To examine whether state child care subsidy policies can combine goals of increasing maternal employment and increasing access to quality child care for children in low-income families, we studied one state's comprehensive policy, through a cross-sectional survey of 665 randomly selected families using centers, Head Starts, family child care homes, public school preschools or informal care, including a sample of families on the waitlist for child care subsidies. We found that, in Massachusetts, families receiving child care subsidies report greater access to child care, more affordable child care, and higher quality child care, than do similar families not receiving subsidies. Lower-income families not receiving subsidies can sometimes access affordable, quality child care through Head Start programs and public preschools, but, when they have to pay for care, they pay a significantly greater proportion of their income than do families receiving subsidies. We also found that families on the subsidy waitlist are at a particular disadvantage. Waitlist families have the greatest difficulty paying for care, the least access, and the poorest quality child care. While the child care subsidy policies benefited those families receiving subsidies, families outside the system still struggled to find and afford child care.