Paid Leave for Personal and Family Illness: Impacts of State Policy Design on Coverage and Access by Race, Gender, and Education Level.

Context: Paid leave for serious personal and family illnesses can significantly improve health outcomes. With no federal paid family and medical leave (PFML) policy, states are increasingly adopting their own. Yet eligibility criteria for paid leave and job protection, alongside benefit adequacy, vary markedly across states, affecting coverage and equity.

Methods: We developed a database of state-level paid leave policies to systematically analyze each state's eligibility criteria for leave and job protection. We applied the policy database's detailed criteria to employment data from the U.S. Current Population Survey Annual Social and Economic Supplement to analyze eligibility by race/ethnicity, gender, and education. We measured benefit adequacy by analyzing whether family income would drop below the federal poverty threshold during a worker's leave.

Findings: Minimum earnings, tenure, and hours rules disproportionately exclude workers with less education and women from paid leave and/or job protection. Minimum firm size disproportionately excludes workers with less education and Latinx workers from job protection. Black and Latinx workers' family income is more likely to fall below poverty during leave.

Conclusions: State-level PFML has expanded coverage in the absence of a federal policy. Lowering or eliminating minimum firm size, tenure, and hours requirements; raising wage replacement rates; and ensuring full job protection would reduce remaining gaps and inequities.