Milestone 2

Access to Quality Care

Birth through age 5

Children need access to quality care in their earliest years to grow, learn, and build a strong foundation for a lifetime of well-being. That means a full range of supports — including child care, special education, well-child visits, behavioral health, and developmental screenings — needs to be accessible and affordable for families.

Why it’s important

The first five years are the most rapid period of brain development in a child's life. When families can access affordable, inclusive, and culturally responsive early learning, child care, and health care, children are more likely to:

Benefit from consistent relationships, environments, and care.
Arrive at kindergarten healthy, ready to learn, and with more skills and confidence.
Thrive in school and throughout life.

Regular well-child visits, developmental screenings, oral health care, and early behavioral health supports help identify and address needs before they become barriers. These services protect children's health and development during the window when intervention matters most.

How Oregon measures up

Strengths

State preschool spending per child

2^nd

Oregon is 2nd in the nation in state preschool spending per child at $18,637 per child in 2023–24, allowing providers to offer better wages, longer hours, and higher quality care.

NIEER’s 2024 Oregon State Profile and Oregon press release.

Preschool access for 3-year-olds

14^th

Oregon ranks 14th nationally for state preschool access for 3-year-olds and enrolls 12% of Oregon 3-year-olds in state pre-K, compared to 8% nationally.

NIEER’s Oregon profile provides the rank, while its Oregon press release states that Oregon served 12% of 3-year-olds compared with 8% nationally. These figures include Oregon’s two state-funded programs: OPK and Preschool Promise.

Oregon Health Plan eligibility

6^yrs

Oregon children are continuously eligible for the Oregon Health Plan until age 6, well above minimum federal Medicaid requirements.

Gaps

Preschool access for 4-year-olds

34^th

Oregon ranks 34th nationally for 4-year-old preschool access (state pre-K only). This NIEER rank reflects the share of Oregon 4-year-olds enrolled in state-funded preschool (OPK and Preschool Promise) in 2023–24 — about 17% of Oregon 4-year-olds.

Verified for 2023–24 by the NIEER Oregon profile and Oregon press release. The rank covers only state-funded pre-K—OPK and Preschool Promise—not all preschool or Head Start enrollment.

Child Care and Early Learning

Indicator 1

Licensed child care supply

In child care deserts, there are not enough state-regulated child care slots available for the children who need care. A shortage means even families who can afford to pay cannot find an available slot. Because of the higher staffing ratios needed when caring for infants and toddlers, these slots are often both the scarcest and the most expensive to maintain.

Key Takeaway

Oregonians’ access to preschool-age child care has improved in recent years, but acute shortages persist statewide, especially for infant and toddler care.

Oregon recommendations

Align reimbursement rates with the true cost of care rather than relying only on market rates.

Build on what is already working in Oregon, such as the Child Care Infrastructure Fund and the Baby Promise pilot.

Address the child care workforce as economic infrastructure with fair wages and accessible pathways into the profession.

Target supply-building investments with an explicit equity framework for rural communities and communities of color, as Oregon did with the Child Care Capacity Building Fund in 2022.

Indicator 2

Child care affordability

Systemic barriers — including inadequate funding, waitlists, and limited provider participation — prevent income-eligible families from accessing Oregon’s Employment Related Day Care (ERDC) program. Even for many middle-income families, and some higher-income working families, child care remains unaffordable.

Note: Oregon’s ERDC program has a waitlist due to increased demand and limited funding. To qualify, families must have an eligible child care need, which includes employment, school or job training, TANF participation, or involvement with child welfare. Through recent expansions, families experiencing homelessness, domestic violence, or teen parents may also qualify. Families generally must enter below 200% of the Federal Poverty Level (FPL), with eligibility extending up to 250% FPL or 85% of state median income. Children are now eligible regardless of immigration status. (DELC ERDC Program Page; ERDC Immigration Status Expansion)

Key Takeaway

Availability and affordability continue to hamper access to child care, with significant effects for children, families, and Oregon’s economy.

Oregon recommendations

Expand access to universal preschool statewide.

Build toward affordable, high‑quality preschool access for all children, regardless of income, geography, or setting, because early learning is a public good.

Remove administrative barriers to subsidy access.

Reduce paperwork burdens, delays, and churn that prevent families from receiving assistance.

Strengthen provider and workforce stability through policies designed to support greater affordability.

Align subsidy and preschool funding strategies with the true cost of care, so providers can retain staff and serve families consistently.

Address affordability for middle‑income families.

Design solutions that address how child care affordability burdens middle-income as well as low-income families.

Advance equity by designing for real family circumstances.

Center subsidy access and preschool expansion around the realities of rural communities, immigrant families, communities of color, and families working nontraditional hours.

Indicator 3

Access to early learning

State-funded preschool (Oregon Prenatal to Kindergarten and Preschool Promise) and federal Head Start and Early Head Start, which are designed to serve children facing the greatest barriers to early learning and healthy development, are limited by available funding. Even when a child qualifies, there may not be a publicly funded slot available for them.

12,597 children enrolled in state-funded preschool

6,840

OPK Enrollment

targeted to families at 100% FPL

5,757

Preschool promise enrollment

targeted to families at 200% FPL

NIEER 2024 Oregon profile and profile PDF

Key Takeaway

Although Oregon’s public investment in early learning has improved access, too many children and families still remain unserved.

Oregon recommendations

Increase outreach and coordinate enrollment across early learning programs to ensure every program is fully utilized by families.

Create more coherent pathways and multiple accessible entry points for families across programs to reduce disconnection between systems.

Build equity into expansion decisions in communities with the greatest unmet need, including rural counties, communities of color, and communities with high concentrations of children in poverty.

Ensure adequate inflationary increases to providers annually, so existing programs are financially sustainable for the long term.

Indicator 4

Early Intervention and Early Childhood Special Education

When Early Intervention (EI, ages 0–3) and Early Childhood Special Education (ECSE, ages 3–5) services are inadequate or delivered in segregated settings, we miss opportunities to intervene during critical windows of brain development, leading to higher long-term costs across the K–12 system and increased family instability.

EI and ECSE Reach

14,544

Oregon children (birth–5) received EI and/or ECSE services

April 2024

Key Takeaway

Oregon has made real progress in serving more young children with disabilities in inclusive early learning settings, but too many children, especially those with more significant support needs, still receive services separately from their peers. Inclusion requires the right staffing, training, and classroom supports to work well for every child.

Oregon recommendations

Expand inclusive preschool and child care options.

Increase the number of early learning settings that can serve children with disabilities alongside typically developing peers, especially in communities where inclusive options remain limited.

Ensure inclusive placements are fully supported.

Provide sustained funding for specialized staff, coaching, training, and classroom supports so inclusion is meaningful and responsive to children’s individual needs.

Strengthen how access and quality are measured.

Use IDEA‑aligned measures that track timely, individualized services delivered in natural and inclusive environments.

Target improvement where access gaps are greatest.

Prioritize policy and funding changes for children with more significant support needs, who remain the least likely to access inclusive early learning settings.

Health Care

Indicator 5

Access to early health care

Even insured children may not receive adequate care and services, such as routine well-child visits, developmental screening, oral health services, and early behavioral health supports. For children on Medicaid, these services are part of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), the federal pediatric benefit designed to deliver comprehensive preventive, dental, developmental, mental health, and specialty care.

Oregon Health Plan enrollment

139,340

children enrolled, ages 0–5

July 2026

Age grouping aligns with Oregon’s continuous eligibility policy.

Key Takeaway

Oregon’s system is doing comparatively well on developmental screening and has improved on well-care and dental prevention since 2020. But too many young children still miss core oral health services and early behavioral health supports, often due to provider shortages, lack of Medicaid acceptance, and geographic access barriers.

Oregon recommendations

Ensure children’s health care providers receive sustainable payment rates from the Medicaid program.

Require coverage of the full array of needed services under the Early Periodic Screening, Diagnostic, and Treatment provision of Medicaid.

Recognize that children are not just small adults.

Children have unique needs, and OHA should require data on network adequacy to be disaggregated by age range.

Maintain Oregon’s commitment to Cover All Kids to ensure all of Oregon’s children can access the care they need.

Protect the progress made with 5-year continuous eligibility by ensuring easy renewals/presumptive eligibility.

Indicator 6

Access to early social-emotional health services

National research suggests between 13% and 25% of preschool-age children have social-emotional or behavioral health needs. Oregon Health Plan set a goal of delivering social-emotional supports to 11% of enrolled preschool-age children in 2025, which is below the range of identified need. Only 5% of Oregon children ages 1–5 enrolled in OHP received social-emotional supports, far short of both the national level of identified need and Oregon’s own goal. Low rates reflect system capacity gaps, including provider shortages, limited referral pathways, and inadequate reimbursement for community-based behavioral health care.

Key Takeaway

Oregon has committed to measuring and improving social-emotional health access for its youngest children, but the gap between actual access and Oregon’s own benchmark signals an urgent need for workforce investment and expanded referral pathways.

Oregon recommendations

Invest in the early childhood behavioral health workforce.

Expand and sustain the workforce serving children ages 0–5, including community‑based providers and integrated settings such as pediatric, early learning, and home visiting environments, where young children and families already have relationships.

Strengthen pathways from screening to treatment.

Ensure developmental and social‑emotional screenings lead to timely intervention by improving referral pathways, care coordination, and follow‑through.

Use CCO accountability to close the access gap.

Leverage Oregon’s CCO Incentive Metrics to hold the system accountable for improving access to social‑emotional health services.

Address system capacity.

Increase reimbursement rates and reduce administrative barriers for community‑based behavioral health care so provider capacity can grow to meet demonstrated need among young children.

Acting on the data

Oregon’s early care and education supply is growing, supported by increased state investment. But significant gaps remain, and the system is not serving Oregon's youngest children equitably or adequately.

In addition, Oregon’s rate of children’s health insurance coverage is among the highest in the nation, yet too many families still face barriers to receiving consistent, connected care, especially for families in rural communities and communities of color. With Federal Medicaid cuts under H.R.1 projected to cost Oregon $4.4 billion in 2027-29 and $6.9 billion in 2029-31, access may be even more challenging.