Report to the 

Honorable Sander M. Levin, 

House of Representatives 

United States Government Accountability Office

GAO

September 2004 CHILD CARE 

State Efforts to 

Enforce Safety and 

Health Requirements 

GAO-04-786 
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

www.gao.gov/cgi-bin/getrpt?GAO-04-786.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Marnie S. 

Shaul (202) 512-7015 shaulm@gao.gov.. 

Highlights of GAO-04-786, a report to the 

Honorable Sander M. Levin, House of 

Representatives 

September 2004

CHILD CARE

State Efforts to Enforce Safety and Health 

Requirements 

State efforts in the licensing and oversight of child care facilities are 

generally about the same as they were in 1999, except that the median 

caseload of the number of facilities per inspector dropped from 118 to 110 in 

2003, as shown in the figure below. We found that in 2003, 38 states 

exempted all family child care providers from being regulated, compared 

with 39 states in 1999. Most states conducted compliance inspections at least 

once a year, meeting or exceeding the recommended level for all types of 

providers. 

Many states organized inspection staff by geography and used technology in 

many parts of the inspection process. Forty-three states reported assigning 

staff to geographic locations throughout the state. States also assigned staff 

based on specific job task and type of child care facility the staff would 

inspect. Many states used multiple criteria to assign staff. Forty-five states 

reported using technology to assist them with many aspects of licensing and 

enforcement functions, such as maintaining statistics on families and 

providers. 

States have adopted a number of promising practices to assist their child 

care licensing and enforcement activities. These practices include the use of 

technology to streamline licensing and enforcement processes and manage 

parent and provider information, rating systems to aid parents in selecting 

the appropriate child care for their child and to offer providers incentives to 

improve and maintain the quality of their care, and working with other 

organizations to train providers and parents. 

Median Caseload, Number of Facilities per Inspector, 1999 and 2003 

0

40

80

120

Source: GAO analysis of 1999 and 2004 surveys.

Number of facilities

1999 2003

118

110

The federal government requires 

states that receive funds from the 

Child Care and Development Fund 

to establish basic health and safety 

requirements. The federal 

government also requires states 

receiving federal funds for child 

care to have procedures in place to 

ensure that providers being paid 

with grant dollars comply with the 

applicable safety and health 

requirements. Because of the 

significant federal role in paying for 

child care services and 

congressional concerns about the 

way in which states ensure the 

safety and health of children in 

child care settings, we were asked 

to follow up on our prior report, 

Child Care: State Efforts to 

Enforce Safety and Health 

Requirements (GAO/HEHS-00-28, 

Jan. 24, 2000). 

This report (1) identifies changes in 

states’ licensing and enforcement 

activities for various types of 

licensed and nonlicensed providers 

since 1999, (2) describes the ways 

child care licensing agencies 

organize inspection staff and use 

technology, and (3) provides 

examples of promising practices in 

state child care licensing and 

enforcement activities. 

To obtain data, we surveyed state 

licensing officials in 2004 about 

their 2003 activities, interviewed 

experts and made site visits to four 

states—Delaware, Florida, North 

Carolina and Oklahoma. 
Page i GAO-04-786 Child Care Licensing 

Letter 1

Results in Brief 3 

Background 4 

Median Inspection Caseload Size Has Decreased since 1999 

although Caseloads Have Continued to Exceed Recommended 

Levels 9 

Many Inspection Staff Are Organized by Geographic Location, and 

Technology Is Used in Most Parts of the Licensing and 

Inspection Process 14 

Promising Practices in Technology, Rating Systems, and Training 17 

Concluding Observations 24 

Agency and Other Comments 25 

Appendix I Scope and Methodology 26 

Appendix II State Caseloads, Fiscal Years 2003 and 1999 28 

Appendix III State Child Care Licensing Budget and Full-TimeEquivalent Staffing Levels, 1999 and 2003 30 

Appendix IV Frequency of Licensure and Monitoring Visits in the 

States 32 

Appendix V State Survey 38 

Appendix VI Comments from the Department of Health and Human 

Services 46 

Appendix VII GAO Contact and Staff Acknowledgments 49 

GAO Contact 49 

Staff Acknowledgments 49 

Contents 
Page ii GAO-04-786 Child Care Licensing 

Related GAO Products 50 

Tables 

Table 1: Types of Child Care 6 

Table 2: Recommended Practices for Critical Factors in Licensing 

and Enforcement 8 

Table 3: Types of Providers State Licensing Agencies Reported 

They Regulated or Exempted, 1999 and 2003 11 

Figures 

Figure 1: Caseload Ranges for State Licensing Staff, 2003 10 

Figure 2: Thresholds for Regulation, as Represented by Number of 

Children Cared For in Family Child Care, 1999 and 2003 12 

Figure 3: Number of Inspection Visits Per Year, 1999 and 2003 13 

Figure 4: Number of States Using Various Criteria to Assign 

Inspection Staff in 2003 15 

Figure 5: How States Use Technology 16 

Abbreviations 

ACF Administration for Children and Families 

CCDF Child Care and Development Fund 

EBT electronic benefits transfer 

FTE full-time-equivalent 

HHS Department of Health and Human Services 

NAEYC National Association for the Education of Young Children 

NARA National Association for Regulatory Administration 

NCCIC National Child Care Information Center 

NHSPS National Health and Safety Performance Standards 

R&R resource and referral 

TANF Temporary Assistance for Needy Families

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reproduce this material separately. 
Page 1 GAO-04-786 Child Care Licensing 

September 9, 2004 

The Honorable Sander M. Levin 

House of Representatives 

Dear Mr. Levin: 

The need for child care has grown dramatically over the past 25 years. In 

1975, 39 percent of women with children under the age of 6 were in the 

labor force; by 2003 that number had grown to 63 percent. Since 1996, 

federal welfare policies have emphasized the importance of work, and 

more welfare parents than ever before have moved into the workforce. 

The federal government assists the work efforts of parents through the 

Child Care and Development Fund (CCDF), providing $4.8 billion to states 

to help parents pay child care costs and to ensure the health and safety of 

children in child care. More than 1.75 million children are enrolled in 

subsidized care each month. 

To help protect children in child care, states license certain child care 

providers and establish requirements including those focused on health 

and safety. All states set licensing requirements and require some child 

care providers to obtain a license to offer care. However, as allowed, most 

states do not license all types of providers in all child care settings. Both 

licensed and nonlicensed providers are eligible to receive funds from 

CCDF, and the federal government requires states to have plans in place to 

ensure that providers being paid with federal child care funds comply with 

the applicable health and safety requirements established by the states. 

Many of the health and safety requirements states establish are based on 

practices, including inspections, recommended by national organizations.1

To ensure compliance with states’ licensing requirements, states oversee 

those child care providers over which they have authority by engaging in 

 1

These organizations include the National Association for the Education of Young Children 

(NAEYC), which is an organization of early childhood educators dedicated to improving 

the quality of child care programs, and the collaboration of the American Academy of 

Pediatrics, the American Public Health Association, and the National Resource Center for 

Health and Safety in Child Care and the Maternal and Child Health Bureau, Health 

Resources and Services Administration, Department of Health and Human Services, which 

puts out the National Health and Safety Performance Standards.. 

United States Government Accountability Office

Washington, DC 20548 
Page 2 GAO-04-786 Child Care Licensing 

various enforcement activities. The most intense enforcement activities 

occur for licensed providers, the most highly regulated status for 

providers. Licensed providers are typically subject to background checks 

and facilities inspection, provided with technical assistance and training, 

and are subject to sanctions—such as fines and revocation of licenses—

for those who do not meet licensing standards. Licensed providers who 

receive subsidies have the most stringent requirements. For nonlicensed 

providers, states’ laws and policies dictate the extent to which states 

engage in such enforcement activities. Consequently, some nonlicensed 

providers receive less intense oversight than do licensed providers, but are 

still subject to regulation (we will call these regulated nonlicensed 

providers). Still other providers are exempt from state regulation because 

of state law. For example, in certain states child care centers run by 

religious organizations are exempt from regulation. Exempt providers who 

receive federal child care funds must comply with state health and safety 

requirements. Parents can choose among a number of different child care 

settings. Some parents may choose to send their child to a child care 

center, where many children are cared for in a nonresidential setting. 

Other parents may choose a “family” care setting, in which one provider 

cares for a number of children within the provider’s home. 

Because of the significant federal role in paying for child care services, 

some members of Congress raised concerns about the way in which states 

ensure the safety and health of children in child care settings. In 1999, we 

surveyed states to identify the most critical licensing and enforcement 

activities.2

 We were asked to update our 1999 study, and in this report we 

(1) identify any changes in states’ licensing and enforcement activities for 

various types of licensed and nonlicensed providers since 1999, 

(2) describe the ways child care licensing agencies organize inspection 

staff and use technology, and (3) provide examples of promising practices 

in state child care licensing and enforcement activities. 

To address these issues, we conducted a mail survey in 2004, to state 

licensing officials in all 50 states and the District of Columbia, asking 

about their licensing and enforcement policies and practices in 2003. 

Specifically, we asked states to report on the frequency of their 

compliance inspections, background checks, training programs and 

educational requirements for licensing staff, and caseload sizes. We 

 2

GAO, Child Care: State Efforts to Enforce Safety and Health Requirements, 

GAO/HEHS-00-28 (Washington, D. C.: Jan. 24, 2000).
Page 3 GAO-04-786 Child Care Licensing 

achieved a response rate of 98 percent, with 49 states and the District of 

Columbia responding to our survey.3

 We then compared our survey results 

with a mail survey we conducted in 1999 to identify any changes that had 

occurred within the past few years. We also used data from the National 

Child Care Information Center for the number of states exempting family 

child care providers from regulation. In addition, we conducted a 

literature search and interviewed child care licensing experts and state 

and federal officials to gather information about critical licensing and 

enforcement activities occurring within the states. We asked experts to 

identify states that had examples of promising practices in automation, 

training initiatives, rating systems for providers, and enforcement 

practices. We used this information to identify four states—Delaware, 

Florida, North Carolina and Oklahoma—in which we conducted site visits. 

For more details on our scope and methodology, see appendix I. We 

conducted our work between October 2003 and July 2004 in accordance 

with generally accepted government auditing standards. 

Most licensing and enforcement activities for regulated providers 

remained about the same in 2003 as they had been in 1999 except the 

median caseload for inspectors decreased. Almost a quarter of the states 

maintained caseload levels recommended by national organizations 

(75 child care facilities to one inspector), but the number of states with 

particularly high inspector caseloads, over 150 to one, dropped from 17 to 

15, and the median caseload dropped from 118 to 110. About the same 

number of states exempted family child care providers from being 

regulated in 2003 (38) as in 1999 (39). States continued to conduct 

compliance inspections as recommended and to exempt some providers 

from licensing. For example, most states reported conducting compliance 

inspections at least once a year, meeting or exceeding the recommended 

level for all types of providers, and all states provided training for 

providers. However, only 4 states required the 24 hours of training per 

year recommended by national professional organizations. Finally, state 

monitoring of exempt providers continued to be limited in many states to 

distributing information about health and safety requirements and asking 

these providers to certify that they complied with state requirements. 

However, the number of states conducting background checks and 

inspections of exempt providers increased between 1999 and 2003, from 

20 to 37 respectively. 

 3

Maine did not respond. 

Results in Brief 
Page 4 GAO-04-786 Child Care Licensing 

Most states reported organizing inspection staff by geography and using 

technology in many parts of the licensing and inspection process. Fortythree states reported assigning staff to geographic locations throughout 

the state. Nineteen states also reported assigning staff based on a specific 

job task, such as responding to complaints or inspecting a particular type 

of child care facility. Some states used multiple criteria to organize their 

staff. For example, some assigned staff first by geographic location and 

then, within that location, assigned by type of provider. Forty-five states 

also reported using technology to assist them with many aspects of 

licensing and enforcement activities. Those uses most frequently reported 

by states were to maintain statistics on providers (34 states), prepare 

reports (28 states), make and reconcile payments (25 states), and track 

and monitor subsidy use (25 states). 

The 4 states we visited have adopted a number of promising practices to 

assist in their enforcement activities. For example, Florida used 

technology to streamline its licensing and enforcement processes and to 

manage parent and provider information particularly effectively. Florida 

licensing staff used laptops for entering inspection information at the child 

care facility and linked child care-related databases. Three states we 

visited have implemented rating systems that differentiate providers by the 

quality of care they provide: North Carolina, Oklahoma, and Florida. Such 

systems have helped parents choose child care providers by allowing them 

to compare the quality of different providers. In addition, ratings systems 

have offered providers incentives to improve and maintain the quality of 

their care. For example, North Carolina used a five-star rating system, 

which reimbursed providers that had more stars (indicating higher levels 

of quality) at higher rates for subsidized children than providers with 

fewer stars. Promising practices were also seen in training programs for 

providers and parents in Delaware, Oklahoma, and North Carolina, which 

had in common statewide systems of interconnected partnerships between 

state and community agencies to ensure quality child care and alignment 

of their training programs with state standards and requirements. 

States are responsible for developing licensing criteria and health and 

safety requirements and conducting enforcement activities to ensure 

providers comply with them and thereby protect the safety and health of 

children in child care settings. While the federal government’s role is 

limited in this area, the states must certify that they have safety and health 

requirements in place and procedures to ensure providers comply with all 

applicable requirements to receive federal CCDF funds. The Department 

of Health and Human Services (HHS) oversees CCDF. 

Background 
Page 5 GAO-04-786 Child Care Licensing 

In fiscal year 2003, the amount of federal funds appropriated for CCDF 

was $4.8 billion.4

 The CCDF funds are provided to states through a block 

grant mechanism which allows states to set priorities, establish policies, 

and spend funds in ways that will help them achieve state child care goals. 

The Child Care and Development Block Grant statute that underlies the 

CCDF requires states to designate a lead agency and to establish state 

plans that commit to establishing and enforcing licensing requirements 

and health and safety standards for child care providers. The statute leaves 

it to the states to decide what requirements are to be applicable to specific 

categories of providers, but for health and safety it sets out three broad 

parameters that must apply to all providers receiving federal assistance:5

physical premises safety, staff training, and control of infectious diseases 

(including childhood immunizations). To qualify for a subsidy provided 

with funds from the CCDF, a provider must comply with these and any 

other applicable state requirements. 

To be eligible for CCDF subsidies, parents must be working, in training, or 

attending an educational program and have children less than 13 years of 

age.6

 States can set income eligibility limits at or below 85 percent of the 

state median income level. States must use a significant portion of their 

CCDF funds for families receiving Temporary Assistance for Needy 

Families (TANF) or families who are at risk for becoming dependent upon 

public assistance.7

 CCDF has five goals: (1) encouraging maximum 

flexibility in developing state child care programs; (2) promoting parental 

choice; (3) encouraging states to provide consumer education information 

to parents; (4) helping states provide child care to parents trying to 

become independent of public assistance; and (5) helping states 

 4

The total amount of federal CCDF funding comes from two sources: the Child Care and 

Development Block Grant Act of 1990 and Section 418 of the Social Security Act. These 

two statutes and their funding sources are administered as a unified program—known as 

CCDF—subject to the requirements of the Child Care and Development Block Grant. Up to 

30 percent of federal funds states receive under the Temporary Assistance for Needy 

Families (TANF) program can be transferred to CCDF and the Social Services Block Grant 

at the state’s discretion. Funds transferred to CCDF are to be administered under the rules 

of CCDF. States may also use TANF directly to fund child care. 

5

The requirements do not apply to relative providers as defined in the regulations, usually 

grandparents or siblings. 

6

States can serve children with special needs under age 19. 

7

More specifically, states must use at least 70 percent of the CCDF funds authorized under 

the Social Security Act for families receiving TANF, transferring off TANF, or families who 

are at risk for becoming dependent upon public assistance. 

CCDF Funding and 

Requirements 
Page 6 GAO-04-786 Child Care Licensing 

implement health, safety, licensing, and registration standards established 

in state regulations. However, CCDF does not specify how the states 

should meet these goals and only requires them to be included as elements 

within the state child care plan. States can also determine which 

enforcement activities apply to different types of child care. Types of child 

care eligible to receive funding under TANF and the block grant are 

described in table 1. 

Table 1: Types of Child Care 

Type Description 

In-home care Care provided in the child’s home 

Relative care Care provided by someone related to the child other than the 

parents in any setting, typically in the child’s or relative’s home 

Family child care An individual provider who provides child care services as the 

sole caregiver in a private residence other than the child’s home 

Group home care Two or more providers who provide child care services in a 

private residence other than the child’s home (this does not 

include 24-hour residential facilities) 

Child care centers Nonresidential facilities that provide care for children and include 

full- and part-time group programs, such as nursery and 

preschool programs. Child care centers can be commercial, 

work-site based, school-based (preschool or after school), or a 

recreational program (such as camps or parks), and care can 

also be run by a religious organizations or by federal, state, or 

local governments 

Source: GAO/HEHS-00-28. 

States regulate those providers over which they have authority by setting 

requirements, including those focusing on health and safety, that such 

child care providers must meet and by enforcing these requirements. 8

State child care licensing offices are responsible for enforcing such health 

and safety requirements, and engage in different oversight activities for 

licensed providers and for regulated nonlicensed providers. 

• Licensed providers are generally subject to standard oversight, which 

generally includes background checks, inspections, technical assistance 

and training, and the application of sanctions when providers are found to 

be out of compliance. 9

 8

Some states are prevented by state law from regulating certain types of providers. 

9

According to the National Child Care Information Center (NCCIC), not all states require 

background checks for all providers. 

Oversight of Child Care 

Providers 
Page 7 GAO-04-786 Child Care Licensing 

• Regulated nonlicensed providers receive less intense oversight. Such 

oversight can include self-certification that health and safety standards 

have been met, background checks, and sanctions. 

• Providers who are legally exempt by state law from oversight are not 

regulated by state child care licensing offices. For example, in certain 

states, child care centers run by religious organizations may be exempt. In 

addition, under federal regulations, the states are not required to apply 

health and safety requirements to certain providers who only care for a 

child to whom they are related. Some states may conduct background 

checks and inspections of their legally exempt providers. 

States vary as to which types or subtypes of child care providers fall under 

each level of oversight.10

When establishing which providers will be required to obtain licenses, and 

hence be subject to standard oversight, and which will be required to 

comply with less intense requirements, states consider a number of 

factors. For example, states consider whether certain providers are 

subject to other health and safety regulating authorities, such as schoolbased programs that must conform to all health and safety requirements 

required for public schools and are overseen by the state education 

department. States also consider the staffing resources they would need to 

carry out the necessary licensing and enforcement activities in light of 

their budget, how to target resources toward the greatest number of 

children, and the impact that licensing activities could have on child care 

availability and parental choice. For example, some providers might pass 

the costs of conforming with licensing requirements on to parents, which 

could make such care too expensive for some parents. Currently, states 

are making choices about the extent to which they license certain 

providers and about which enforcement activities apply to different types 

of providers. 

 10Subtypes of group or family homes are defined by the number of children, with each state 

setting a threshold. Subtypes of centers include commercial, religious, school-based 

preschool, school-based after-school, recreation, work site, centers run by the federal 

government, and centers run by state or local government. 
Page 8 GAO-04-786 Child Care Licensing 

There are no specified federal requirements for licensing and enforcement 

activities, so many states rely on recommendations made by professional 

organizations in developing their own standards. Professional 

organizations recommend standards for several critical licensing and 

enforcement activities, including background checks, monitoring visits, 

training for licensing staff, and caseload size. Table 2 outlines 

recommended practices for critical licensing and enforcement activities. 

Table 2: Recommended Practices for Critical Factors in Licensing and Enforcement 

Critical factors Recommended practice 

Background checks Before granting a license, every state should obtain a 

criminal record check and child abuse registry check for 

anyone who has any contact with children in a facility and 

those family members in a family child care home who are 

over 10 years of age 

Monitoring visits 

(inspections) 

Centers and group homes should receive at least one 

unannounced inspection per year 

Training for licensing staff Staff should have appropriate education and experience for 

the form of child care they are assigned to inspect. They 

should receive no less than 40 hours of orientation training 

upon employment and an additional 16 hours of training 

about child abuse. In addition, they should receive at least 

24 hours of continuing education each year 

Caseload size On average, each staff person’s caseload should consist of 

no more than 75 provider facilitiesa

Source: American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child 

Care and Maternal and Child Health Bureau, Health Resources and Services Administration, Department of Health and Human 

Services. Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care, 2nd 

Edition. (Washington, D.C.: 2002) and NAEYC, Licensing and Public Regulation of Early Childhood Programs: A Position Statement

(Washington, D.C: 1997) at http://nrc.uchsc.edu/CFOC/XMLVersion/Appendix_AA.xml. 

Note: For each factor we used either the National Association for the Education of Young Children 

(NAEYC) or National Health and Safety Performance Standards recommendation, but not both, 

because in some cases one of the documents did not cover a particular enforcement activity or in 

other instances, the recommended practice was not specific enough. 

a

NAEYC recommends 50 as a more desirable number. 

Licensing and 

Enforcement Activities 

Recommended by National 

Organizations 
Page 9 GAO-04-786 Child Care Licensing 

In 2003, the median caseload size for inspectors decreased, but most 

licensing and enforcement activities for licensed providers remained about 

the same as those in 1999. Almost a quarter of the states maintained 

caseloads at recommend levels, and fewer states had caseloads levels over 

150. Most states conducted compliance inspections at least once a year, 

which met or exceeded the recommended level for all types of providers. 

However, most states do not require the amount of training recommended 

by national professional organizations. Most states continued monitoring 

exempt providers by distributing information about health and safety 

requirements and asking these providers to certify that they complied with 

state requirements, although some states engaged in more intense 

monitoring practices for these providers. 

In 2003, almost a quarter of the states maintained caseloads at or below 

the recommended level of 75 facilities to one inspector, and the number 

doing so had increased by 1 since 1999. Specifically, in 1999, 11 states were 

meeting the recommended caseload levels, and that number increased to 

11 states and the District of Columbia by 2003. The median number of 

facilities per inspector decreased during this time, from 118 facilities per 

inspector to 110 facilities per inspector, but the number of facilities per 

inspector was still well above the recommended level of 75 in 2003. In 

1999, caseloads ranged from 52 in Missouri to 333 in Colorado, while in 

2003, caseloads ranged from 35 per inspector in Hawaii to 600 per 

inspector in Iowa. Although the range was broader in 2003 than in 

1999, more states decreased the size of their caseloads than increased 

them. Between 1999 and 2003, the caseload in 23 states and the District of 

Columbia decreased while the caseload in 16 states increased. The number 

of states with particularly high caseloads, over 150, dropped from 17 to 

15, between 1999 and 2003. Among the states whose caseloads decreased 

were several states with the some of the highest caseloads in 1999. For 

example, Colorado’s caseload went from 333 to 138 as its licensing budget 

nearly doubled. Figure 1 illustrates the ranges of caseload levels of 

licensing staff by state in 2003; see appendix II for a comparison of 

caseload by state in 1999 and 2003 and appendix III for comparisons of 

licensing budgets and staffing levels by state in 1999 and 2003. 

Median Inspection 

Caseload Size Has 

Decreased since 1999 

although Caseloads 

Have Continued to 

Exceed 

Recommended Levels 

Almost One-Quarter of the 

States Maintained 

Recommended Caseload 

Levels for Inspectors, and 

Median Caseloads 

Decreased 
Page 10 GAO-04-786 Child Care Licensing 

Figure 1: Caseload Ranges for State Licensing Staff, 2003 

While state data showed 12 states maintaining caseloads at recommended 

levels, states reported that they were visiting facilities as often as 

recommended, and in 15 states, more often. States may be managing to 

visit facilities as often as recommended while maintaining caseloads 

higher than those recommended, in part because the caseload standard 

itself is not appropriate for some states. Experts note that this standard 

does not fully account for time-saving technology that might allow some 

states to operate effectively with larger than recommended caseloads. 

Further, licensing staff could be making trade-offs not captured in our 

survey. For example, staff could be maintaining their schedule for 

monitoring visits at the expense of performing other duties, including 

processing applications, providing technical assistance, or documenting 

inspection visits in a timely manner. 

Source: GAO analysis of state survey, 2004.

75 or fewer facilities for one licensing staff (12)

76-150 facilities for one licensing staff (17)

150 or more facilities for one licensing staff (15)

Not enough data provided to determine caseload (7)
Page 11 GAO-04-786 Child Care Licensing 

According to the data reported through state surveys and NCCIC, one less 

state exempted family child care providers-–sole caregivers who care for 

children in a private residence other than the child’s—than were exempted 

from health and safety requirements in 1999. In 1999, 39 states exempted 

some family child care providers from regulation, and by 2003, 38 states 

were exempting some of these types of providers. In addition, fewer states 

required licensure for some types of centers in 2003 than had in 1999, 

including religious centers, federal centers, and recreation centers. See 

table 3. 

Table 3: Types of Providers State Licensing Agencies Reported They Regulated or Exempted, 1999 and 2003 

 Number of statesa 

 Regulated 

 Licensed Regulated, nonlicensedb

 Exempted from state 

regulationc

Type of provider 1999 2003 1999 2003 1999 2003

Family child care 30 35 18 16 39d38d

Group homes 35 35 6 6 2 2

Centers 

Commercial 47 46 2 3 0 3

Religious 43 39 7 8 3 5

School-based preschool 27 31 5 6 11 16

School-based after-school 33 35 4 5 13 16

Recreation 18 14 1 4 20 32

Work site 46 44 3 4 1 7

Federal 20 14 2 8 21 16

State/local 38 39 5 4 6 7

Source: GAO analysis of 1999 and 2003 state surveys and NCCIC. 

a

The sum of the number of states for each year for each type of provider may not equal 50, either 

because states may have licensed or regulated some subtype of provider but not others or because a 

state may not have provided data for certain categories. 

b

Regulated, nonlicensed providers are also known as registered or certified providers. Registered or 

certified only includes those providers regulated by the state licensing agency. Providers can also 

become voluntarily regulated or regulated by another state or local agency. 

c

The state exemption does not extend to providers of child care for which federal assistance is 

provided. By federal regulation, these providers are subject to state health and safety regulations. 

d

This is the number of states that exempted some family child care providers. 

Many states set thresholds at which regulation begins according to the 

number of children served by different types of providers and exempt 

from regulation those providers falling below these thresholds. For 

example, states commonly determine which family child care providers 

The Number of States 

Exempting Some Family 

Child Care Remained 

about the Same 
Page 12 GAO-04-786 Child Care Licensing 

will be regulated based on the number of children in care. Specifically, in a 

given state, providers caring for 7 or more children in their home might be 

regulated, while providers caring for 4 children in their home might be 

exempted from regulation. As figure 2 illustrates, these regulatory 

thresholds have changed very little since 1999. However, 18 states met or 

exceeded the recommended practice of regulating providers who cared for 

2 or more unrelated children in 2003, whereas 13 were doing so in 1999.11

Figure 2: Thresholds for Regulation, as Represented by Number of Children Cared 

For in Family Child Care, 1999 and 2003 

a

States in this category would exceed NAEYC’s recommended practice of regulating providers who 

care for 2 or more unrelated children. 

b

States in this category would meet NAEYC’s recommended practice of regulating providers who care 

for 2 or more unrelated children. 

 11NAEYC recommends regulating providers who care for two or more unrelated children. 

Number of states

5 or more

Number of children

1999

2003

Source: GAO analysis of state survey, 1999, and NCCIC, 2003.

0

5

10

15

20

1a 2b 3 to 4

11

13

2

5

18

14

13

17
Page 13 GAO-04-786 Child Care Licensing 

Although some changes had occurred since 1999, states continued to 

conduct compliance inspections in accordance with recommended 

practices of conducting compliance inspections at least once a year. 

However, the number of states that visited facilities at least twice a year 

dropped by about half for all types of settings. According to the data 

reported to us through our survey, 41 states inspected centers at least 

annually, and 32 states did so for group homes. Similarly, 28 states 

conducted inspection visits to family child care homes at least once a year. 

See figure 3 and appendix IV. 

Figure 3: Number of Inspection Visits Per Year, 1999 and 2003 

The number of states requiring providers to pursue ongoing training 

increased from 26 in 1999 to 29 in 2003, and as in 1999, the same number 

of states (4) specifically followed the recommended practice by requiring 

at least 24 hours of training per year for center directors, and 3 states 

required this of center teachers. No states required this level of training for 

family child care providers. The same number of states (32) required 

Inspections Still 

Conducted in Accordance 

with Recommended 

Practices, but Most States 

Short of Recommended 

Hours of Training 

0

5

10

15

20

25

30

Less

than

once

a year

At

least

once

a year

At

least

twice

a year

Family child care Group homes Centers

Less

than

once

a year

At

least

once

a year

At

least

twice

a year

Less

than

once

a year

At

least

once

a year

At

least

twice

a year

Source: GAO analysis of state surveys, 1999 and 2004.

1999

2003

8

6

12

19

16

9

6

7

14

23

21

9

4

8

17

26

29

15

Number of states
Page 14 GAO-04-786 Child Care Licensing 

licensing staff to have an academic degree in a related field in 1999 and 

2003. Similarly, in 1999 and 2003, the same number of states (33) required 

licensing staff to have work experience in licensing or a related field 

before being assigned to licensing and enforcement activities. Finally, 

although very few states had required licensing staff to pass a test in 

1999 (7), even fewer required this in 2004 (3). 

More states informed exempt, subsidized providers about the 

requirements under the federal grant by sending them a package of 

information about health and safety requirements in 2003 (32) as reported 

doing so in 1999 (28). In addition, 17 states reported informing providers 

by requiring them to attend a short briefing or orientation sessions. Of 

these, 13 states both sent them a package of information and required 

attendance at a briefing or orientation. 

In monitoring providers exempted from regulation who were receiving 

CCDF funds, states exercised the wide discretion given them by the grant 

in determining how, or whether, to enforce state and local safety and 

health requirements for such providers. Some states monitored such 

providers relatively intensely, while others did not have the authority to do 

so under state law. For example, some states conducted background 

checks on exempt providers or inspected such providers. The number of 

states conducting background checks and inspections for such providers 

increased since 1999. For 2003, 37 states reported conducting background 

checks on exempt providers, compared with 20 in 1999. Similarly, for 

2003, 12 states reported conducting inspections for such providers 

compared with 6 in 1999. Finally, for 2003, 9 states reported conducting 

both background checks and inspections, while 4 states reported doing so 

in 1999. 

While 43 states assigned staff to a geographic location, those states using 

this broad method varied in the specifics of such assignments. Nineteen 

states also reported assigning staff based on specific job task, such as 

responding to complaints. Nineteen states reported assigning staff to 

inspect a particular type of child care facility, such as centers or family 

homes. Some states used multiple criteria to organize their staff; these 

states frequently first assigned staff based on geographic location and then 

relied on secondary criteria, such as type of child care facility. See 

figure 4. 

Many States Engage in 

Enforcement Activities for 

Exempt Providers 

Receiving Child Care 

Subsidies 

Many Inspection Staff 

Are Organized by 

Geographic Location, 

and Technology Is 

Used in Most Parts of 

the Licensing and 

Inspection Process 
Page 15 GAO-04-786 Child Care Licensing 

Figure 4: Number of States Using Various Criteria to Assign Inspection Staff in 2003 

a

Other includes four states that indicated they used no criteria to assign staff. 

Note: States can list more than one criterion. 

Forty-five states reported using technology to assist them with many 

aspects of licensing and enforcement activities. States used technology for 

tracking and monitoring subsidy use, inspecting facilities, making and 

reconciling payments to providers, linking state and local agencies, 

maintaining statistics on providers, maintaining statistics on families, and 

preparing reports to meet federal and state mandates. See figure 5. 

Specific job tasks

Geographic location

Child care facility type

Discretion of local/regional offices

Othera

0

Number of states

Source: GAO analysis of state survey, 2004.

5 10 15 20 25 30 35 40 45 50

8

14

19

19

43
Page 16 GAO-04-786 Child Care Licensing 

Figure 5: How States Use Technology 

Note: States can list more than one use of technology. 

Technology to complete some of these tasks was available in only a 

limited number of locations, such as the state licensing office, while for 

other tasks the technology could be accessed anywhere in the state by 

authorized users. More states had the ability to maintain statistics on 

providers and families (24 states) and preparing reports to meet federal 

and state mandates (20 states) statewide than for any other tasks (tracing 

and monitoring subsidy use (18 states), making and reconciling payments 

(17 states), facility inspection checklist (16 states) or linking state and 

local agencies (12 states)). 

28 Preparing reports to meet federal

and state mandates

34

12

11

Maintaining statistics on providers

Tracking and monitoring subsidy use 25

Making and reconciling payments 25

Facility inspection checklist 22

Linking state and local agencies

Other

0 5 10 15 20 25 30 35 40

Number of states

Source: GAO analysis of state survey, 2004.

Maintaining statistics on families 16
Page 17 GAO-04-786 Child Care Licensing 

States we visited have adopted a number of promising practices to assist 

in their child care licensing and enforcement activities. First, some states 

used technology in ways that allowed them to streamline their licensing 

and enforcement processes and to manage parent and provider 

information particularly effectively. Second, the states we visited had 

paired frequent inspections with technical assistance to help ensure that 

child care providers would meet state health and safety regulations. Third, 

three states we visited had implemented rating systems that differentiate 

providers by the quality of care they provide. Such systems have helped 

parents choose child care providers by allowing them to compare the 

quality of different providers. In addition, these systems have helped states 

determine what training and technical assistance each provider needs and 

have offered providers incentives to improve and maintain the quality of 

their care. Fourth, all the states we visited encouraged partnerships with 

community organizations to improve the training and education of 

providers. For example, states partnered with community colleges to 

connect providers with educational opportunities and with resource and 

referral agencies to meet the ongoing training needs of providers. 

States we visited used technology to make licensing and enforcement 

information more readily available to providers and parents, save time and 

resources, and track payments and subsidy use. For example, Florida—the 

state with the most complete, integrated, and up-to-date technology 

system of the states we visited—used technology to create an online 

public information system for providers and parents. Providers can use 

this system to access online information about state policies and 

regulations, training requirements, how to start a center, and other 

information. This has helped providers increase professionalism and selfmonitoring, according to state officials. Parents can use the system to 

access the compliance histories of each provider. 

In addition, some states have used technology to make critical licensing 

and enforcement activities more efficient. For example, Florida’s Internetbased system allows providers to register for training online and access 

their transcripts and final examination results. Florida officials also told us 

that posting provider information online reduced the amount of time child 

care licensing staff had to spend answering questions from providers and 

consequently allowed them to spend more time on other enforcement 

activities. 

Promising Practices 

in Technology, Rating 

Systems, and Training 

States Can Use Technology 

to Make Critical Licensing 

and Enforcement 

Activities More Accessible 

and Efficient 
Page 18 GAO-04-786 Child Care Licensing 

Two states we visited—Florida and North Carolina—have used laptops to 

make the enforcement process more efficient.12 Specifically, in these states 

inspectors were able to enter data into their laptops while conducting 

inspections rather than having to enter this information into the computer 

after returning to the office. In addition, inspectors in Florida were able to 

print a copy of the compliance report for providers while on-site to 

facilitate discussions of areas needing improvement. The laptops also 

saved inspectors time by allowing them to quickly access provider 

information, state child care regulations, noncompliance citations, and 

inspection forms. Officials in both Florida and North Carolina said that 

using laptop computers had helped inspectors spend less time on 

administrative duties and allowed them to spend more time providing onsite technical assistance to providers. The project coordinator in Florida 

said that this system which only covers child care licensing, was more 

affordable than other states’ licensing systems, which are part of their 

larger statewide child welfare information systems.13

In another state, technology was used to make it easier for providers and 

parents to manage subsidy payments and reduced the likelihood of fraud 

or overpayment. Specifically, Oklahoma reported using an electronic 

benefits transfer (EBT) system to automatically calculate payment rates 

and to track subsidy use. Because Oklahoma reimburses providers at over 

160 different rates depending upon the characteristics of the family and 

provider receiving a subsidy, the likelihood of error had been significantly 

higher before the system was implemented, when licensing staff were 

responsible for identifying the appropriate rate. According to state 

officials, this system has saved time processing paperwork. Further, the 

EBT system has allowed parents receiving a child care subsidy to 

document the time and attendance for their children using an EBT card 

issued by the state, and providers are automatically reimbursed at the 

appropriate rate.14 This automated system has also has also helped 

 12Florida’s system has been in place since 2002. North Carolina is currently piloting a 

similar system. 

13According to data provided by the program coordinator, Florida’s new system of 120 

laptops with related equipment, software, training, help desk and support contract, cost 

about $700,000 for the whole state. Annual costs of supporting the licensing component of 

their system have run about $400,000 to $500,000. 

14The card covers the subsidized amount for that parent. The parents also have to give the 

provider a copayment to cover the full costs. The same EBT card can be used for food 

stamps and TANF benefits if the family qualifies for those benefits. 
Page 19 GAO-04-786 Child Care Licensing 

officials identify instances of child care fraud and payment abuse, 

according to state officials. 

We found that in the states we visited, only those that had recently 

invested in computer systems, such as Florida, had been able to take 

advantage of new technologies at an affordable price. In contrast, other 

states that had not recently invested in computer systems, such as 

Delaware, had been unable to adopt such promising practices. 

Specifically, although Delaware had been on the leading edge of using 

technology almost a decade ago, it had been unable to maintain this 

advantage. One state official said that it is costly to implement and 

maintain the technology necessary to support facilities inspection, 

particularly when the state’s system is relatively old and needs to be 

updated. For example, Delaware’s system was designed in 1995 to help 

staff investigate child abuse, but was being used in 2003 to track the 

licensing process. According to state officials, the system was difficult to 

use for management purposes. To upgrade the system to adopt promising 

practices such as entering data while conducting on-site inspections, the 

state would need to develop the system and obtain additional equipment, 

such as laptop computers. However, officials told us that despite the 

increases in the state licensing budget since 1999, the state does not have 

the funding to upgrade the system and purchase additional technological 

equipment because these funds had been for specific purposes, such as 

staffing and infant and toddler programs. 

Florida, North Carolina, and Oklahoma have implemented rating systems 

to tie the level of reimbursement to a provider’s quality.15 These rating 

systems helped create a market system by giving parents more information 

about the quality of child care providers, and offered incentives to 

providers to obtain higher levels of education and improve quality in their 

facilities. In implementing rating systems, states set standards for different 

tiers of quality and assessed providers against these standards. The lowest 

tier included those providers who only met the state licensing criteria, 

while the highest tiers in Florida and Oklahoma included those providers 

who have achieved accreditation by national organizations. States differ in 

 15Delaware has a rating system in draft form. 

Rating Systems Helped 

Parents Choose Child Care 

and Offered Providers 

Incentives to Improve and 

Maintain the Quality of 

Child Care 
Page 20 GAO-04-786 Child Care Licensing 

the number of tiers in their systems: North Carolina has five, Oklahoma 

has four, and Florida has two tiers.16

Ratings systems have helped parents choose child care providers by 

allowing them to compare the quality of different providers. While some 

parents might not have known whether national accreditation would mean 

higher-quality care, they can easily identify that a provider with five stars 

was considered to provide better quality than a provider with one star. 

Rating systems also offered providers incentives to improve and maintain 

the quality of their facilities by offering higher levels of reimbursement to 

higher-quality providers. For example, through the star rating systems in 

North Carolina and Oklahoma, providers with more stars received a higher 

rate of reimbursement than providers with one star. Similarly, in Florida 

high-quality providers also receive financial incentives such as a 

reimbursement rate for subsidized children that is 20 percent higher than 

the market rate, a tax break for high-quality providers whose clientele 

does not include subsidized families, and an exemption from sales tax on 

educational materials. Officials in Oklahoma said that the rating system 

has provided incentives to all providers to improve the quality of their 

care, even providers who do not serve subsidized children. Such providers 

use the star rating as a marketing tool for their facilities, according to state 

officials. 

Finally, the rating systems—and the standards and indicators of quality on 

which they are based—can help states focus their child care quality 

efforts. For example, North Carolina’s five-star rating system forms the 

core of all its child care quality efforts, according to state officials. The 

Stars program provided the criteria for identifying areas in which 

individual centers needed to improve and the steps centers could take to 

obtain a higher rating, the basis for developing and providing full-day 

professional development and workshops throughout the year, and links 

with financial supports to encourage and reward participation in 

professional development that could lead to higher-quality child care. 

 16The two tiers are at the state level. Local agencies in Florida may have additional tiers for 

reimbursement tied to quality issues. 
Page 21 GAO-04-786 Child Care Licensing 

Training is an integral part of ensuring and upgrading the quality of early 

childhood education for all the states we visited. We found promising 

practices in training and information programs for providers and parents. 

Training and information for providers includes information on starting up 

a facility and program standards that may be available in information 

packages or on the Internet; orientation training; technical assistance; staff 

development courses; conferences, and model observation training sites. 

Parent information services includes providing information on what to 

look for when evaluating child care providers, as well as related 

information on vaccinations, screening and playground safety and where 

to access parent support services. Delaware, North Carolina, and 

Oklahoma were cited by experts as having notable training programs.17

What they have in common is that each training program is part of a total 

statewide system of interconnected partnerships between state and 

community agencies to ensure quality early childhood care. 

In these three states, licensing officials offered prelicensing training so 

that potential providers could get information on state requirements to 

avoid being out of compliance. In Delaware, staff from the Family & 

Workplace Connection, which is the umbrella organization that provides 

both training and resource and referral (R&R) services and offered a wide 

range of training opportunities that included some technical assistance, 

also attended new provider orientations given by the licensing office, to 

meet these providers and inform them of other services they supply, like 

the food program, which can furnish free food to providers, or grant 

opportunities. According to one official, these supports helped providers 

understand the health and safety requirements, which in turn helped 

facilitate compliance. In Delaware, inspectors also walked new providers 

through the health and safety regulations and addressed providers’ 

questions or concerns on their first walk-through of the facility. 

The bulk of training for providers was provided by training 

organizations—community colleges, early education training centers, 

some R&R agencies, and universities—working in partnership with the 

licensing offices for ongoing staff development. Such training is designed 

to help providers meet ongoing training requirements and provide them 

with technical assistance so they can improve the quality of their care by 

 17Although Florida’s new training system appears to have the same comprehensive 

structure as the other states we visited, we did not closely examine it because Florida was 

not initially cited as having a model training program by experts we interviewed. 

Training 

Prelicensing and New 

Providers Training 

Staff Development Training 
Page 22 GAO-04-786 Child Care Licensing 

engaging in training programs aligned with state standards and 

requirements. Oklahoma, North Carolina, and Delaware pursued different 

strategies to implement this alignment, and Florida demonstrated how a 

comprehensive Internet information system saves time for providers, 

training organizations, and state officials. 

• Oklahoma’s three-tiered training program comprehensively addresses all 

training needs from meeting minimal requirements for child care licensing 

to the most advanced professional development for early care and 

education workers and center directors. Tier I is short-term, job-related 

training that can be counted toward ongoing training requirements. 

Providers can pursue Tier I training by attending workshops or 

conferences related to their job, watching videos, and self-directed 

reading, and by participating in in-service training. Tier II is in-depth 

training that providers engage in by completing courses approved by the 

state’s Center for Early Childhood Professional Development. Tier III 

training is advanced training, formal education through credit-bearing 

courses at accredited colleges, universities, and technology centers that 

transfer for credit to such schools, leading to the highest levels of the 

quality enhancement star system, the career development ladder, and the 

Oklahoma director’s credential. 

• North Carolina has woven its provider training into its comprehensive 

Smart Start program, which is a recognized national model of partnerships 

working together to meet the needs of young children. As part of this 

program, the education level of staff is one of three areas on which 

providers are evaluated when their quality rating is determined.18 Providers 

who meet higher standards for education and experience receive more 

stars because, according to state officials, child care teachers with more 

early childhood education and experience are prepared to provide 

children with a more enriching child care experience. Providers can 

improve their star rating by increasing staff education and experience 

levels and by employing more teachers with early childhood education 

credentials and experience. Providers can pursue such credentials by 

completing certificate or higher education programs offered at community 

colleges and universities. Such training activities are facilitated and 

coordinated by the North Carolina Institute for Early Childhood 

Professional Development. 

 18The others areas are program standards and compliance history, i. e., how well the 

program adhered to the rules. 
Page 23 GAO-04-786 Child Care Licensing 

• Delaware First, the career development program for early childhood 

professionals that is operated by the Family & Workplace Connection, has 

developed Core Curricula—Basic, Advanced, and Specialty—that can be 

used to fulfill training requirements and also to pursue a Child 

Development Associate degree or college credit. 

• Florida and Delaware provided training information and administrative 

functions through the Internet. This has saved time for providers, 

inspectors, and training organizations by allowing providers to register 

online for courses offered at community colleges or other organizations 

offering child care training. In addition, providers and inspectors have 

been able to access providers’ transcripts online.19 State officials say that 

this program has saved the state time and money, although no studies have 

been done to quantify these savings. Other state officials have noted that 

using an Internet system has promoted quality in child care by making the 

process transparent and easily accessible. In Florida, for example, families 

seeking quality child care can see the latest the inspection reports on a 

facility because they are immediately posted on the Internet. 

According to child care officials and the National Association for the 

Education of Young Children (NAEYC), training opportunities are 

maximized and retention rates for child care workers increased when 

rewards for training and higher quality child care are linked. For example, 

both North Carolina and Oklahoma offer incentives to providers to 

encourage them to pursue training. These incentives are offered through a 

program for college scholarships funded by state, federal, and private 

dollars (T.E.A.C.H. Early Childhood).20 Both North Carolina and Oklahoma 

have also adopted a salary supplement program called WAGE$ to reward 

increased education attainment. 

Parent training is provided by R&R organizations in each state, which 

provide information on the Internet and by telephone, as well as through 

written brochures, fact sheets, and newsletters. For example, Florida’s 

R&R provides parents a database listing all legally operating child care and 

early childhood providers, available options for care, indicators of quality 

to look for when considering a provider, and what to consider when 

checking on a child’s placement, that is, determining how well the 

 19Transcripts are proof that education requirements have been met. 

20The T.E.A.C.H. program was operating in 22 states in 2003. 

Parent Training 
Page 24 GAO-04-786 Child Care Licensing 

placement will meet a child’s needs. In Delaware, the R&R offered 

workshops throughout the year to parents on over 105 topics pertaining to 

children up to school age. In all four states we visited, the R&R agency 

provided a system to help parents locate child care—often known as a 

child care locator—as well as information about how to choose quality 

care and what training opportunities were available for parents. One 

expert we interviewed told us that it is important to educate parents 

because they are the ones who visit the child care facility every day and 

are most effective in helping to ensure provider compliance with state 

child care standards. 

By expanding who is covered by licensing requirements and parental 

knowledge, states have increased oversight on child care providers since 

1999. However, some states have decreased the number of inspections per 

facility per year. At the same time, states are maintaining their flexibility in 

administering CCDF and providing parents with choice in the child care 

options available to them. States use inspections to oversee the child care 

provided in facilities with the greatest number of children and use less 

intensive methods like self-certification for other facilities they regulate. 

Self-certification affords less assurance that providers are meeting safety 

and health requirements, but in an era when caseload sizes already exceed 

recommended levels in many states and states find themselves challenged 

by increasing child care demand, it helps keep low-cost child care 

available. 

The use of technology has also increased in the states for state licensing 

staff, providers, and parents. Not only have the number of states using 

technology in the areas associated with state activities in new areas, 

providing information and training resources for parents licensing and 

enforcement increased, but technology has also expanded into new areas, 

providing information and training resources for parents, providers, and 

training organizations on a broad range of topics for a number of different 

functions. The obvious advantages of an up-to-date, Internet-based, 

integrated information system have been demonstrated by Florida. 

However, the size of the investment required for this type of system 

depends on whether or not the state chooses to create an independent 

licensing information system, or if the state wants its licensing system to 

be part of a larger statewide child care information system. Florida found 

it more affordable to do the former. 

Concluding 

Observations 
Page 25 GAO-04-786 Child Care Licensing 

We provided officials of the Administration for Children and Families 

(ACF), HHS, an opportunity to comment on a draft of this report. ACF was 

pleased with the findings and noted that the report will be especially 

helpful to ACF and the states because it compares state child care health 

and safety enforcement in 1999 and 2003. ACF’s comments are reproduced 

in appendix VI. ACF also supplied technical comments that were 

incorporated as appropriate. 

Unless you publicly announce its contents earlier, we plan no further 

distribution until 30 days after the date of this letter. At that time we will 

send copies of this report to the Honorable Wade F. Horn, Assistant 

Secretary, Administration for Children and Families, HHS; appropriate 

congressional committees; and other interested parties. In addition, the 

report will be available at no charge on GAO’s Web site at 

http//:www.gao.gov. If you or your staff have any questions or wish to 

discuss this material further, please call me on (202) 512-7215. 

Sincerely yours, 

Marnie S. Shaul, Director 

Education, Workforce, and 

 Income Security Issues 

Agency Comments 
Appendix I: Scope and Methodology 

Page 26 GAO-04-786 Child Care Licensing 

To perform our work, we conducted a mail survey in 2004 of state 

licensing officials in all 50 states and the District of Columbia about their 

licensing and enforcement policies and practices in 2003. Specifically, we 

asked states to report on the frequency of their compliance inspections, 

background checks, training programs and educational requirements for 

licensing staff, and caseload sizes. We achieved a response rate of 

98 percent, with 49 states and the District of Columbia responding to our 

survey. Maine did not respond. In our 1999 survey, we achieved a 

100 percent response rate. 

We compared our survey results with a mail survey we conducted in 

1999 to identify any changes that had occurred within the past few years. 

Of the 30 substantive questions on our 2004 survey, 17 were identical to 

those in the 1999 survey, 1 was a version of another 1999 question, and 12 

were new questions. To ensure their reliability, we pretested all new 

questions with current or former state licensing officials. 

Rather than using our survey data for the number of states exempting 

family child care providers’ regulation, we used data from the National 

Child Care Information Center (NCCIC). The responses to question 16 of 

our survey (on the number of states exempting some family child care 

homes from state regulation) proved problematic, as it had in the 1999 

survey. Callbacks to a sample of respondents whose survey responses 

differed from data produced by NCCIC showed that respondents 

misunderstood our question. The NCCIC information was based on 

published state standards of the regulation threshold point for the number 

of children served rather than survey data. Therefore we used the NCCIC 

data in this report to answer this question. Since this was similar to what 

we had done to compensate for the problems in responses to that question 

in the 1999 survey, the data for the 2 years are comparable. 

In addition, we conducted a literature search and interviewed child care 

licensing experts and state and federal officials to gather information 

about critical licensing and enforcement activities occurring within the 

states. The experts we interviewed included university research 

professors, representatives from public policy organizations, staff from 

organizations that deal with the policy and practice of providing child care 

services. 

With the information we gathered through these expert interviews, we 

identified and conducted site visits in four states—Delaware, Florida, 

North Carolina, and Oklahoma—to provide examples of promising 

practices in licensing and enforcement. We conducted our work between 

Appendix I: Scope and Methodology 
Appendix I: Scope and Methodology 

Page 27 GAO-04-786 Child Care Licensing 

October 2003 and July 2004 in accordance with generally accepted 

government auditing standards. 
Appendix II: State Caseloads, Fiscal Years 

2003 and 1999 

Page 28 GAO-04-786 Child Care Licensing 

State 

Number of child care 

facilities 2003 

Number of full-time 

equivalent staff for child 

care licensing and 

enforcement 2003

Caseload 

(facilities/

inspector)

1999

Caseload 

(facilities/ 

inspector) 

2003 

Percentage change 

in caseload, 1999 

to 2003

Alabama 3,356 a 276 a a 

Alaska 1,924 32 b 60 a 

Arizona 2,857 40 90 71 -21

Arkansas 2,680 5 91 536 489

California 59,179 246 249 241 -3

Colorado 7,179 52 333 138 -59

Connecticut 4,937 32 171 154 -10

Delaware 2,024 15 160 135 -16

District of Columbia 595 9 85 66 -22

Florida 9,844 85 118 116 -2

Georgia 8561 54 229 159 -31

Hawaii 1006 29 a 35 a 

Idaho a a a a a 

Illinois 13,550 75 a a 

Indiana 4,637 45 116 103 -11

Iowa 7,196 12 c 600 a 

Kansas 8,612 31 166 278 67

Kentucky 2,224 38 97 59 -40

Louisiana 6,969 25 a 279 a 

Maine b .b 327 b b 

Maryland 12,844 152 113 85 -25

Massachusetts 12,766 59 204 216 6

Michigan 18,749 61 228 307 35

Minnesota 1,614 0 142 a a 

Mississippi a 25 109 a a 

Missouri 4,389 77 52 57 10

Montana 1,884 12 152 157 3

Nebraska 4,038 28 153 144 -6

Nevada a 7 63 a a 

New Hampshire 1,212 9 74 135 82

New Jersey 9,101 31 129 294 128

New Mexico 1,006 11 a 91 a 

New York 16,298 406 104 40 -61

North Carolina 9,066 116 135 78 -42

Appendix II: State Caseloads, Fiscal Years 

2003 and 1999 
Appendix II: State Caseloads, Fiscal Years 

2003 and 1999 

Page 29 GAO-04-786 Child Care Licensing 

State 

Number of child care 

facilities 2003 

Number of full-time 

equivalent staff for child 

care licensing and 

enforcement 2003

Caseload 

(facilities/

inspector)

1999

Caseload 

(facilities/ 

inspector) 

2003 

Percentage change 

in caseload, 1999 

to 2003

North Dakota 1,623 19 104 85 -18

Ohio 21,244 59 149 360 142

Oklahoma 6,521 130 56 50 -10

Oregon 6,055 40 75d 151 102

Pennsylvania 9,081 71 157 128 -19

Rhode Island 1,786 9 168 198 18

South Carolina 3,583 52 250 69 -72

South Dakota 1,150 12 175 96 -45

Tennessee 4938 168 71 29 -59

Texas 20,293 281 66 72 9

Utah 2,012 26 70 77 11

Vermont 1,905 8 271 238 -12

Virginia 6,590 75 104 88 -16

Washington 9,012 88 118 102 -13

West Virginia 4,014 44 57e91 60

Wisconsin 5,588 60 82 93 14

Wyoming 717 17 149 42 -72

Source: GAO surveys, 1999 and 2004. 

a

Data were not available. 

b

State that did not respond to this survey. 

c

Iowa only provided caseload data for centers. 

d

Oregon provided an estimate of its caseload for group homes and centers only. 

e

West Virginia could provide data only on the number of its child care centers. 
Appendix III: State Child Care Licensing 

Budget and Full-Time-Equivalent Staffing 

Levels, 1999 and 2003 

Page 30 GAO-04-786 Child Care Licensing 

Most state licensing offices reported increases in budgets and the number 

of full-time equivalent (FTE) staff since1999, although an increase in one 

did not necessarily reflect an increase in the other. 

 Licensing budget FTEs 

State 1999 2003a

Percentage 

change,

 1999 to 2003 1999 2003 

Percentage 

change,

1999 to 2003

Alabama bb b 16 b b

Alaska bb b b 32 b

Arizona b$2,115,961 b25 40 +60

Arkansas $2,170,972 2,928.492 +35 35 5 -86

California 77,405,725 232,195,000 +200 197 246 +25

Colorado 2,900,000 5,545,095 +91 25 52 +108

Connecticut 1,750,000 2,652,000 +52 36 32 -11

Delaware 1,689,841 2,094,500 +24 14 15 +7

District of Columbia 1,186,000 1,187,000 0 7 9 +29

Florida 5,719,145 15,634,362 +173 75 85 +13

Georgia 4,017,676 5,752,602 49 54 +10

Hawaii 9,556,728 632,304 -93 0 29 c

Idaho bb b b b b

Illinois b16,907,943 b 171 b b

Indiana 2,152,464 2,832,145 +32 34 45 +32

Iowa b b b b 12 b

Kansas 2,596,754 3,670,352 +41 55 31 -44

Kentucky 8,888,500 2,499,300 b 21 38 +81

Louisiana 1,800,000 222,961 -88 b 25 b

Maine 600,000 d d 11 d d

Maryland 8,438,215 11,599,924 +37 126 152 +21

Massachusetts 7,000,000 7,018,242 0 69 59 -14

Michigan 8,000,000 18,546,700 +132 93 61 -34

Minnesota 3,320,013 b b 114 b b

Mississippi 750,000 1,701,701 +127 15 25 +67

Missouri 5,000,000 5,399,384 +8 86 77 -10

Montana b 652,142 b 12 12 0

Nebraska b1,722,772 b28 28 0

Appendix III: State Child Care Licensing 

Budget and Full-Time-Equivalent Staffing 

Levels, 1999 and 2003 
Appendix III: State Child Care Licensing 

Budget and Full-Time-Equivalent Staffing 

Levels, 1999 and 2003 

Page 31 GAO-04-786 Child Care Licensing 

 Licensing budget FTEs 

State 1999 2003a

Percentage 

change,

 1999 to 2003 1999 2003 

Percentage 

change,

1999 to 2003

Nevada b1,581,258 b17 7 -59

New Hampshire 692,576 851,746 +23 16 9 -44

New Jersey 3,452,400 2,717,369 -21 28 31 +11

New Mexico 674,200 565,000 -16 15 11 -27

New York 13,498,700 28,000,000 +107 234 406 +74

North Carolina 5,670,000 11,732,850 +107 67 116 +73

North Dakota 453,400 954,050 +110 18 19 +6

Ohio 3,999,575 5,351,784 +1239 66 59 -11

Oklahoma 5,680,905 7,100,000 +25 111 130 +17

Oregon 2,732,259 5,532,146 +102 34 40 +18

Pennsylvania 4,500,000 5,750,000 +28 55 71 +29

Rhode Island b 825,760 b 7 9 +29

South Carolina 1,612,433 3,148,902 +95 15 52 +247

South Dakota 608,110 694,690 +14 10 12 +20

Tennessee 1,922,700 7,300,000 +280 81 168 +107

Texas 14,100,000 23,989,393 +70 329 281 -15

Utah 2,576,798 3,004,179 +17 31 26 -16

Vermont 629,972 658,514 +5 7 8 +14

Virginia 6,919,074 12,061,452 +74 57 75 +32

Washington 5,411,000 9,615,023 +78 79 88 +11

West Virginia bb b 7 44 +529

Wisconsin 3,480,800 6,266,910 +80 60 60 0

Wyoming 444,279 1,135,621 +156 6 17 +183

Source: GAO surveys, 1999 and 2004 

a

The latest year for which budget data were available was 2003. 

b

Some states could not provide us with FTE or budget information for particular years. 

c

Cannot express as a percentage change because 1999 was zero. 

d

Maine did not respond to the survey. 
Appendix IV: Frequency of Licensure and 

Monitoring Visits in the States 

Page 32 GAO-04-786 Child Care Licensing 

State 

Number of years for which a 

license is issued 

Does the state conduct renewal 

visits? 

Frequency of routine compliance 

visits 

Alabama 

Family day carea 2 Yes Once a year 

Group homesb 2 Yes Once a year 

Centersc 2 Yes Once every 2 years 

Alaska 

Family day care 2 Yes Once a year 

Group homes 2 Yes Once a year 

Centers 2 Yes Once a year 

Arizona 

Family day care 3 Yes Once a year 

Group homes 3 Yes Once a year 

Centers 3 Yes Once a year 

Arkansas 

Family day care Nonexpiring N/A At least twice a year 

Group homes N/A N/A N/A 

Centers Nonexpiring N/A At least twice a year 

California 

Family day care Nonexpiring N/A Not inspected on a regular basis 

Group homes Nonexpiring N/A Not inspected on a regular basis 

Centers Nonexpiring N/A Not inspected on a regular basis 

Colorado 

Family day care Nonexpiring Yes Once every 2 years 

Group homes Nonexpiring Yes Once every 2 years 

Centers Nonexpiring Yes Once every 2 years 

Connecticut 

Family day care 2 No Less often than once every 2 years 

Group homes 2 No Once every 2 years 

Centers 2 No Once every 2 years 

Delaware 

Family day care 1 No Once a year 

Group homes 1 Yes Once a year 

Centers 1 Yes Once a year 

Appendix IV: Frequency of Licensure and 

Monitoring Visits in the States 
Appendix IV: Frequency of Licensure and 

Monitoring Visits in the States 

Page 33 GAO-04-786 Child Care Licensing 

State 

Number of years for which a 

license is issued 

Does the state conduct renewal 

visits? 

Frequency of routine compliance 

visits 

District of 

Columbia 

 

Family day care 1 Yes Once a year 

Group homes N/A N/A N/A 

Centers 1 Yes Once a year 

Florida 

Family day care 1 Yes At least twice a year 

Group homes N/A N/A N/A 

Centers 1 Yes At least twice a year 

Georgia 

Family day care Nonexpiring No N/A 

Group homes Nonexpiring Yes Once every 2 years 

Centers Nonexpiring Yes Once every 2 years 

Hawaii 

Family day care 1 Yes At least twice a year 

Group homes 1 Yes At least twice a year 

Centers 1 Yes At least twice a year 

Idaho 

Family day care 2 Yes Once every 2 years 

Group homes 2 Yes Once every 2 years 

Centers 2 Yes Once every 2 years 

Illinois 

Family day care 3 N/A Once a year 

Group homes N/A N/A Once a year 

Centers 3 N/A Once a year 

Indiana 

Family day care 2 Yes Once a year 

Group homes 2 Yes Once a year 

Centers 2 Yes Once a year 

Iowa 

Family day care 2 No Less often then once every 2 years 

Group homes 2 No Less often than once every 2 years 

Centers 2 Yes Once a year 

Kansas 

Family day care 1 No Not inspected on a regular basis 

Group homes Nonexpiring Yes Once a year 

Centers Nonexpiring Yes Once a year 
Appendix IV: Frequency of Licensure and 

Monitoring Visits in the States 

Page 34 GAO-04-786 Child Care Licensing 

State 

Number of years for which a 

license is issued 

Does the state conduct renewal 

visits? 

Frequency of routine compliance 

visits 

Kentucky 

Family day care 1 Yes Once a year 

Group homes 1 Yes Once a year 

Centers 1 Yes Once a year 

Louisiana 

Family day care 1 Yes Once a year 

Group homes 1 Yes Once a year 

Centers 1 Yes Once a year 

Maine 

Family day care d d d 

Group homes d d d 

Centers d d d 

Maryland 

Family day care 2 Yes Once every 2 years 

Group homes N/A N/A N/A 

Centers 1 Yes Less often than once every 2 years 

Massachusetts 

Family day care 3 Yes Once a year 

Group homes 3 Yes Once a year 

Centers 2 Yes Once a year 

Michigan 

Family day care 3 No Less often than once every 2 years 

Group homes 2 Yes Once a year 

Centers 2 Yes Once a year 

Minnesota 

Family day care 2 Yes Not inspected on a regular basis 

Group homes 2 Yes Not inspected on a regular basis 

Centers 1 Yes Once every 2 years 

Mississippi 

Family day care 1 Yes Once a year 

Group homes 1 Yes Once a year 

Centers 1 Yes Once a year 

Missouri 

Family day care 2 Yes Twice a year 

Group homes 2 Yes Twice a year 

Centers 2 Yes Twice a year 
Appendix IV: Frequency of Licensure and 

Monitoring Visits in the States 

Page 35 GAO-04-786 Child Care Licensing 

State 

Number of years for which a 

license is issued 

Does the state conduct renewal 

visits? 

Frequency of routine compliance 

visits 

Montana 

Family day care Varies with past performance No Once every 2 years 

Group homes Varies with past performance No Once every 2 years 

Centers Varies with past performance Yes Once a year 

Nebraska 

Family day care Nonexpiring No Once a year 

Group homes Nonexpiring Yes Once a year 

Centers Nonexpiring Yes Once a year 

Nevada 

Family day care 1 Yes At least twice a year 

Group homes 1 Yes At least twice a year 

Centers 1 Yes At least twice a year 

New Hampshire 

Family day care 3 Yes Once a year 

Group homes 3 Yes Once a year 

Centers 3 Yes Once a year 

New Jersey 

Family day care 3 Yes Once every 2 years 

Group homes N/A N/A N/A 

Centers 3 Yes Once a year 

New Mexico 

Family day care 1 Yes Once a year 

Group homes 1 Yes Once a year 

Centers 1 Yes Once a year 

New York 

Family day care 2 no response Once every 2 years 

Group homes 2 Yes Once every 2 years 

Centers 2 Yes Once every 2 years 

North Carolina 

Family day care Nonexpiring N/A Once a year 

Group homes Nonexpiring N/A Once a year 

Centers Nonexpiring N/A Once a year 

North Dakota 

Family day care 1 Yes Once a year 

Group homes 1 Yes Once a year 

Centers 1 Yes Once a year 
Appendix IV: Frequency of Licensure and 

Monitoring Visits in the States 

Page 36 GAO-04-786 Child Care Licensing 

State 

Number of years for which a 

license is issued 

Does the state conduct renewal 

visits? 

Frequency of routine compliance 

visits 

Ohio 

Family day care N/A N/A N/A 

Group homes N/A N/A N/A 

Centers 2 Yes At least twice a year 

Oklahoma 

Family day care Nonexpiring N/A At least twice a year 

Group homes Nonexpiring N/A At least twice a year 

Centers Nonexpiring N/A At least twice a year 

Oregon 

Family day care 2 N/A Once every 2 years 

Group homes 1 N/A At least twice a year 

Centers 1 N/A At least twice a year 

Pennsylvania 

Family day care 2 No Not inspected on a regular basis 

Group homes 1 Yes Once a year 

Centers 1 Yes Once a year 

Rhode Island 

Family day care 2 Yes Once every 2 years 

Group homes 1 Yes Once a year 

Centers 1 No At least twice a year 

South Carolina 

Family day care 1 No Not inspected on a regular basis 

Group homes 2 Yes At least twice a year 

Centers 2 Yes At least twice a year 

South Dakota 

Family day care N/A Yes Once every 2 years 

Group homes Nonexpiring Yes Once a year 

Centers Nonexpiring Yes Once a year 

Tennessee 

Family day care 1 Yes At least twice a year 

Group homes 1 Yes At least twice a year 

Centers 1 Yes At least twice a year 

Texas 

Family day care Nonexpiring N/A Less often than once every 2 years 

Group homes Nonexpiring N/A Once a year 

Centers Nonexpiring N/A Once a year 
Appendix IV: Frequency of Licensure and 

Monitoring Visits in the States 

Page 37 GAO-04-786 Child Care Licensing 

State 

Number of years for which a 

license is issued 

Does the state conduct renewal 

visits? 

Frequency of routine compliance 

visits 

Utah 

Family day care 2 Yes Once a year 

Group homes 2 Yes Once a year 

Centers 2 Yes Once a year 

Vermont 

Family day care 1 No Not inspected on a regular basis 

Group homes 1 Yes At least twice a year 

Centers 1 Yes At least twice a year 

Virginia 

Family day care Nonexpiring Yes At least twice a year 

Group homes N/A N/A N/A 

Centers Nonexpiring Yes At least twice a year 

Washington 

Family day care 3 Yes Less often than once every 2 years 

Group homes N/A N/A N/A 

Centers 3 Yes Once a year 

West Virginia 

Family day care 2 Yes Once a year 

Group homes 2 Yes Once a year 

Centers 2 Yes Once a year 

Wisconsin 

Family day care Nonexpiring Yes Once a year 

Group homes N/A N/A N/A 

Centers Nonexpiring Yes At least twice a year 

Wyoming 

Family day care 1 N/A At least twice a year 

Group homes 1 N/A At least twice a year 

Centers 1 N/A At least twice a year 

Source: GAO survey, 2004 

N/A: not applicable 

a

Family day care is provided by an individual provider in a private residence other than the child’s 

home. 

b

Group homes provide care by two or more providers in a private residence other than the child’s 

home. 

c

Centers are nonresidential facilities that provide care for children and include full- and part-time 

group programs, such as nursery and preschool programs. 

d

Maine did not respond to our survey. 
Appendix V: State Survey 

Page 38 GAO-04-786 Child Care Licensing 

Appendix V: State Survey 
Appendix V: State Survey 

Page 39 GAO-04-786 Child Care Licensing 
Appendix V: State Survey 

Page 40 GAO-04-786 Child Care Licensing 
Appendix V: State Survey 

Page 41 GAO-04-786 Child Care Licensing 
Appendix V: State Survey 

Page 42 GAO-04-786 Child Care Licensing 
Appendix V: State Survey 

Page 43 GAO-04-786 Child Care Licensing 
Appendix V: State Survey 

Page 44 GAO-04-786 Child Care Licensing 
Appendix V: State Survey 

Page 45 GAO-04-786 Child Care Licensing 
Appendix VI: Comments from the Department 

of Health and Human Services 

Page 46 GAO-04-786 Child Care Licensing 

Appendix VI: Comments from the 

Department of Health and Human Services 
Appendix VI: Comments from the Department 

of Health and Human Services 

Page 47 GAO-04-786 Child Care Licensing 
Appendix VI: Comments from the Department 

of Health and Human Services 

Page 48 GAO-04-786 Child Care Licensing 
Appendix VII: GAO Contact and Staff 

Acknowledgments 

Page 49 GAO-04-786 Child Care Licensing 

Eleanor Johnson, Assistant Director, (202) 512-7209 or johnsone@gao.gov 

In addition to the person named above, Margaret Armen, Amy Buck, 

Patricia Bundy, Kara Kramer, Jerry Sandau, and Jay Smale also made 

major contributions to this report. 

Appendix VII: GAO Contact and Staff 

Acknowledgments 

GAO Contact 

Staff 

Acknowledgments 
Related GAO Products 

Page 50 GAO-04-786 Child Care Licensing 

Child Care: Recent State Policy Changes Affecting the Availability of 

Assistance for Low-Income Families. GAO-03-588, May 5, 2003. 

Child Care: States Exercise Flexibility in Setting Reimbursement Rates 

and Providing Access for Low-Income Children. GAO-02-894, September 

18, 2002. 

Child Care: States Have Undertaken a Variety of Quality Improvement

Initiatives, but More Evaluations of Effectiveness Are Needed. 

GAO-02-897, September 6, 2002. 

Child Care: States Increased Spending on Low-Income Families. 

GAO-01-293, February 2, 2001. 

Child Care: State Requirements for Background Checks. 

GAO/HEHS-00-66R, February 28, 2000. 

Child Care: State Efforts to Enforce Safety and Health Requirements.

GAO/HEHS-00-28, January 24, 2000. 

Child Care: How Do Military and Civilian Center Costs Compare? 

GAO/HEHS-00-7, October 14, 1999. 

Welfare Reform: States’ Efforts to Expand Child Care Programs. 

GAO/HEHS-98-27, January 13, 1998. 

Related GAO Products 

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