Each year, Vanderbilt University’s Prenatal-to-3 Policy Impact Center releases an update on policies that benefit families and children, from conception to age 3.
Tennessee is one of just eight states that has not implemented any of the organization’s core four policies. The state has not expanded Medicaid coverage, does not offer a statewide paid family and medical leave program, does not offer a minimum wage of at least $10 per hour and does not offer a refundable state-earned income tax credit of at least 10 percent.
In addition to those specific policies, the nonpartisan research center — part of Vanderbilt University’s Peabody College of Education and Human Development — also presents eight additional strategies and breaks them down into smaller steps.
Cynthia Osborne
Prenatal-to-3 executive director Cynthia Osborne tells the Scene one change that could have a quick impact for Tennessee families is additional access to affordable child care. While the state succeeds in offering child care subsidies to families who make 85 percent of the state median income or less and recently limited family co-payments, a bill that would change the way reimbursement rates for the subsidies are set failed in the legislature earlier this year.
“That would have a huge impact on really preserving the wages of the families with lower earnings levels to begin with,” Osborne explains.
Another area that saw movement in the past legislative session: doula services. Doulas provide nonclinical emotional, physical and informational support for pregnant people. To meet Prenatal-to-3’s standards, doula services need to be covered by Medicaid, and the state would need to provide funding for doula training. Bills from state Sen. London Lamar (D-Memphis) created a Doula Services Advisory Committee to evaluate both reimbursement and training in 2023, and in 2024 created a maternal health equity advisory committee. Gov. Bill Lee included $1 million in the 2023-24 budget to create a pilot program to try out TennCare doula payment.
Looking at scarcity, cost burden and workforce issues — and how the state will try to dig out of it
The state has not implemented a paid family leave program statewide, but it did begin offering 12 weeks of paid family leave to state employees in 2023.
Though there have been incremental changes, Tennessee is still ranked 49th overall. Meanwhile, its Southern neighbors have changed around it, Osborne says.
“Our role is to provide the educational resources, the information, the data, the evidence about what works, so that others can take it to their state’s elected officials and advocate for change,” Osborne says. “There’s been a lot of progress over the past five years in a lot of states. Unfortunately we have not seen the change in Tennessee that we have seen in other states.”
North Carolina, for example, expanded Medicaid in 2023. Montana — like Tennessee, a state with a Republican-supermajority legislature — recently approved a higher minimum wage and increased the earned income tax credit.
When it comes to evaluating the outcomes of these policies, where Tennessee is strongest is in its percentage of children whose parent lacks parenting support — meaning parental health and well-being are strong. The state is ranked sixth in this category; 10 percent of parents say they lack emotional support, compared to 26.4 percent in the lowest-ranked state. Tennessee’s worst category is the percentage without access to Early Head Start programming — the state is ranked 50th, with 94.5 percent of children lacking access.
One way to measure the difference between states is the center’s policy impact calculator. For example, if a family works and has children in Colorado, that family has access to more than $54,000 in annual resources. If they live in Tennessee, they have a little less than $23,000 in resources to pull from, Osborne says.
Adding insult to injury in Tennessee is the state’s nearly total abortion ban. Around 20 percent of children younger than 3 live in poverty — more babies born means more babies born with economic disadvantage, Osborne points out. The center’s policies are aimed at giving those kids a fair start.
“The point I always try to make is that state policy choices matter,” she says. “The variation across states is huge with regard to what children and their parents have available to help support them, and our state leaders can play a huge role in shaping the future and well-being of our children and therefore our society.”
