The State of Wisconsin's YoungStar system was created by the Legislature and Governor in 2010 to "drive quality improvement in child care throughout the state." YoungStar uses a five-star system to rate child care providers based on several measures of quality, including staff education levels, learning environment, business methods, and health/safety. The program's stated goals are to "create a clear, understandable tool to help parents choose quality child care; create incentives for providers to improve services, particularly for low-income children; link the quality of child care providers to Wisconsin Shares payments; and help prevent fraud in the Wisconsin Shares system." In 2012 and 2013--as a follow-up to a multi-year research project that explored the economic impacts of high quality early childhood education--the Public Policy Forum published a pair of reports analyzing YoungStar's implementation. The reports covered the quality ratings received by child care providers in Milwaukee County and the challenges and opportunities for improving the quality of child care locally. Since that time, YoungStar has undergone changes and additions, and the quality ratings of child care providers have changed. This report provides an update on the impacts of YoungStar and how it has impacted child care quality in Milwaukee County. Specifically, it addresses the ratings of Milwaukee County providers and the accessibility of quality child care for Milwaukee County children and parents, as well as the tools and services available to providers to help them improve their YoungStar rating. Key findings include the following: (1) The majority of children receiving Wisconsin Shares subsidies in Milwaukee County (54%) are enrolled at 3 Star providers; (2) YoungStar is achieving success in moving 2 Star providers up the ratings scale; (3) Despite this overall success, home-based family providers appear to face unique difficulties in improving their YoungStar ratings; (4) Nearly one in five (19%) children receiving Wisconsin Shares subsidies in Milwaukee County is enrolled at a high-quality (4 or 5 Star) provider; (5) Two ZIP codes in Milwaukee County have no high-quality (4 or 5 Star) providers; (6) Barriers to improved ratings differ by star level, but appear to be consistent across child care provider types; and (7) YoungStar's tiered reimbursement system is producing increased total provider payments in Milwaukee County.