Jazmin Orozco Rodriguez | KFF Health News (TNS)

Candy Murnion remembers vividly the event that pushed her to open her first day care business in Jordan, a town of fewer than 400 residents in a sea of grassland in eastern Montana.

Garfield County’s public health nurse, one of few public health officials serving the town and nearly 5,000 square miles that surround it, had quit because she had given birth to her second child and couldn’t find day care.

“My primary goal was to give families a safe place to take their children so they could work if they needed to,” said Murnion, 63. She started in 2015 with eight slots, the maximum she could cover herself, and slowly grew. Then, during the covid-19 pandemic, a surge in federal aid to child care programs helped her raise wages for her workers and expand to a second facility.

Today, her day care programs, the only ones in Jordan, can serve up to 30 children, ranging from 6 weeks old to school age. But after that pandemic-era funding support ended in September, Murnion began to wonder how long she could sustain her expanded capacity, or whether she’d need to raise prices or lower enrollment.

And she isn’t alone.

Data collected prior to the pandemic shows that more than half of Americans lived in neighborhoods classified as child care deserts, areas that have no child care providers or where there are more than three children in the community for every available licensed care slot. Other research shows parents and child care providers in rural areas face unique barriers. Access to quality child care programs and early education is linked to better educational and behavioral outcomes for kids and can also help link families and children to immunizations, health screenings, and greater food security by providing meals and snacks.

Policymakers and researchers now fear that inequitable child care access threatens the sustainability and longevity of rural communities.

“If we want to keep rural parts of this country alive and thriving, we need to address this,” said Linda Smith, director of the Early Childhood Initiative at the Bipartisan Policy Center, a Washington, D.C.-based think tank.

According to an October report that Smith co-authored, there is a 35% gap between the need for and availability of child care programs in rural areas, compared with 29% in urban areas, based on data from 35 states.

The report echoed concerns local, state, and national experts have raised for a number of years.

A report published last year by the National Advisory Committee on Rural Health and Human Services found that, per capita, more parents rely on family members or friends for child care in rural areas than in urban areas. This isn’t sustainable for parents, said Cara James, CEO and president of Grantmakers in Health, a nonprofit that helps guide health philanthropy.

“Right now, we have a system that’s very expensive for people who can afford it and for people who can access it, not necessarily available to all those who need it,” James said. “That’s leading us to rely on other workarounds that are not ideal or ones that are giving the children the best support that they need to grow into healthy adults.”

For example, according to a state report, Montana’s total child care capacity met 44% of estimated demand in 2021 and infant care capacity met only 34% of estimated demand. Garfield County had only 23% of potential demand for children under six. Nationally, the rural health advisory committee has found, child care deserts are most likely to be located in “low-income rural census tracts.”

The dearth of child care in many rural communities exacerbates workforce shortages by forcing parents, including those who work in health care locally, to stay home as full-time caregivers, and by preventing younger workers and families from putting down roots there.

Eighty-six percent of parents in rural areas who are not working or whose partner is not working said in a 2021 Bipartisan Policy Center survey that child care responsibilities were a reason why, while 45% said they or their spouse cared for at least their youngest child. Staying home to care for children is a responsibility that disproportionately falls on women, affecting their ability to participate in the workforce and make an independent living.

A report from the rural health advisory committee shows that when center-based care is readily available in a community, the percentage of mothers who use that type of care and are employed doubles from 11% to 22%.

According to the Biden administration, pandemic emergency funding increased maternal labor workforce participation, stabilized employment and increased wages for child care workers, tempered costs for families, and helped providers afford their facilities.

That funding included $52 billion in emergency aid allocated by Congress for child care program owners and low-income families. Murnion’s day care was one of an estimated 30,000 in rural counties that received federal grants.

She said the roughly $100,000 she received in federal aid allowed her to raise wages for her workers to $13 an hour and expand her facility space. She said she doesn’t take a paycheck from the business and instead relies on income from a family ranch and trucking business.

Now that the federal aid programs have expired, Murnion and other child care operators nationwide are wrestling with how to sustain those wages without hiking the cost of care for parents.

The Biden administration requested congressional approval of $16 billion to extend the pandemic-era child care stabilization program but doesn’t have enough support to continue the funding, despite nearly 80% of voters supporting increasing federal funding for states to expand their child care programs.

According to the administration, the funding would support more than 220,000 child care providers in the U.S. that collectively serve more than 10 million kids. Montana would receive an estimated additional $46 million if Congress approved the request.

Although federal aid helped Murnion get through the pandemic, she said she doesn’t want to rely on the government forever. She charges parents $30 a day for one child and $22 a day each for siblings. And she doesn’t charge parents for days their children don’t attend. If she does need to raise prices, Murnion said, she’ll increase the per-sibling cost.

The pandemic provided some meaningful lessons, said Smith of the Bipartisan Policy Center. “Those stabilization grants were, I think, a key to what we actually need to do with child care down the road.”

The number of child care programs has grown since before the pandemic in most states, but the employee count per facility has decreased. The federal cash infusion helped child care employment rebound after a 35% dip at the beginning of the pandemic. By November 2022, the number of workers in child care jobs had climbed to 92% of the pre-pandemic level.

In the best circumstances, Smith said, parents would pay more for child care, and the corresponding supply or availability of programs would increase. But because parents are struggling to keep up with the rising costs, which in some places can be more than in-state college tuition, supply is stagnant.

Smith said the end of federal aid programs kicked the issue back to state and local governments. “I think most people would agree that what we need is some type of funding that goes to the programs to keep it so that they can do what they need to do and not charge the parents for it,” she said.

Some state and local governments are doing so. In Alabama, lawmakers approved $42 million last year in the state budget for child care. The Missouri state legislature approved $160 million for child care. Voters in rural Warren, Minnesota, narrowly approved a half-percent sales tax to support a child care center that was struggling to stay open.

During last year’s legislative session, Montana lawmakers and Republican Gov. Greg Gianforte approved new laws to improve child care access, including removing state licensing requirements for small in-home day cares and expanding a program that helps lower-income families pay for child care.

“You can’t sit here in Washington, D.C., and figure out how you’re going to get child care out in eastern Montana,” Smith said. “It just doesn’t work.”

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(KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

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