Achieving Paid Family Leave in Minnesota: A Q&A with Senator Alice Mann and Former Representative Ruth Richardson 

Network:
Milbank State Leadership Network
Focus Area:
State Health Policy Leadership
Topic:
Population Health
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In January, Minnesota launched its paid family and medical leave program, making it one of 13 states with a statewide paid leave program in place or in process. For this Q&A, Milbank’s National Director for Population Health, Morgan McDonald, MD, talked with the legislation’s sponsors, Former Rep. Ruth Richardson, an alumna of the Emerging Leaders Program, and Sen. Alice Mann, MD, an alumna of the Milbank Fellows Program, about their motivations and approach to passing the bill. Both interviewees highlighted how their ongoing communication with each other and with the members of a large and diverse coalition — as well as their use of both storytelling and data — led to this investment in Minnesota’s families and businesses. (Watch a video of the interview at right.)

Q: For readers who may be new to the topic, what does the evidence say about the benefits of paid family medical leave? 

Richardson: There are broad benefits—for families, businesses, and government. For families, paid leave is associated with lower maternal mortality and severe morbidity, lower infant mortality, higher infant birth weight, longer breastfeeding duration, fewer hospitalizations, better mental health, and less postpartum depression. 

Mann: We also see fewer infant infections (pneumonia, GI, ear infections), which means fewer clinic visits and hospitalizations. On the business side, states with programs report higher productivity and profitability, better employee retention, and lower training costs. In states with paid leave programs, more women are returning to the workforce, and businesses are spending less time and money – all of which helps close the gender pay gap. 

Q: Given the strong evidence, why has implementation taken so long, and what resistance did you encounter in Minnesota? 

Richardson: A large coalition had worked on this for more than a decade. At first there was resistance, but I saw a significant shift in the debate during the COVID-19 pandemic. It shone a light on the universal need to care for oneself or a loved one. Resistance often comes from the fear of change and from the notion that the policy is “new,” but we emphasized that many states — and nearly all countries — already do this. There was a blueprint in place. 

Mann: Paid leave helps keep women financially stable after childbirth and during caregiving. It’s important to say out loud that anytime we have a policy that disproportionately benefits women, there’s pushback.  

Q: When did you feel the timing was right to pass the bill? 

Richardson: The moment it felt within reach was in 2023. I’d carried the bill for multiple sessions. We needed a new Senate author, and the stars magically aligned and my former housemate, Sen. Mann, stepped in. We had one of the  largest, most diverse coalitions — faith groups, labor, small businesses, families — that I saw in my time in legislature. We were able to combine powerful family stories with the data. From the outset, we committed to getting the bill across the finish line by any means necessary. 

Mann: At every committee hearing and press conference we merged the research (we literally carried a box of studies from hearing to hearing) and the stories. We would bring up person after person to talk about how their life changed when they had a baby, when they had a heart attack, when they were diagnosed with cancer, and what happened to their income and their job and their stability. 

We changed the bill at every committee stop to address concerns from people in our party and across the aisle. It was a tremendous amount of work. 

Q: What strategy helped you manage so many stakeholders and versions of the bill? 

Richardson: There was a steady stream of people coming to our offices with their wish lists: from labor, chambers of commerce, large employers. I think that that big coalition gave us a lot of opportunity to pressure test the bill. And the Senate and House bills were changing in very different ways. Sen. Mann and I met weekly to track the changes. We used conference committee to think about what best served families, the state, and businesses. 

Mann: All these meetings, from those with a family member to the largest business in the state, taught us something new that we were able to then incorporate into the bill — and make it appeal to the most people.

Q: What does Minnesota’s paid family and medical leave program look like? 

Mann: 

  • Funding: A premium split evenly between employers and employees because everyone participates in the community. 
  • Duration: Up to 12 weeks for bonding (new child) or caring for oneself or a loved one. If there’s another qualifying event in the same year, an additional 8 weeks is available. 
  • Qualifying Event: Must be at least 7 consecutive days — we’re talking major life events (e.g., a stroke, birth, hip fracture, new cancer diagnosis), not a cold. 
  • Wage Replacement: Progressive, from 55% of wages for highest earners to 90% for lowest earners, so the benefit actually works for lowerincome families. 
  • Program Design: We selected timeframes tied to measurable health outcomes and return to work data—long enough to matter, far below thresholds where leave reduces return rates (e.g., 12 months). 

Q: What leadership skills made the difference? 

Richardson: The process of getting this signed into law was a master class in integrating research, policy, and practice. We kept administrators (who implement the law) involved so implementation would match legislative intent. Between coauthors, there was constant communication, no ego, and a willingness to compromise — while staying committed to protecting women, low income workers, people with disabilities, and advancing racial equity. Paid leave research showed a disparity in access: people who already had access to paid leave were those who could more easily have afforded a leave without pay. And the people who did not have access to it were the individuals for whom paid leave would be the difference between having an income or being in poverty. So those were guiding lights for us. 

Mann: Communication and storytelling were critical. With a one vote majority in the Senate, I met one on one with every senator to explain how the bill impacts people and businesses, and to build trust. 

Q: Anything you wish you could change? 

Richardson: I wish seasonal workers were covered. Some compromises were necessary to get the votes. If we could make it perfect, we would — but the program still covers the vast majority of Minnesota workers. 

Q: How did the rollout proceed, and what are you seeing so far? 

Richardson:  The program is off to a strong start coming in $70 million under budget while already approving more than 20,000 applications from workers who need time to care for a new child, a loved one, their own health or safety, or navigate a military leave. The new insurance program was implemented on time, under budget, and in line with projected usage. The rollout demonstrates that Minnesota can support working families, implement a major program responsibly, and run a program efficiently. The $70 million in savings will be reinvested to support working Minnesotans. 

Q: How are you resourcing, evaluating, and ensuring equity in the program? 

Richardson: The initial bill included roughly $668 million to build the program — hiring, systems, and operations to serve the whole state in an efficient and timely way. Long term sustainability comes from the insurance model with pooled risk across employers and employees — especially helpful for small businesses that can’t spread risk on their own. 

Mann: Unlike some states that collect premiums for a year before benefits start, we used upfront funding, so premiums and benefits begin on the same day in Minnesota. People have needed this for decades; starting benefits immediately signaled our commitment. It’s also a smart investment for the state, because one of the benefits from the state perspective is less reliance on social welfare programs. This is really investing in the economic sustainability of families. 

We also invested in outreach, so lower income communities understand and use the benefit, and the administrative paid leave team is tracking data to monitor uptake and outcomes by zip code, race, and gender — so there is not a disparate impact. 

Q: What advice do you have for other states? 

Mann: 

  • Learn from other states—replicate what works; don’t repeat mistakes 
  • Stay in lockstep with implementers so you have their buy-in 
  • Build a big, diverse coalition. 
  • Pick a strong partner you trust. 

Richardson: I hope we move from state by state conversations to a national program — it would level the playing field in a way that would be transformational. Paid leave is extremely popular — supported across parties, with roughly 80% public support. 

Interview condensed with use of AI.