Paid sick leave, or the ability to remain home from work in the event of illness and receive compensation, has risen in prominence after the COVID-19 pandemic. Among the OECD countries, all but two, the United States and South Korea, have national paid sick leave (PSL) policies. Yet despite federal inaction in the United States, states have been adopting PSL, with 15 plus the District of Columbia having done so by the end of 2020. In the absence of federal policy, what drives states to adopt PSL mandates? In this article, we investigate two possible explanations – women in politics and jurisdictional competition. In the former, we suggest that increases in female representation in state-level governance make it more likely that a state will adopt a PSL policy. In the latter explanation, we suggest that jurisdictional competition in the form of cities or counties adopting municipal PSL policies creates pressure on the state-level government to enact statewide policies to harmonize policy, in a process of “bottom-up” federalism. To evaluate our hypotheses, we create a dataset of all state and municipal PSL policies in the United States. We find strong support for the gender representation argument, but not for the jurisdictional competition argument.