The State of Paid Family and Medical Leave in the U.S. in 2023

Category: Work Injuries

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Explore this guide to workplace leave laws in the United States.


Today in the United States, workers are not guaranteed a single paid day off by federal law, and many aren’t even entitled to unpaid time. The Center for American Progress presents a series of fact sheets explaining the three major types of laws that give workers rights in relation to workplace leave. This fact sheet addresses paid family and medical leave laws.

Paid family and medical leave can include:

  • Medical leave, which covers a worker’s own serious health condition.
  • Parental leave, which covers bonding with a new child. Parental leave may also be referred to as maternity leave, paternity leave, or bonding leave.
  • Caregiving leave, which covers caring for a loved one with a serious health condition.
  • Deployment-related leave, which covers needs in connection with a loved one’s current or impending active-duty military service, such as making legal or financial arrangements, attending official military events, or being with a loved one home from service on a short-term leave.
  • Safe leave, which covers needs when a worker or their loved one is a victim of sexual or domestic violence, such as seeking a restraining order or relocating to safety.

Defining ‘serious health condition’

Under the federal Family and Medical Leave Act, a serious health condition is an illness, injury, or other medical condition that requires either inpatient care or ongoing treatment by a health care provider.1 Serious health conditions can include acute conditions such as cancer or a stroke, chronic conditions such as asthma or diabetes, and recovery from serious injuries or accidents, as well as both physical and mental conditions. State laws vary in their exact definitions, but most use definitions similar to federal law.

Who has paid family and medical leave?

Within paid medical leave, short-term disability insurance is an important source of pay for workers taking extended time off from work for health reasons. According to the U.S. Bureau of Labor Statistics, 43 percent of the private sector workforce has access to short-term disability coverage through their employer. In other words, a majority—57 percent—of private sector employees do not have access.2

Access to short-term disability coverage is not evenly distributed. For example, only about 1 in 10 of the lowest 10 percent of earners have access to short-term disability coverage.3 Similarly, only about 1 in 5 part-time workers (19 percent) have access to short-term disability coverage through their employers, compared with half (51 percent) of full-time workers.4 Workers in industries with large numbers of low-income workers are also less likely to have access to short-term disability through their employers. Service workers (23 percent),5 leisure and hospitality workers (19 percent), and accommodation and food service workers (19 percent) are all about half as likely to have access as the private sector workforce as a whole.6

Most—though not all—private sector employees have access to at least some paid sick time through their employer, which could cover a serious health condition. However, most do not have enough paid sick time to cover an extended illness or injury. In 2021, private sector workers with paid sick time received an average of seven days per year7—not enough to cover lengthy recovery from surgery or repeated absences due to medical treatments such as chemotherapy.

Regarding paid family leave, the Bureau of Labor Statistics shows that only about 1 in 4 employees (24 percent) in the private sector workforce have access to paid family leave. More than 3 in 4 (76 percent) private sector employees do not have access to paid family leave.8

As with short-term disability insurance, access to paid family leave is not evenly distributed. Among the lowest 10 percent of earners, only about 1 in 20 (6 percent) have access to paid family leave.9 Just 12 percent of part-time workers have paid family leave, compared with a still low 28 percent of full-time workers.10 Many industries also have paid family leave coverage rates that are notably lower than that of the private sector workforce as a whole, including construction (12 percent), leisure and hospitality (10 percent), accommodation and food service (10 percent), and transportation and warehouse work (9 percent).11

What laws provide paid family and medical leave?

No U.S. federal law provides a right to paid family or medical leave. However, important proposals have been advanced, such as one that passed in the U.S. House of Representatives as part of the Build Back Better Act,12 building on the long-standing proposal for the Family and Medical Insurance Leave (FAMILY) Act.13

Eleven states have passed paid family and medical leave laws: California,14 Colorado,15 Connecticut,16 Delaware,17 Massachusetts,18 Maryland,19 New Jersey,20 New York,21 Oregon,22 Rhode Island,23 and Washington state,24 along with Washington, D.C.25

New Hampshire has enacted a voluntary law that provides paid leave only to private sector employers or employees who opt in by purchasing coverage, with guaranteed coverage for state employees.26 Vermont’s governor has taken a similar approach.27 Unlike the states listed above, New Hampshire and Vermont do not legally guarantee workers the right to paid leave, only provide a voluntary opportunity to purchase insurance coverage.

Understanding temporary disability insurance

Decades ago, five states passed temporary disability insurance (TDI) laws, which give workers a right to cash benefits when they are unable to work due to an off-the-job illness or injury (meaning one that is not covered by workers’ compensation).28 Of these states, four—California, New Jersey, Rhode Island, and New York—have since built upon these programs to also cover paid family leave needs such as parental and caregiving leave.29 Hawaii still has a TDI law but to date has not expanded it to include family leave needs. For this reason, Hawaii is generally not included in the list of states that have paid family and medical leave laws.

What needs do paid family and medical leave laws cover?

All states’ paid family and medical leave laws provide benefits to workers for:

  • Medical leave to address their own serious health condition.
  • Caregiving leave to care for a loved one with a serious health condition.
  • Parental leave to bond with a new child, for both foster and adoptive parents and for parents of any gender.

Most state paid family and medical leave laws provide deployment-related leave—benefits to address the impact of a loved one’s military deployment. Some also provide safe leave, or benefits to address workers’ additional needs when they or their loved ones are victims of sexual or domestic violence.

What ‘family definition’ means

The term “family definition” refers to the set of loved ones for whom a worker can care under a particular law. Paid family and medical leave and paid sick time laws typically include at least a worker’s child, parent, spouse or domestic partner, sibling, grandparent, or grandchild.30 Many also include other loved ones, including “chosen family”—those a worker considers family but to whom the worker may not have a legal or biological relationship.31

Who do paid family and medical leave laws cover?

Paid family and medical leave laws generally cover all or nearly all private sector (nongovernment) employees in a state; many also cover some or all state and local government employees.32 Except in Delaware, state paid family and medical leave laws cover employers regardless of size, meaning that employers with as few as one employee may be covered. Most state programs allow self-employed workers—including sole proprietors, freelancers, and independent contractors—to opt into coverage voluntarily.33

Workers become eligible for paid benefits by meeting minimum standards in terms of how much they have earned, how long they have worked or been employed, or some combination of both. In most state paid leave programs, workers can combine earnings or time worked from multiple covered employers to meet these requirements. This makes benefits portable, meaning that workers can keep their benefits as they move from job to job or combine multiple sources of income.34 In most programs, workers who otherwise meet the eligibility requirements can receive benefits if they are unemployed or between jobs when they experience a qualifying need. If a state law also provides employment protections (such as the right to get one’s job back), a worker may need to meet additional requirements to be eligible for those protections.

What rights do paid family and medical leave laws provide?

All state paid family and medical leave laws provide the right to cash benefits through an insurance system.

Some, but not all, state paid family and medical leave laws also provide the right to time off from work or related employment protections, including:

  • Right to reinstatement (“job protection”): Several states give employees the right to get their job (or an equivalent job) back following leave for which the employee is eligible for cash benefits under the law.35
  • Right to health insurance continuation: In some states, employees who receive health insurance through their employer are entitled to continuation of that coverage while they are on leave (including that employers continue paying any employer share of the premium).36
  • Protection against discrimination or retaliation: Most states prohibit employers from retaliating or discriminating against employees for exercising their rights under the paid family and medical leave law. This means employers cannot take any negative action, such as firing an employee or writing them up, because the employee used a protected right.37

Different states provide these rights in different combinations. In some states, employees who are eligible for cash benefits under the law need to meet additional requirements to be eligible for employment protections, such as having been employed by their current employer for a certain amount of time.

Those receiving cash benefits through a state paid family and medical leave law may also be eligible for employment protections under other laws, such as the federal Family and Medical Leave Act or similar state laws. However, where employees are not specifically protected by state or federal law, it is possible that they may legally lose their jobs for taking time off from work in connection with receiving cash benefits under a state paid family and medical leave law.

How long can workers receive benefits under paid family and medical leave laws?

Most state paid family and medical leave laws provide at least 12 weeks of benefits.38 Some provide even longer for medical leave (workers’ own serious health needs). Nearly all state programs allow workers to receive more than 12 weeks of benefits under certain circumstances, especially when workers have more than one qualifying need in a year or for those with certain pregnancy-related needs. Depending on workers’ needs and the specific rules in the law, these benefits may be used all at once (continuously) or in smaller blocks over a period of time (intermittently).

How much money do workers receive through paid family and medical leave laws?

Benefits are usually set as a percentage of workers’ own income, known as the wage replacement rate. There are two main ways to set the wage replacement rate:

  • Flat rate: All workers receive the same percentage of their income.
  • Progressive rate: Lower-income workers receive a higher percentage of their income, while higher-income workers receive a smaller percentage of their income, usually on a sliding scale.39

Under all state paid family and medical leave laws, benefits are capped at a maximum weekly amount. Typically, this maximum amount adjusts annually, usually either in proportion to the state’s overall average wages or tied to inflation.

Who pays for paid family and medical leave?

State paid leave laws are insurance systems.40 Employees, employers, or both pay into the system through payroll contributions, typically a percentage of wages, up to a cap.41 Then, when workers need benefits, they make a claim and the insurance system pays them out of those funds, rather than the employer paying out of pocket.

States vary in the exact structures of their insurance systems. Generally, workers are covered through a government-run insurance fund by default. Most states allow employers to receive special permission to provide benefits privately (such as by purchasing a commercial insurance policy), rather than through a state-run fund.42 These private plans must meet strict requirements to ensure they provide benefits at least as generous as the state fund.43

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