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441 G St. N.W.

Washington, DC 20548

February 15, 2019

The Honorable Lamar Alexander

Chairman

The Honorable Patty Murray

Ranking Member

Committee on Health, Education, Labor and Pensions

United States Senate

The Honorable Robert C. “Bobby” Scott

Chairman

The Honorable Virginia Foxx

Ranking Member

Committee on Education and Labor

House of Representatives

Child Care and Development Fund: Subsidy Receipt and Plans for New Funds

The federal child care subsidy program known as the Child Care and Development Fund 

(CCDF) is the primary source of federal funding dedicated to assisting low-income families who 

are working or participating in education and training by increasing their access to quality child 

care.1 In fiscal year 2015, the latest year for which data are publicly available, CCDF provided 

child care assistance to about 1.4 million children each month.

2 Discretionary funding for CCDF 

is authorized by the Child Care and Development Block Grant (CCDBG) Act of 1990, as 

amended, and the U.S. Department of Health and Human Services (HHS) administers the funds 

to states.

3 In addition to authorizing funding, the CCDBG Act of 2014 included various 

 1

CCDF is not an entitlement program, which means that states are not required to serve all eligible families who 

apply for CCDF subsidies; thus some eligible families who apply for subsidies may not receive them. Families who 

qualify for, but do not receive, CCDF subsidies could still receive public assistance for child care through other federal 

or state programs such as Head Start or a state’s pre-kindergarten program if they meet eligibility requirements. 

Further, not all eligible families may apply for CCDF subsidies because, as we previously found, several factors 

influence families’ child care decisions that can make it difficult or unappealing to pursue subsidies. See GAO, Child 

Care: Access to Subsidies and Strategies to Manage Demand Vary Across States, GAO-17-60 (Washington, D.C.: 

Dec. 15, 2016).

2

At the time of this report’s issuance, preliminary 2016 data from the U.S. Department of Health and Human Services 

also estimated that about 1.4 million children received child care assistance each month.

3

Discretionary CCDF funds are entirely federal funds that are allocated to states based on a statutory formula. See, 

42 U.S.C. § 9858m. Under the program, these discretionary funds do not require a state match. CCDF is also made 

up of mandatory and matching funding, which is authorized under the Social Security Act (42 U.S.C. § 618) and 

administered by HHS. A portion of the mandatory funding is guaranteed to states, without states having to match the 

funds with state child care spending. To be eligible for its share of the remaining mandatory funds (matching funds), a 

state must first spend a designated amount of its own state funds. 42 U.S.C. § 618(a)(2).
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requirements for states. Among them, states must spend at least 70 percent of remaining 

discretionary funds on subsidies for eligible families, after setting aside funds for administrative 

and quality activities.

4 In fiscal year 2019, states are required to spend at least 8 percent of 

CCDF funding for “quality activities”—activities that are designed to improve the quality of child 

care services the state provides—which may include supporting the professional development 

of the child care workforce and improving the supply and quality of child care programs and 

services for infants and toddlers.5 In March 2018, the Consolidated Appropriations Act, 2018

was enacted, which provided $5.2 billion in discretionary CCDF funding for fiscal year 2018, 

nearly twice the amount provided in fiscal year 2017.6

The CCDBG Act of 2014 also included a provision for GAO to review every 2 years the number 

of families eligible to receive assistance under the CCDBG Act of 1990, as amended, as well as 

those who have applied for assistance and those who have been placed on a wait list for 

assistance.7 To address this provision, this report describes (1) what is known from the most 

recent data available from HHS about the extent to which eligible children received child care 

subsidies and their characteristics, and (2) how states plan to use the increase in CCDF funding 

from the Consolidated Appropriations Act, 2018, including addressing wait lists. The report

includes the slides we used to brief your staff in October 2018 (see enclosure I). HHS since 

updated its data on subsidy receipt in January 2019, and this letter reflects the updated data. 

To answer what is known from the most recent data available from HHS about the extent to 

which eligible children received child care subsidies and their characteristics, we summarized 

the most recent analysis of CCDF eligibility and subsidy receipt data available from HHS’s

Assistant Secretary for Planning and Evaluation (ASPE), as reported in Factsheet: Estimates of 

Child Care Eligibility & Receipt for Fiscal Year 2015 (January 2019). According to HHS, the 

eligibility estimates were produced using the Transfer Income Model (TRIM), a micro-simulation 

model developed and maintained by the Urban Institute under contract with ASPE. TRIM is 

based on the Annual Social and Economic Supplement of the Current Population Survey (CPS). 

TRIM compares family income and work status data from the CPS against CCDF rules to 

generate estimates of children and families eligible for subsidies.

To answer how states plan to use the increase in CCDF funding from the Consolidated 

Appropriations Act, 2018, including addressing wait lists, we collected information from state 

 

4

42 U.S.C. § 9858c(c)(3)(E)(ii). The CCDBG Act of 1990, as amended, requires states to spend 70 percent of 

remaining discretionary funds on “direct services,” which HHS defines in its grant reporting instructions as “solely...for 

child care subsidies to eligible children.” States may spend no more than 5 percent of CCDF funding on 

administrative activities. 42 U.S.C. § 9858c(c)(3)(C).

5

42 U.S.C. § 9858e(a)(2)(A), (b)(1)(A), (b)(4). Under the statute, the minimum percentage states must spend on 

quality activities increases to 9 percent of CCDF funding for fiscal year 2020 and beyond. In addition, for each fiscal 

year starting in fiscal year 2017, states must spend at least an additional 3 percent on activities related to the quality 

of child care for infants and toddlers. 42 U.S.C. § 9858e(a)(2)(B).

6

Pub. L. No. 115-141. Because funds appropriated under this act are discretionary CCDF funds, states are also 

required to spend at least 70 percent of the remaining funds on subsidies for eligible families after setting aside funds 

for quality and administrative activities.

7

Pub. L. No. 113-186, § 12(a), 128 Stat. 1971, 2001. For the remainder of this report, unless otherwise noted, we 

refer to the CCDBG Act of 1990, as amended, as “the CCDBG Act.”
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CCDF administrators in two ways.

8 First, we surveyed CCDF administrators in the 50 states and 

the District of Columbia (D.C.) using a Word-enabled questionnaire in May and June 2018 and 

received a 100 percent response rate. We asked CCDF administrators about state child care 

activities, including those related to CCDBG Act requirements, and any additional purpose for 

which their state expected to spend at least some of the additional funds from the Consolidated 

Appropriations Act, 2018. We took several steps to minimize measurement error and data 

collection and processing errors.

9 Specifically, we pre-tested draft versions of the questionnaire 

with CCDF administrators in three states to check the clarity of the questions and layout of the 

questionnaire, and made revisions in response, as appropriate. In addition, we directly extracted 

respondent data from our questionnaire into a spreadsheet to facilitate analysis, and visually 

inspected the extracted data for any errors. Second, we conducted semi-structured interviews 

with CCDF administrators in 15 states, including D.C., in May and June 2018 to collect in-depth 

information about their plans to use the new funding and the impact on their wait lists, if 

applicable. We selected states with and without wait list policies that also reflected variation in 

the level of CCDF funding set aside for quality activities, according to the most recently 

available data from HHS, and geography (see enclosure III for a list of these states). Through 

our interviews and follow-up, we obtained information on states’ plans for future spending, 

potential impacts of not having received the new funds, and challenges associated with the 

funding. While information obtained during these interviews is not generalizable and may be 

preliminary and subject to change, it provides point-in-time insight into state plans for these 

funds from a variety of states. 

We conducted this performance audit from April 2018 to February 2019 in accordance with 

generally accepted government auditing standards. Those standards require that we plan and 

perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on our audit objectives. We believe that the evidence obtained 

provides a reasonable basis for our findings and conclusions based on our audit objectives.

Background

States administer the federal CCDF program by providing subsidies to eligible families in the 

form of certificates or vouchers to use for child care in homes, child care centers, and 

classrooms, or through grants or contracts to child care providers. States have flexibility to 

establish specific eligibility criteria within broad federal eligibility rules, according to HHS 

regulations.

10 For example, under federal eligibility rules, a family’s income may not exceed 85 

percent of state median income,11 but most states set their income limits below the federal 

maximum. As a result, generally, fewer families qualify for subsidies under state eligibility rules 

than under federal eligibility rules, according to HHS.

 8

For purposes of this report, we are referring to the increase in CCDF funds appropriated under the Consolidated 

Appropriations Act, 2018 as “new funds” or “new funding.”

9

Measurement error can include variations in how respondents interpret questions, respondents’ willingness to offer 

accurate responses, and nonresponse error (failing to collect data on answers to individual questions from 

respondents).

1045 C.F.R. §§ 98.16(g)(5), 98.20(b). 

1142 U.S.C. § 9858n(4)(B). 
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The CCDBG Act of 2014 and HHS’s final rule implementing the law specify activities that state 

child care programs are required to or have the option to undertake as part of their CCDF 

program. These activities fall into four key areas, according to HHS: (1) protecting the health 

and safety of children in child care; (2) helping parents make informed consumer choices and 

access information to support child development; (3) supporting equal access to stable, highquality child care for low-income children; and (4) enhancing the quality of child care and the 

early childhood workforce. The Act added some specific requirements, such as requirements for 

comprehensive criminal background checks for child care providers.12 States may also use 

CCDF funds for a variety of additional child care activities that are not explicitly required under 

the act. Enclosure II describes various state child care activities and their related requirements 

from the CCDBG Act of 2014, where applicable.

HHS Estimated That One-Quarter of Eligible Children Received Subsidies, and They Were 

Younger and from Lower-Income Families than Other Eligible Children

An estimated one-quarter of children eligible for child care subsidies under state eligibility rules 

received them (2.1 million of the 8.4 million children in an average month estimated to be 

eligible under state rules), according to HHS’s analysis of data from fiscal year 2015, the most 

recent year for which such analysis is available.13 This represented 15 percent of all children 

estimated to be eligible under federal rules (see fig. 1).

Figure 1: HHS’s Estimated Number of Children Eligible Under Federal and State Rules, and Estimated 

Number Receiving Child Care Subsidies, Fiscal Year 2015

 12Pub. L. No. 113-186, § 7, 128 Stat. 1971, 1990 (adding 42 U.S.C. § 9858f).

13This fiscal year 2015 estimate, reported by HHS’s Office of the Assistant Secretary for Planning and Evaluation, 

represents the number of children who received child care subsidies funded through CCDF or related government 

funding streams, which includes counts of children who receive subsidies funded directly through the Temporary 

Assistance for Needy Families (TANF) program, the Social Services Block Grant, or state expenditures claimed as 

TANF maintenance of effort funds. The ASPE estimate was produced using a different methodology than the fiscal 

year 2015 figure cited earlier in this report: it includes subsidies funded through these additional related government 

funding streams whereas the 2015 figure, from HHS’s Administration for Children and Families, is limited to subsidies 

funded through CCDF only and reported by states to HHS. Additionally, the ASPE estimate is limited to children in 

the 50 states and Washington, D.C. only. See ASPE, Factsheet: Estimates of Child Care Eligibility & Receipt for 

Fiscal Year 2015. Fiscal year 2015 data were not available at the time of our briefing in October 2018. Therefore, the 

briefing slides in enclosure I reflect data from fiscal year 2013, the most recently available data at that time.
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HHS also estimated that, among families who met federal eligibility criteria in fiscal year 2015, 

children from lower-income families were more likely to receive child care subsidies compared 

to children from higher-income families. For example, 45 percent of 5-year-olds from families 

with incomes below the federal poverty line received subsidies, while 11 percent of 5-year-olds 

with family incomes between 150 and 199 percent of poverty received subsidies. In addition, 

HHS estimated that, for those eligible under federal rules in fiscal year 2015, preschool-aged 

children were more likely to receive subsidies compared to older, school-aged children.14 For 

example, 51 percent of 3-year-olds from families with incomes below the federal poverty line 

received subsidies, while 29 percent of 6- to 9-year-old children with family incomes below the 

poverty line received subsidies. 

Almost All States Plan to Spend New Funds on Activities Related to CCDBG Act 

Requirements, and One-Third to Address Wait Lists, Despite Future Funding Uncertainty

Almost all states (44) reported they expect to spend the new discretionary CCDF funding from 

the Consolidated Appropriations Act, 2018, on at least one of several state child care activities

related to CCDBG Act requirements, according to our survey.

15 The most frequently reported 

activities were child care provider payment rates and parental copayments (31 states), 

professional development of the child care workforce (30 states), and consumer education (30

states) (see fig. 3 in enclosure I). For example, under the CCDBG Act, states must certify that 

their child care provider payment rates are sufficient to ensure that children who are eligible for 

subsidies have the same access to child care services as children who are not eligible for CCDF

subsidies. When determining payment rates for CCDF providers, states are required to consider 

the costs associated with higher-quality care.

16 Officials in two states told us their states plan to 

increase payment rates for subsidized child care providers who provide nighttime and weekend 

care, in an effort to promote access to child care for families with nontraditional work hours. 

Another state plans to use these funds to increase payment rates for providers of infant and 

toddler care to increase access for eligible infants and toddlers, according to its CCDF 

administrator. 

Three-quarters of states we surveyed (38) also reported they expect to spend the new funds on 

at least one additional state child care activity that is not explicitly required.

17 The activities most 

frequently cited were for a tiered quality rating system (25 states), a child care resource and 

referral system (20 states), and spending on quality activities beyond the required minimum (20

states) (see fig. 4 in enclosure I). According to HHS, states are required to provide information 

on child care provider quality, as determined by a quality rating and improvement system or 

other indicator of quality, if available.18 Although tiered quality rating systems are not required,

 14GAO previously found that children who received CCDF subsidies in an average month in 2011-2012 were often 

younger and from lower-income families when compared to all eligible children. GAO-17-60. 

15Of the remaining states, six answered “don’t know” for all activities, and one answered either “no” or “don’t know” 

for all activities. 

1642 U.S.C. § 9858c(c)(4)(B)(iii)(II), (c)(5). In setting payment rates, states must ensure equal access for CCDFeligible children to child care services that are comparable to child care services provided to families who do not 

receive subsidies. 42 U.S.C. § 9858c(c)(4)(A). HHS suggests states use a benchmark of the 75th percentile of rates 

reported in the market rate survey for payment rates, while noting there is no specific threshold set for equal access.

17Of the remaining states, eight states answered “don’t know” for all optional activities, four states answered either 

“no” or “don’t know” for all activities, and one state answered “no” for all activities. 

1842 U.S.C. § 9858c(c)(2)(E)(i)(II), 45 C.F.R. § 98.33(a)(3).
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some state officials we interviewed were planning on using funds to increase reimbursements 

for high-quality child care providers (which would be determined through a quality rating 

system), while other state officials planned to use funds on efforts to implement or improve their

current tiered quality rating system. According to CCDF administrators from several states, 

these efforts can incentivize child care providers to increase the quality of their child care 

services to qualify for higher reimbursements. In the absence of the new funds, officials in one 

state, for example, said they may have needed to disenroll some families receiving subsidies in 

order to reallocate needed funds to implement and administer their rating system. Without the 

new funds, officials in another state said they would not have been able to update the state’s 

tiered quality rating system, which is necessary to create a sufficient financial incentive for child 

care providers to improve the quality of their service.

Nearly one-third of states (16) reported in our survey that they plan to use new CCDF funds to 

pay for subsidies for children on their wait lists to receive child care, among other subsidyrelated plans.

19 States may use a wait list when they do not have sufficient CCDF funds to 

provide subsidies to all eligible families that apply.20 According to our interviews with CCDF 

administrators, all 5 states that use a wait list might have had to expand their wait lists in the 

absence of the new funds. For example, one state’s CCDF administrator told us the state’s wait

list may have expanded further without the new funds after already growing following 

implementation of the 12-month eligibility redetermination requirement, which allowed 

participating families to continue receiving subsidies for a longer period of time. Without the new

funds, another state might have needed to further restrict its priority population for child care 

subsidies, in effect, reducing the number of families that receive priority, which would contribute 

to an increase in the size of the state’s wait list, according to a state official. Similarly, officials in 

half of the states we interviewed without wait lists indicated they might have needed to create 

one had they not received the new funds.

However, several state CCDF administrators expressed uncertainty about their states’ plans for 

using the new CCDF funds in our interviews (conducted in May and June 2018). Officials from 

more than a third of the states we interviewed (6) said their spending plans were still in flux. In 

some of these states, officials said they were still developing and reviewing their funding 

proposals as part of their state’s legislative and budgeting process and they were awaiting 

future legislative approval or spending authorization.21 For example, in one state, the CCDF 

 19Other subsidy-related areas in our survey in which states reported plans to spend new CCDF funds include 

provider payment rates and parental copayments (31 states), 12 month eligibility period and graduated phase-out 

requirements (25 states), and tiered quality rating systems (25 states). 

20Our survey collected information on whether states planned to spend at least some of the new funds on subsidies 

for children on a wait list, if applicable in that state. Our survey did not collect information on whether states were 

using a wait list. The National Women’s Law Center reported in 2017 that 19 states used a wait list for CCDF. See 

National Women’s Law Center, Persistent Gaps: State Child Care Assistance Policies 2017 (Washington, D.C.: 

October 2017). According to our survey data, 12 of the 19 wait list states in the National Women’s Law Center study 

reported that they would spend at least some of the new funds on subsidies for children on a wait list.

21In August 2018, HHS issued a memorandum to states containing guidance on spending the new CCDF funds. 

According to the memo, states retain flexibility on how to invest funds to best meet their needs, though they were 

requested to remain mindful of congressional priorities that the funds are intended to increase access to affordable, 

high-quality child care to more low-income working families. The memo states there were no changes to discretionary 

spending requirements, aside from the prohibition that no funds made available in the fiscal year 2018 appropriations 

may be provided to any child care provider if a serious injury or death occurred with that provider due to a 

substantiated health or safety violation. States have until September 30, 2019, to obligate the new funds and until 

September 30, 2020, to liquidate them, according to HHS.
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administrator said she was awaiting information on how much money the state would receive 

before she planned to convene stakeholder groups to discuss potential funding proposals. In 

another state, the CCDF administrator said her office needed to wait for other local budget 

appropriation decisions before her office could commit the new CCDF funds to specific 

priorities. Officials in more than half of the states we interviewed also told us they faced

challenges making spending decisions because it was unclear to them whether the new funds 

would be provided on an ongoing basis.22 For example, CCDF administrators in two states that 

plan to expand subsidies to children on their wait lists expressed concerns about having to 

disenroll children from the program if funding is discontinued.

Agency Comments 

We provided a copy of this draft report to HHS for review and comment. HHS provided technical 

comments only, which we incorporated as appropriate.

We are sending copies of this report to the appropriate congressional committees, the Secretary 

of the Department of Health and Human Services, and other interested parties. In addition, the 

report is available at no charge on the GAO website at http://www.gao.gov.

If you or your staff have any questions about this report, please contact me at (202) 512-7215 or 

larink@gao.gov. Contact points for our Offices of Congressional Relations and Public Affairs 

may be found on the last page of this report. GAO staff who made key contributions to this 

report are listed in enclosure IV.

Kathryn A. Larin 

Director, Education, Workforce, and Income Security Issues 

Enclosures – 4

 22Future funding is subject to the annual appropriations process. 
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Enclosure I: Briefing to Senate Committee on Health, Education, Labor and Pensions and 

House Committee on Education and the Workforce, October 24, 2018
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Enclosure II: State Child Care Activities, Including Those Related to Requirements Under 

the Child Care and Development Block Grant (CCDBG) Act of 1990, as amended, and 

Relevant Federal Regulations

Shaded activities are those with related requirements from the CCDBG Act of 1990, as amended, and relevant federal regulations.

Category Activity Description

Protect the Health 

and Safety of 

Children in

Child Care

Licensing States must certify that they have licensing requirements for child care 

providers, although they may exempt certain types of providers. 42 U.S.C. 

§ 9858c(c)(2)(F), (K).

Monitoring/Inspections 

for compliance with 

health, safety, and fire 

standards

States must certify that they have policies to annually conduct 

unannounced inspections of all licensed Child Care and Development Fund 

(CCDF) providers for compliance with all child care licensing standards, 

including health, safety, and fire standards, including at least one 

prelicensure inspection. State licensing inspectors must be trained in the 

state’s health and safety standards and licensing rules and the ratio of 

licensing inspectors to child care providers must be sufficient to ensure that 

inspections occur in a timely manner. 42 U.S.C. § 9858c(c)(2)(K)(i).

Criminal background 

checks 

States must have policies in effect and must conduct comprehensive 

criminal background checks every 5 years for child care staff of providers 

that are licensed, regulated, or registered by the state, or that serve 

children receiving CCDF subsidies. Child care providers receiving CCDF 

funds are prohibited from employing child care staff who refuse to consent 

to the check. Providers are also prohibited from employing child care staff 

who meet one of the disqualifying criteria mentioned in the law, including 

convictions for specified felonies, or violent misdemeanors committed as 

an adult against a child. 42 U.S.C. § 9858f.

Health and safety 

standards 

States must certify that they have health and safety standards that are 

applicable to CCDF providers, and procedures to ensure that CCDF 

providers comply with them. States are required to develop health and 

safety requirements in specific topic areas, such as the use of safe 

sleeping practices and pediatric first-aid. States must also certify that all 

CCDF providers will receive minimum health and safety training in these 

areas, to be completed pre-service or during an orientation period, in 

addition to ongoing training. 42 U.S.C. § 9858c(c)(2)(H)(ii)(I).

Help Parents 

Make Informed 

Consumer 

Choices and 

Access 

Information to 

Support Child 

Development

Consumer education States must certify that they will collect and disseminate information to 

parents of CCDF-eligible children, the public, and child care providers 

about the availability of the full diversity of child care services that will 

promote informed child care choices. States must make public 

electronically the results of monitoring and inspection reports, as well as 

information on deaths, serious injuries, and substantiated child abuse for 

child care providers in the state. 42 U.S.C. § 9858c(c)(2)(E). HHS 

regulations also specify that states must have a website describing 

licensing, monitoring, and background check processes, as well as a 

searchable list of licensed child care providers, along with information 

about the provider’s quality rating, if available. 45 C.F.R. § 98.33. 

Child care resource 

and referral systema States may develop a child care resource and referral system to support state quality improvement efforts, for example, through local or regional 

agencies that provide training and professional development, coaching, 

and technical assistance to child care providers and consumer education to 

parents. See, 42 U.S.C. § 9858e(b)(5).

Support Equal 

Access to Stable, 

High-Quality Child 

Care for LowIncome Children

12-month eligibility 

period

States must ensure that children who receive CCDF assistance will 

continue to do so for at least 12 months before their eligibility 

redetermination, regardless of temporary changes in parents’ work or 

activities and changes in family income, as long as income does not

exceed 85 percent of state median income (SMI). 42 U.S.C. § 

9858c(c)(2)(N)(i).
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Shaded activities are those with related requirements from the CCDBG Act of 1990, as amended, and relevant federal regulations.

Category Activity Description

Graduated phase-out 

of assistance

States must certify they have policies and procedures to allow for a 

graduated phase-out of assistance for children whose family income at 

redetermination exceeds the initial eligibility limit but is below 85 percent of 

SMI. 42 U.S.C. § 9858c(c)(2)(N)(iv).

Child care provider 

payment rates

States must demonstrate that payment (reimbursement) rates for CCDF 

providers are based on the results of a statistically valid and reliable market 

rate survey, or alternative methodology, and take into account costs 

associated with higher-quality care when setting payment rates. States 

may differentiate provider payment rates according to geographic area, age 

or needs of the child, and nontraditional care hours, for example, and they 

are required to reevaluate payment rates at least every 3 years. 42 U.S.C. 

§ 9858c(c)(4)(B).

Parental copayments States must provide that they will establish and periodically revise, by rule, 

a sliding fee scale that provides for cost sharing by families that receive 

CCDF services. 42 U.S.C. § 9858c(c)(5). Families must contribute to the 

cost of care based on family size and income. States may exempt families 

with income at or below the poverty level from copayments, among other 

categories (families caring for children in protective services or families that 

meet other conditions established by the state). 45 C.F.R. § 98.45(k).

Enhance the 

Quality of Child 

Care and the Early 

Childhood 

Workforce

Professional 

development of the 

child care workforce 

States must describe the training and professional development 

requirements designed to enable providers to promote the social, 

emotional, physical, and cognitive development of children, including 

providing an assurance that these requirements will be conducted on an 

ongoing basis and provide for a progression of professional development. 

42 U.S.C. § 9858c(c)(2)(G). 

Early learning and 

developmental 

guidelines

States must provide an assurance that they will develop, maintain, or 

implement early learning and developmental guidelines for statewide use 

by child care providers for children from birth to kindergarten entry that 

cover the essential domains of early childhood development (i.e., cognition, 

and social, emotional, and physical development). 42 U.S.C. § 

9858c(c)(2)(T).

Quality set-aside In fiscal year 2019, states must use at least 8 percent of their CCDF funds 

on at least one of ten specified activities designed to improve the quality of 

child care services, such as the training and professional development of 

the child care workforce and evaluating the quality and effectiveness of 

child care programs. States may elect to spend more than the required 

minimum on quality activities. The minimum percentage states must spend 

on quality expenditures has increased in recent years, to a maximum of 9 

percent of CCDF funding for fiscal year 2020 and beyond. In addition, 

beginning in fiscal year 2017, states have been required to spend at least 

an additional 3 percent on quality expenditures for infants and toddlers.42 

U.S.C. § 9858e(a)(2)(A)(ii), (b).

High-quality program 

standards

States may support the development or adoption of high-quality program 

standards relating to health, mental health, nutrition, physical activity, and 

physical development. 42 U.S.C. § 9858e(b)(9). Standards create a 

common definition of quality for child care providers and can be used to 

help inform parents.

Tiered quality rating 

systems 

States may develop a tiered quality rating system for child care providers 

and services. 42 U.S.C. § 9858e(b)(3). These systems consist of a

systematic approach to assess, improve, and communicate the level of 

quality in early and school-age care and education programs. Such 

systems award quality ratings to programs that meet a set of defined 

program standards, encouraging a path of continuous quality improvement.

Accreditation of child States may support child care providers in the voluntary pursuit of 
Page 29 GAO-19-222R Child Care and Development Fund

Shaded activities are those with related requirements from the CCDBG Act of 1990, as amended, and relevant federal regulations.

Category Activity Description

care providers accreditation by a national accrediting body with demonstrated, valid, and 

reliable program standards of high quality. 42 U.S.C. § 9858e(b)(8). 

States may incorporate national accreditation systems into their quality 

rating systems to generally signify achieving higher levels of quality.

Wage supports for 

providers

States may provide wage supports and educational scholarships to child 

care providers. 45 C.F.R. § 98.53(a)(1)(vii).

Source: Child Care and Development Block Grant Act of 1990, as amended; Department of Health and Human Services (HHS) 

regulations; HHS CCDF Fundamentals Resource Guide; and HHS Form ACF-696. | GAO-19-222R.

Note: The state child care activities included in the table are not comprehensive. 

a

A child care resource and referral system could also be grouped with the activities that enhance the quality of child 

care and the early childhood workforce.
Page 30 GAO-19-222R Child Care and Development Fund

Enclosure III: List of States Interviewed

Alaska: Child Care Program Office, Division of Public Assistance, Department of Health and 

Social Services

Colorado: Office of Early Childhood, Department of Human Services

District of Columbia: Division of Early Learning, Office of the State Superintendent of Education

Florida: Office of Early Learning, Department of Education

Illinois: Division of Family & Community Services, Department of Human Services

Indiana: Office of Early Childhood and Out-of-School Learning, Family and Social Services 

Administration

Michigan: Office of Great Start, Department of Education

Montana: Early Childhood Services Bureau, Department of Public Health and Human Services

New Mexico: Child Care Services Bureau, Children, Youth and Families Department

North Carolina: Division of Child Development and Early Education, Department of Health and 

Human Services

Oklahoma: Child Care Services, Department of Human Services

Rhode Island: Department of Human Services

South Carolina: Division of Early Care and Education, Department of Social Services

South Dakota: Division of Child Care Services, Department of Social Services

Utah: Office of Child Care, Department of Workforce Services
Page 31 GAO-19-222R Child Care and Development Fund

Enclosure IV: GAO Contact and Staff Acknowledgments

GAO Contact

Kathryn A. Larin, (202) 512-7215 or larink@gao.gov

Staff Acknowledgments

In addition to the contact named above, Janet Mascia (Assistant Director), Avani Locke 

(Analyst-in-Charge), and Elizabeth Hartjes made key contributions to this report. Also 

contributing to the report were Seto Bagdoyan, James Bennett, Thomas James, Kirsten Lauber, 

Sheila R. McCoy, Jonathon Oldmixon, Jessica Orr, Jason Palmer, Brenda Rabinowitz, James 

Rebbe, Jessica Rider, Michelle Sager, and Almeta Spencer.

(102730)
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