Envision the Future: Paid family and medical leave

Policy, technology, and government experts discussed the future of implementing paid family and medical leave programs across the nation at this Nava event.

What would a future where everyone in the nation has access to paid leave to care for a new baby, a sick loved one, or their own illness? Nava gathered experts and advocates in paid family and medical leave (PFML) to discuss this question, with a focus on implementation and policy.

Drawing from experience in the advocacy, policy, and technology challenges of implementing PFML across the country, panelists discussed issues such as building inclusively and how peoples’ lived experiences can impact product design. Nava Design Lead Makaela Stephens discussed Nava’s work helping to build Massachusetts’ first PFML program from scratch.


  • Tameka Henry, Voices of Workers Leader: Paid Leave for All

  • Greg Norfleet, Deputy Director of Operations for the Massachusetts Department of Family and Medical Leave

  • Kathleen Romig, Director of Social Security and Disability Policy, Center on Budget and Policy Priorities

  • Makaela Stephens, Nava Design Lead on Massachusetts’ PFML program

Watch the full panel.

Here are selected highlights, edited for concision and clarity.

The impact of chronic illness on a family

Tameka Henry

I have been a caretaker for my husband since he became disabled in 2006. He has a chronic illness called gastroparesis. It often lands him in the hospital and we had to fight for disability for him for years. With him not working, I became the main caretaker for our home and breadwinner. I'm often faced with the challenge of, do I take off work to care for my family, or do I go to work and work for a paycheck to make sure that we maintain our livelihood? Throughout the years, it's been challenging. I've lost jobs because you have to make that decision.

And I know that I'm not the only family that is faced with this and so that's why this work is so important to me and to many Americans. We really have to create policies that are inclusive of all families and all situations, because we never know when we're going to need it. Americans and families, we just don't have time to wait for a comprehensive policy that protects everyone.

What an equitable PFML program would look like

Kathleen Romig

Right now, some people are covered in their medical emergency if you're lucky enough to live in Massachusetts and have a great state program, or if you're lucky enough to work for Microsoft where you have a great program at your employer. But there are huge gaps in the systems that we have now. And what I would envision is a policy that protects everyone, whether you work for a big company or a small company, whether you work part-time or full-time, whether you're new on the job or you've been there for 20 years, whether you live in a blue state or red state. It would not only provide the cash that people need to replace the wages when they're not able to work, but it would also ensure that when they went back to work, they would still have a job and it would still be substantially the same job that they left.

And so I would envision something that was as inclusive as we could possibly imagine and inclusive also of the different reasons that people take leave. Like Tameka said, I think often people picture new moms and new babies when they think of paid family and medical leave. But most people who take paid family and medical leave are doing it because they themselves are unable to work because of their own illnesses and their own medical conditions. And to do that and to care for family members, to make sure that we're including all kinds of different reasons that people aren't able to go to work.

Greg Norfleet

Jumping in from Massachusetts, where paid family and medical leave is a reality, we have job protections in our program as well.

I'm excited the program adopted across the country, but I'm also very aware that the work is just starting. Getting the program passed and building a solution that meets those requirements are going to be huge accomplishments, but that's not where the work stops. The bills that you'll see pass, that list of stuff that needs to be in compliance with the law – that's really just the floor for what you can do in service delivery for benefit programs.

And honestly, if you get past that floor at launch, you're doing really well. Historically about 87% of government IT projects, with a budget of over $6 million, fail to launch for one reason or another. So realistically, what you're going to launch the day that paid family and medical leave becomes a reality for the rest of the country, it's not going to be everything that you want it to be on day one. So, but now that you're live, you've got to stay committed to the vision of inclusivity and of trying to make the program better, more accessible over time. And you should really be focused as in the government sense of putting the structures in place to continue improving that service for your stakeholders.

Tameka Henry

For me being a grassroots advocate, it would be important to me that all families know that this protection exists for them. I would like for there to be a campaign that highlights and shares where we have been, where we have come from, and how you are protected by this plan.

Makaela Stephens

Echoing all of this, I hope that when this program finally happens, it will be built to acknowledge that applicants are under a lot of stress, even if it's a kind of joyous stress while giving birth to a new child. I'm hoping that the program is really built for lived experience. And I think one of the ways I hope we're getting to that outcome is by actually involving the communities that have been most impacted by this and actually seeking their input and giving them decision-making power to make this the most equitable program it can be.

On building the first digital-native program in Massachusetts

Greg Norfleet

We launched our program on January 1st, 2021, and so far we've paid out nearly $600 million in benefits programs to over 90,000 people who were experiencing a big life event. In the department, we look at that as funds that allowed people to actually experience that life event instead of having to worry about making ends meet.

We're the first public benefits program in Massachusetts that's been passed since the birth of the internet, and we should act like it. Our vision has always been to create a constituent-centered government service that leverages modern tools and processes to provide an experience that improves over time.

When we started off, I was the third person hired. So we were a three-person office on a tight timeline. And we had 30 months from bill passage to actually launching the thing, serving 3.7 million employees in the state and 225,000 employers across the state as well. The team that is delivering this program has grown much larger. It’s now a combination of our vendors, our state employees, our other state offices, as well as other states that have PFML programs have been really active in helping us understand how to actually get one of these things off the ground and giving us feedback on what's working and what's not working.

I think the PFML is a program that's absolutely worth fighting for. And we built the team to deliver on the promises of the law. I'm endlessly proud of the people that we've put together on this team, because even though we've launched the program, we're still obsessed with making it more efficient, accessible and easy to use over time. It's a culture within DFML at this point that we call constructive dissatisfaction. And it just means that we're continuously looking for ways to improve the service that's above and beyond just good enough. Our team really lives up to that.

Involving employers in building a PFML program

Greg Norfleet

Remember that you're building PFML for a diverse set of stakeholders, all of whom have legitimate needs in your program. I particularly want to call out the role of employers.

Oftentimes you think about the impact of Paid Family and Medical Leave on families, which is absolutely transformational. But it also has a really big impact on the labor market and on employers themselves. You should really engage with employers early on because they will have a lot of questions about how this will work for them. And they're also the primary way that employees get information about benefits programs, or about benefits that could be available to them.

In our program, employers file taxes quarterly in order to create the trust fund to be able to pay the benefits. So we engaged them really early on and we learned that we needed to support things for them like bulk filing, which wasn't something that immediately came to mind. It was an early must-have, because most employers don't file their own taxes, they pay someone else to do it. We helped make that process easy for them by working with the Department of Revenue to add their tax type into their system instead of building something fresh.

Makaela Stephens

Yeah, so like Greg said, there's a wide range of stakeholders that you do need to consider when implementing paid leave. We decided to do some discovery research with employers. We had one-on-one interviews with them and tried to understand how they currently manage leave, how they were expecting things might change, what tools they might need when PFML became law.

And just one of the foundational things we actually learned in that research is that there's not a single employer experience to build for. Employers are really complicated. You have large businesses, you have small businesses, there are third party administrators. There is also something called professional employer organizations. They all have their own workflows and they all have their own needs. And they're all going to kind of interact with the program a little bit differently. So like Greg was saying, as we were developing these tools for leave administrators, we really had to do a lot of follow-up research to understand how to make this service kind of fit their workflow.

The policy landscape for PFML

Kathleen Romig

We are definitely the closest we have ever been to having PFML across the country. President Biden ran on a platform of having a national paid family and medical leave program. He proposed a comprehensive program that was certainly a big part of the Build Back Better agenda that was in Congress last year. Now, as I think most people know that effort has stalled, not just in paid leave, but across the board. But we have a highly supportive president. The House overwhelmingly passed a comprehensive paid leave program. We have some really important champions.

On the benefit side of the equation, Build Back Better was very close to what I had described at the top of as the ideal: that it would be like Social Security. It would cover people no matter how long they're in a job, whether they're part-time or full-time, no matter what state they live in, it would be completely portable. It was very comprehensive in coverage, not just new babies and medical issues and caregiving as people are kind of accustomed to, but things like military leave for when a spouse is being deployed and the family needs to move and find new schools and things like that. It would include what they call safe leave for survivors of domestic violence or stalking when they need to relocate and start their lives over.

But BBB was being passed as part of a special, fast track procedure called budget reconciliation. Anything that you do through budget reconciliation has to actually do something to the budget, whether on the tax side or the spending side. The problem is, you can't require employers to actually let their employees go . But that's not a budget issue. So there simply were not 10 Republican votes to do any of this.

That was an important part that was missing. The Family Medical Leave Act, which was passed in the 1990s under President Clinton, does provide job protection to about half the workforce when they need to take family medical leave. But many people are left out. Of course, if you're lucky enough to live in one of the states that offers Paid Family and Medical Leave, then you would also be protected. So, a large fraction of workers would be protected and they would be able to go back to their same job, the same pay and everything when they finish their leave. But it was something that required more votes that just weren't there.

How lived experience should influence program design

Tameka Henry

From my point of view, it is important to remember the stories of the individuals that are being impacted by their not being a plan. I know that they look at data all the time, but I want them to remember the stories of those individuals who have faced so many barriers already. And it's just important to remember when you’re making decisions, to do so with us and not just for us. Bring us into the rooms, let us share our stories. Everyone doesn't have a seat at the table, so it’s important that when we do have the opportunity, that we share our stories with everyone so they know the importance of what it is that we need and how we've been impacted.

Makaela Stephens I'm happy to share one particular story about how we tried to approach this. Something that's not really unique in state paid leave legislation, but in my research is different compared to the private industry, is that if you give birth, you generally qualify for both medical and family leave. Each of these have separate leave allotments. So recovering from childbirth can be considered a serious health condition that is part of medical leave and then you also have the family leave to bond with your child. Unlike some other states, Massachusetts was pretty unique because they leave the amount of medical leave for pregnancy or childbirth recovery up to the healthcare provider to determine. So your doctor might say, for example, that you need 12 weeks of medical leave, but then you have an additional allotment for family leave to bond with your child.

This is not the most straightforward policy to navigate. So we prioritized doing some research early on with parents to see how they would navigate applying for leave given this kind of dual application process. From that research, we got a lot of good feedback on how we could, in plain language, explain how the program works.

One of the other things we learned in that research, which is not actually surprising in retrospect, is that most parents wanted to apply for pay leave before their child is born. It's an incredibly stressful time with so much to do, and you also know in advance , unlike most other kinds of medical leave. So we shared this insight with the policy team. We had to brainstorm to figure out how we could let parents apply before birth and still satisfy the regulatory requirements, which said that an application isn't complete until you have shown proof of birth. In the end, we were able to actually figure something out thanks to the really innovative policy team. We went live with this and Massachusetts actually became the first State in the country to allow parents to apply for paid leave before their child arrived.

That was one of the really nice ways that we were able to kind of meet the user needs from the get go. If, for example, other states or a federal program comes about, I think having more people with lived experience in the teams themselves can really augment these kinds of conversations… to just make sure that you are designing with and not just for your constituents.

How ten years of national PFML could change the nation

Greg Norfleet

Being involved in a state that has a paid family and medical leave program, our eventual goal is that eventually you don't even notice us anymore. That we're not talking about PFML anymore because we're successful in building it in such a way that it's not a big deal. It's just taken for granted that people can be present for those big moments in their life without having to make ends meet.

And I honestly hope that a lot of the stuff that we're doing together is scaled and replicated elsewhere. So the folks that are building paid family and medical leave today in the Commonwealth are building the benefit programs of the future tomorrow. I'm really proud of everything that we've accomplished as a department, but I'm also super excited about what's going to come next.

Tameka Henry

I'm excited too, Greg, because we have been at this for a long time and I'm just ready. I really feel that we will have a happy and healthier society and a thriving workforce and a community where families are together and less stressed. I don't know if it would be so much stress if you knew that you could take off work and know you had a job to come back to. Ten years from now, that's what I want to see: a happier and healthier society.

Kathleen Romig

I think if we had a comprehensive Paid Family and Medical Leave system, then we'd have a more inclusive economy and a more inclusive society. We really saw during the pandemic where the pain points are in our economy and our society. We saw that the virus hit communities of color the hardest, so those communities died at disproportionate rates, were hospitalized at disproportionate rates, and missed work at disproportionate rates. If we had medical leave, they would've been helped at disproportionate rates because they needed the help. The same thing when we look at the widespread closures. School closures and childcare closures, which disproportionately hit women, specifically mothers.

We saw the unemployment rate skyrocket among people with low incomes and people with disabilities whose employment rate is not very high in the best of times and got even higher during the pandemic. People with low incomes who are the most likely to work without even a single sick day – millions of people don't even have a single sick day. Then you have to take time off because your child is quarantined from school, or because you've caught the virus at your job and you need to recover. So I think when we bring everybody in, then we have a more equitable society and more inclusive economy.

Makaela Stephens

Echoing everyone else, I hope that in 10 years, every kind of worker deciding to put their health or their family member's health first is not a fraught financial decision. It's just something they can easily do and they have the support of a community to do it. And I would love to see that this is a really seamless , maybe invisible. I’d love to see interactions with other benefits, say for example, WIC, so that claimants are actually getting a fully rounded safety net and all the support that they're entitled to. I would love to see that this spurs a revitalization of care work and valuing that kind of work.

This panel, hosted virtually in February, 2022, is part of Nava’s Envision the Future series that imagines what easy-to-use, equitable public services could look like in the future. Watch the full panel. To find out about forthcoming events, sign up for Nava’s newsletter.

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