://www.mass.gov/news/massachusetts-unemployment-and-job-estimates-for-january-2022 (January 2022) (likely overestimate due to inconsistent coverage of public sector workers)
- Conn.: https://www1.ctdol.state.ct.us/lmi/ctnonfarmemployment.asp (March 2022, non-farm civilian labor force) (likely overestimate due to inconsistent coverage of public sector workers).