Paid Leave in the U.S.


Paid family and medical leave and sick leave can help workers meet their personal and family health care needs, while also fulfilling work responsibilities. Access to paid leave is a particularly salient concern for women, who comprise nearly half of the nation’s workforce and who are often the primary caretaker for children and aging parents. Yet, many U.S. workers do not have access to paid leave time.

The federal Family and Medical Leave Act (FMLA) requires eligible employers to provide certain workers unpaid family leave; however, unlike nearly all other industrialized nations, the U.S. does not have national standards on paid family or sick leave, despite strong public support. Paid leave has garnered increasing attention among elected officials at the national and local level, particularly in light of the COVID-19 pandemic. Some temporary paid leave benefits programs were enacted as a result, though the majority of those have since expired. Some employers also report taking more permanent action on their paid leave policies during this time. Some efforts at the federal level have begun to gain momentum, including a provision of the 2020 Build Back Better Act that would create a national paid family and medical leave program. Additionally, the Healthy Families Act, which was introduced in 2019, which would require most U.S. employers to offer workers paid sick leave, though efforts to bring it to a vote have since stalled. Many states and localities have passed laws to expand access to paid leave to workers in their states. Employees not covered by these local laws must rely on voluntary employer policies, which can vary considerably in scope and compensation.

This fact sheet summarizes federal, state, and local policies on paid family and medical leave and paid sick leave and presents data from KFF Employer Health Benefits Surveys on the share of firms that offer workers these benefits.

Paid Sick Leave: Paid sick leave can be used to recover from a short-term injury or illness such as a cold or for doctor’s appointments. It is often provided on an accrual basis up to a set number of hours or days per year, such as one hour of leave earned for every 30 hours worked up to seven days per year, and replaces 100% of the worker’s regular wages. On average, private sector workers are offered seven days of paid sick leave per year. Paid sick leave benefits are paid by the employer.

Paid Family and Medical Leave: Paid family and medical leave typically provides a set number of weeks or months to be used for a worker’s own serious, longer-term health condition, to care for a family member with a serious health condition, or to care for or bond with a new child, and for reasons related to a family’s member’s military service. On average, it provides six to twelve weeks of fully or partially paid leave per year, without the need for accrual. Paid family and medical leave may be insured and is often funded by contributions from the employer and/or the worker.

Federal, State, and Local Policies on Sick and Family and Medical Leave

Sick Leave

According to the Bureau of Labor Statistics (BLS), eight in ten workers (79%) have access to paid sick leave through their employer in 2021; however, workers in certain occupations, part-time workers, and lower-wage workers are less likely to have access paid sick leave.

Proponents of a national paid sick leave mandate stress that workers should not be forced to choose between going to work sick and losing pay or their job, pointing to numerous studies on the benefits of paid sick leave, including ameliorating financial burdens, preventing the spread of illnesses (including coronavirus), increased use of preventive health care services, reduced on-the-job injuries, and fewer inappropriate emergency room visits. Opponents of a national paid sick mandate generally contend that a mandate is not necessary because many employers already provide these benefits or that it should be a voluntary benefit. They cite concerns about the financial implications for employers who would be required to provide this benefit, particularly for smaller businesses, and potential reductions in wages designed to offset those costs.

There is no federal requirement that employers offer paid leave to employees who are sick or need time off to care for a sick a family member. In 2020, the Families First Coronavirus Response Act (FFCRA) temporarily required employers with fewer than 500 workers and all public employers to provide up to two weeks of fully-paid sick leave to workers unable to work due to their own quarantine or symptoms of coronavirus. Those requirements expired at the end of 2020. In 2015, the Obama Administration issued an executive order that requires federal contractors to offer at least seven days of paid sick leave per year to their employees, on an accrual basis, which took effect in 2017. At the time of enactment, this applied to approximately 300,000 people working on federal contracts. Furthermore, government employees have generally had access to paid sick leave through employee benefits packages. Introduced in Congress annually since 2004 (with some modifications), the Healthy Families Act would require employers nationwide with 15 or more employees to provide at least one hour of earned paid sick leave for every 30 hours workers, up to 56 hours per year (7 days based on a 40-hour work week). Employees would be able to use sick leave for their own illness, to care for a sick family member, obtain medical care, or address needs resulting from domestic violence, sexual assault, or stalking, known as “safe time.” The Healthy Families Act has stalled in the House and Senate.

There has been more traction on paid sick leave policies at the state and local level. Since the first law was passed by voter initiative in 2006 in San Francisco, fourteen states plus D.C., and 20 other localities have passed laws requiring covered employers to provide eligible employees paid time off for their own illness or to care for sick children (Figure 1).1 Two additional states have general paid leave laws that allow employees to use accrued leave for any reason, including illness. Eight states and eleven localities permit use of accrued paid sick leave for workplace closure or closure of the worker’s child’s school or childcare associated with a public health emergency. All state and all local paid sick leave laws except Pittsburgh, Oakland, and Berkeley permit use of accrued leave for “safe time.” The scope and generosity of paid sick leave laws vary. Most state and local laws have exemptions based on the size and type of employer and/or permit employers to impose certain worker eligibility requirements. Most laws also permit employers to impose a waiting period before new employees can use accrued leave, most often 90 days from the start of employment. Laws generally provide for accrual of 30-40 hours per year, though there is wide variation by policy, with lower accrual rates for smaller employers in many cases.

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Figure 1: State and Local Paid Sick Leave Laws, 2021

Family and Medical Leave

FMLA and Unpaid Family and Medical Leave

The most recent nationwide policy reform occurred in 1993, when the federal government passed the Family and Medical Leave Act (FMLA), giving eligible employees up to 12 weeks of unpaid, job-protected leave per year for their own serious health condition, to care for a seriously ill family member, and for the arrival of a new child, as well as up to 26 weeks to address needs related to a family member’s military deployment. The law applies to public agencies and private employers with 50 or more employees. The FMLA has provided job security to millions of workers who need to take time off work for a qualifying reason; however, just over half (56%) of the workforce is eligible for FMLA protections because small employers are exempt, and even in covered worksites, not all employees are eligible. As of 2018, 31 states and the District of Columbia have opted to expand job-protected leave benefits beyond FMLA’s minimum standards by expanding eligibility, the duration of leave, the definition of family members, or qualified reasons for taking leave in the private and/or public sector.

Paid Family and Medical Leave

BLS data found that less than one in four (23%) workers have access to paid family leave in 2021. Data on the share of workers with access to paid medical leave for a longer, serious illness are limited, but BLS also estimates that 40% of workers have access to short-term disability insurance.​

Proponents of a national paid family and medical program leave urge that it would provide employees with greater financial security when they must take an extended leave for medical reasons or to care for an ailing family member or new child. Research indicates that access to paid family and medical leave is associated with improved physical and mental health for new parents, decreased infant mortality, financial security for caregivers in the short- and long-term, and improved connections to the workforce, particularly for women, who are more likely than men to be caregivers for children and older adults. Opponents often cite concerns about the impact of new federal requirements on businesses, government overreach into the free market, increased taxes for businesses (should that be the funding mechanism), as well as the financial implications a new benefit would have on wages and employment.

There have been many attempts to enact a national paid leave policy, but no permanent federal legislation has ever been passed. In 2020, the Families First Coronavirus Response Act (FFCRA) temporarily required U.S. employers with fewer than 500 workers and all public employers to provide up to two weeks of partially paid leave to workers who needed time off work to care for someone in quarantine or if their child’s school or daycare had closed due to the pandemic; however, requirement expired at the end of 2020.  The Family and Medical Insurance Leave (FAMILY) Act, re-introduced in 117th Congress, if passed, would create a national insurance program to provide workers up to 12 weeks of their partial income for their own serious health condition or that of an immediate family member, and for the birth or placement of a child. The program would be funded by employee and employer payroll contributions. The Build Back Better Act, H.R. 5376, was adopted by the House of Representatives on November 19, 2021, with the support of President Biden, and is being considered through budget reconciliation. This broad package of health, social, and climate change policies includes a provision for 4-weeks of partially-paid family and medical leave for nearly every U.S. worker, funded largely through general revenues. As of December 2021, the Senate continues to debate the legislation and its passage remains uncertain.

There has been some progress on paid parental leave for federal workers. The Federal Employee Paid Leave Act, which took effect in October 2020, grants federal employees 12 weeks of paid leave following the birth or placement of a child. The policy, part of the National Defense Authorization Act for Fiscal Year 2020, applies to 2.1 million civilian workers employed by the federal government, though employees must have been in federal service for at least one year to be eligible and the legislation must be reauthorized for each fiscal year.

Nine states and D.C. have enacted paid family and medical leave laws in their jurisdictions (Figure 2), an increase from four states in 2016.2,3,4 In November 2020, Colorado became the first state to enact paid family and medical leave through a ballot measure. These programs provide paid time off for a worker’s own serious illness, to care for a seriously ill family member, or to bond with a new child, with varying degrees of comprehensiveness. Three states also include time off for workers who need to address issues related to domestic violence, stalking, or sexual assault, known as “safe time.” One state permits use of paid leave for reasons associated with a public health emergency, effective Jan. 2022. Paid leave durations for an employee’s own serious medical condition range from 6 to 52 weeks per year and 4-12 weeks for family leave. Four states5 plus D.C. provide a 2–4-week extension for a worker’s own pregnancy-related health issues. Wage replacement ranges from 50% to 100% of regular pay, up to certain caps. Some states provide benefits on a sliding scale, with a higher percentage of wage replacement for lower-income workers. Coverage for public sector and self-employed workers varies by state. All have minimum earnings or employment length requirements to qualify, and some have 7-day unpaid waiting periods. Paid leave benefits are administered by the state or by employers with qualifying programs and are funded through employer and/or employee contributions.

Employer Health Benefits Survey Data

Paid Parental Leave

The 2019 KFF Employer Health Benefits Survey asked a nationally representative sample of non-federal public and private employers about the benefits they offer their employees. Overall, 25% of firms offer paid parental leave (either maternity, paternity, or both) to at least some employees for the birth or placement of a child. Thirty-five percent of workers are employed in firms that offer paid parental leave.

Paid parental leave offer rates vary by firm characteristics such as size and wage levels. Firms with 1,000 or more workers (35%) are more likely to offer paid parental leave than smaller firms (Figure 3). Among large firms (200 or more workers), firms with many higher-wage workers6 (41%) are more likely to offer paid parental leave than firms with few higher-wage workers (23%) (Figure 4).

Paid Sick Leave

The 2017 Employer Health Benefits Survey found that about two in three firms (68%) provide paid sick leave to their full-time workers (Figure 5). Large firms (94%) were more likely than small firms (3-199 workers) (67%) to provide paid sick leave to their full-time workers. While only a small fraction (1.7%) of firms in the U.S. are classified as large, they employ approximately 62% of the nation’s workforce. Between 2016 and 2017, the share of large firms offering paid sick leave to their full-time workers increased from 84% to 94%.

Paid leave benefits are far less prevalent for part-time workers and are more commonly offered by large firms. Over half of large firms (56%) provided paid sick leave to their part-time workers, compared to about a quarter (26%) of small firms. There is variation between different sizes of small and large firms in the provision of paid sick leave, for both full- and part-time workers.

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Figure 5: Percentage of Firms That Provide Paid Sick Leave to Full-Time and Part-Time Workers, by Firm Size, 2017

Whether or not a firm offers paid sick leave also depends on firm characteristics. Among large firms, private for-profit firms (88%) are less likely to offer this benefit than private not-for-profit (99%) and public employers (100%) (Figure 6). Additionally, large firms with at least some union workers (98%) are more likely than firms with no union workers (92%) to provide paid sick leave to their full-time staff.

Among non-federal employees, 87% work in firms that offer paid sick leave to their full-time workers, and 50% work in firms that offer this benefit to part-time workers. The lower likelihood of paid sick leave for part-time workers has a disproportionate impact on women, who are more likely than men to hold part-time jobs. Women are also more likely than men to care for children when they are sick and have to stay home from school.


Benefits such as sick leave and paid family and medical leave can help workers meet their personal and family health care needs with greater financial security. This issue has gained new urgency during the COVID-19 pandemic as workers needed time off work to recover from the virus and to care for children and other family members who had fallen ill. Some Democratic lawmakers have introduced legislation that would create a national paid family and medical leave program and a national paid sick leave program; however, it remains to be seen whether Congress will take these bills up. President Biden has spoken about the need for supporting American families, and the Senate is currently debating budget reconciliation legislation that includes four weeks of paid family and medical leave for all U.S. workers, though the future of this provision, and the legislation as a whole, is uncertain. Short of that, the movement for paid leave will likely continue to be centered on state and local policies or those voluntarily adopted by employers or negotiated through union contracts. Given that most people will need time off during their working lives to care for a personal or family illness, or for a new child, this issue will continue to be a salient concern for working families across the country in the years to come.

  1. The three local paid sick leave laws passed in TX are on hold due to a pending court challenge. NM's law takes effect July 1, 2022. CO's law for employers with fewer than 16 workers takes effect Jan. 1, 2022; the law is currently in effect for all other CO employers. Allegheny Co.’s law was enacted in Sept. 2021 and will take effect 90 days after the county posts compliance information for employers. All other state and local laws are in full effect.

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  2. Laws take full effect Jan. 1, 2022, for CT; Jan. 1, 2023, for OR; and Jan. 1, 2024, for CO. All other state laws are in full effect.

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  3. Hawaii has a state paid medical leave that provides up to 26 weeks of paid leave per year for an employee’s own serious health condition. Hawaii does not provide paid family leave.

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  4. Two-thirds (10) of the fifteen state laws (including DC) were enacted just in the past five years. Five were passed between 2008 and 2015.

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  5. WA, CT, OR, and CO.

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  6. Firms with many higher-wage workers are those where at least 35% of workers earn more than the 75th percentile of national earnings ($63,000 in 2019).

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