State-level paid sick leave: impacts of policy design on access by immigrant workers.

INTRODUCTION: Access to paid sick days (PSDs) matters deeply to public health and workers' economic security. State-level PSD laws have expanded rapidly, yet little is known about whether they are closing coverage gaps for immigrant workers, who are both overrepresented in public-facing jobs and disproportionately excluded from employer-provided PSD. METHODS: We built a state-level database of eligibility rules in all 15 states and DC with statewide PSD laws in effect as of 2024 and linked them to labor force data from the 2024 Current Population Survey Annual Social and Economic Supplement. We assessed how exclusions based on independent contractor status, firm size, minimum weekly hours, and annual work requirements shaped PSD coverage differences between citizens and noncitizens. RESULTS: Overall, coverage was lower among noncitizens than citizens (84.0% vs 86.9%, P < .05). Significant disparities were identified in 6 jurisdictions, with the largest gap in Connecticut (49.3% vs 65.8%). Policy simulations showed that excluding independent contractors and small-firm employees were primary drivers of disparities. Removing these exclusions narrowed gaps and sometimes resulted in near-universal coverage. CONCLUSION: Removing exclusions from state-level PSD policies would reduce inequities and increase access for immigrant workers, with benefits for all.