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ASTHO interviewed two state health agencies (SHAs), two nonprofit partners, and one university partner that were heavily invested in state early childhood development policy about how their programs fared during the COVID-19 pandemic.

This toolkit details structure and outcomes of ASTHO’s Vaccine Equity Project to help jurisdictions in their pursuit of vaccine equity.

Participant Experience ELM Leadership Accelerator Participant Experience Welcome to the Leadership Accelerator! This 8-week program is designed to provide public health professionals with the skills and knowledge they need to become effective leaders in their field. The program is conducted in a cohort-style format, allowing participants to learn from each other and build a strong network of peers. Accelerator Overview Duration 8 weeks Sessions Four 2-hour sessions Target Audience Public health managers and supervisors. Cohort-Style Workshops Participants will be part of a small cohort, allowing for personalized attention and a supportive learning environment. Program Opportunities Please check back for information on upcoming cohort opportunities. Application, Engagement, and Program Details Application and Selection Process Interested individuals can apply online. The application will include a brief questionnaire to better match you with your peers. Applications will be reviewed by our selection committee and selected participants will be notified via email. Online Learning ELM Online is the featured online (on-demand) content of the program. Participants are encouraged to register for the online course (ELM Part 1 and ELM Part 2) and review the suggested lessons before each session. Program Sessions The program consists of four sessions, each focusing on a different aspect of leadership development (Leading Others, Leading Others with Empathy, Leading the Organization). Sessions will be conducted virtually and will include a mix of lectures, group discussions, and interactive activities. Key Competencies and Outcomes Participants will learn leadership behaviors and presence, how to lead peers with emotional intelligence, assess performance and provide coaching, lead diverse teams, communication problem-solving and decision-making strategies, organizational performance and change management strategies. Peer Learning Participants will learn from each other and share their experiences and insights. Small group discussions and breakout sessions will allow for meaningful interactions and collaboration. Coaching Each participant will have direct access to the skilled and experienced public health leaders at ASTHO. This individualized guidance and support will be available to you throughout the program. Application Information Deadlines Applications are currently closed. Please check back for information on applying for the next cohort. Application Requirements To apply, you will need to log in to, or create, an ASTHO account and answer the short questionnaire. Selection Criteria Participants will be selected based on their experience, position level, and capacity to fully engage with the program. website False

This product identifies strategies for preventing ACEs, the role of public health in ACEs across levels of government, and policy development strategies to inform ACEs prevention.

Minnesota's Healthy Start Act is an example of the power of cross-sector collaboration to prevent adverse childhood experiences.

This guide captures the experiences and best practices of state and local public health agencies and their partners who are currently in the Cardiff Model implementation phase.

Colorado Department of Public Health and Environment Improvements in Public Health Hiring Practices ASTHO Staff Colorado Department of Public Health and Environment’s (CDPHE) Prevention Services Division (PSD) is working to streamline its hiring approach, process, and procedures to remove biases that commonly plague hiring practices. Colorado Department of Public Health and Environment’s (CDPHE) Prevention Services Division (PSD) is working to streamline its hiring approach, process, and procedures to remove biases that commonly plague hiring practices. The division’s innovative efforts take a practical approach, starting with diversifying application questions to allow candidates to highlight their multiple skills and lived experiences, moving away from the idea that having a more formal education automatically makes someone the best candidate. The approach also extends to harvesting data on salary to remove bias in salary offers, allowing for greater consistency in compensation across the agency. PSD’s efforts do not stop there! In this video, meet the team promoting the diversification of human capital within their public health agency. CDPHE discusses the vision behind its methods, the tools it developed, and lessons learned. If you are interested in learning more about Colorado’s advances in hiring practices, you can reach out to the team at athina.lujan-roche@state.co.us and meladie.lowe@state.co.us. article yes

Public health agencies share a special partnership with Medicaid, which can be utilized to increase access to care and promote health equity.

Samuel Walker of Java Jam, a fatherhood initiative dedicated to amplifying the lived experiences of men experiencing the birthing and lactation journey alongside their partners.

Impact of the Advisory Committee on Immunization Practices Recommendations on State Law Impact of the ACIP Recommendations on State Law Learn about the impact of ACIP recommendations on state law related to immunizations, insurance coverage, vaccine administration, and more. The Advisory Committee on Immunization Practices (ACIP) was formed in 1964 to “provide ongoing expert advice to the [HHS] Secretary on federal immunization policy.” Today, ACIP makes recommendations to CDC about vaccines with a focus on the control of vaccine-preventable diseases. ACIP recommendations help inform clinical and public health practice and include: “(1) the age and other population groups (e.g., by sex, occupation) recommended to receive that vaccine; (2) the recommended age or frequency to receive each dose and the interval between doses (for multidose vaccines); and (3) any precautions and contraindications.” The CDC director reviews ACIP’s recommendations and decides whether they should be formally adopted. While ACIP recommendations are just that, recommendations and not requirements, they have a far-reaching impact on vaccine policy with nearly 600 statutes and regulations across 49 states, three territories, and Washington, D.C., referencing ACIP. These laws often direct the use or consideration of ACIP recommendations in developing or implementing state or territorial vaccine policy. If the ACIP recommendations change, then any state or territorial policy that depends on them will be altered as well. References to ACIP recommendations appear in several different areas of vaccine policy including state and territorial laws related to: School immunizations. Mandatory insurance coverage. Provider scope of practice to dispense or administer vaccines. Required vaccine information. Mandatory and voluntary immunizations for health care workers and patients. Standing orders and protocols for dispensing or administering vaccines. Notifications for recommended or overdue immunizations. Vaccine purchasing determinations. Immunization Requirements for School Enrollment and Attendance State and territorial law, through statute or rule, may direct the use of or allow the consideration of ACIP recommendations when determining the jurisdiction’s vaccine requirements for school enrollment and attendance. This means any changes or deletions to the ACIP recommendations could automatically impact the jurisdiction’s school immunization laws. Some states give deference only to ACIP recommendations when determining school immunization requirements while other states include the recommendations of ACIP and other national organizations, such as the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP). The degree of adherence to ACIP recommendations also varies, with some jurisdictions requiring strict adherence to the recommendations and others taking ACIP recommendations into consideration for their vaccine policy decision making. In Hawaii, for example, the health department “may adopt, amend, or repeal as rules, the immunization recommendations of the United States Department of Health and Human Services, Advisory Committee on Immunization Practices.” Missouri’s statute permits school enrollment when a child “has been adequately immunized against vaccine-preventable childhood illnesses specified by the department of health and senior services in accordance with recommendations of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices” while Alabama’s law provides that “vaccine doses should be administered according to the most recent version” of ACIP’s recommendations. New Mexico’s law states that “[t]he immunizations required and the manner and frequency of their administration shall conform to recommendations of the advisory committee on immunization practices of the United States department of health and human services and the American academy of pediatrics.” Jurisdictions can identify their statutes, rules, and other policies that are tied to ACIP recommendations and assess the impact any changes to the recommendations would have on current public health practices and activities. Earlier this year, Colorado enacted HB 1027, a bill relating to school immunizations. The bill changes the source for the health department’s list of recommended school immunizations from ACIP to the state board of health and directs the board to consider ACIP recommendations as well as recommendations by AAP, AAFP, ACOG, and ACP when establishing required school immunizations, their manner, and frequency. The new law also allows the state health department to use the guidelines from AAP, AAFP, ACOG, and ACP along with ACIP when conducting its annual evaluation of immunization practices. Required Coverage by Insurance Providers ACIP-recommended vaccines are often required by states to be covered by Medicaid managed care organizations or private insurers. Changes to ACIP recommendations could impact the vaccines covered by these insurers. In Delaware, a “health carrier shall provide coverage for […] immunizations for routine use in children, adolescents and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices.” Colorado enacted SB 196 giving the state insurance commissioner the ability to maintain current ACIP recommendations. The revised law states that if the ACIP recommendations “are repealed, modified, or otherwise no longer in effect, the commissioner may adopt rules to require compliance with the guidelines or recommendations that were in effect in January 2025, or that comply with the recommendations of the Nurse-Physician Advisory Task Force for Colorado Healthcare.” Scope of Practice to Administer or Dispense Immunizations State law may give pharmacists, pharmacy technicians, and other health care providers the legal authority to dispense or administer vaccines. The vaccines allowed under this authority are often tied to ACIP recommendations so that altering the recommendations could result in these providers no longer able to dispense or administer certain vaccines. Maine law permits pharmacists to “administer vaccines licensed by the United States Food and Drug Administration that are recommended by the United States Centers for Disease Control and Prevention Advisory Committee on Immunization Practices, or successor organization, for administration to a person 18 years of age or older.” In Vermont, pharmacy technicians can “only administer immunizations […] pursuant to the schedules and recommendations of the Advisory Committee on Immunization Practices’ recommendations for the administration of immunizations, as those recommendations may be updated from time to time.” Dentists in Minnesota are permitted to give vaccinations if they “comply with guidelines established by the federal Advisory Committee on Immunization Practices relating to vaccines and immunizations.” Requirements to Provide Information About Vaccines In Alabama, information about the influenza vaccine that schools provide parents or guardians must include “related recommendations issued by the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention.” Illinois law directs the state’s department of public health to develop an informational brochure relating to meningococcal disease that includes “the latest scientific information on meningococcal disease immunization and its effectiveness, including information on all meningococcal vaccines receiving a Category A or B recommendation from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.” In Tennessee, hospitals are directed to provide parents of newborns with educational information about pertussis and the availability of a vaccine for pertussis “in accordance with the latest recommendations of the advisory committee on immunization practices.” Tenn. Code Ann. § 68-5-110. Oregon law requires post-secondary schools that provide housing to inform incoming students of vaccine-preventable diseases known to occur in young adults and ACIP recommendations for vaccines related to those diseases. Vaccination of Healthcare Workforce and Patients Some states instruct hospitals or long-term facilities to offer or require their employees and/or patients and residents certain vaccinations in adherence to ACIP recommendations. In New Mexico, every fall and winter hospitals are required to offer older patients vaccines for influenza and pneumococcal “in accordance with the latest recommendations of the advisory committee on immunization practices.” In Missouri, first responders who may be deployed for a bioterrorism event may be offered vaccinations for smallpox, anthrax, “and other vaccinations when recommended by the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.” New Jersey law requires health care facilities to “establish and implement an annual influenza vaccination program in accordance with the current recommendations of the Advisory Committee on Immunization Practices.” Regulations in Texas direct nursing homes “to offer immunizations in accordance with the most recent recommendations of the Advisory Committee on Immunization Practices.” Standing Orders and Protocols Indiana law authorizes the state health commissioner to issue a statewide standing order for pharmacists to administer or dispense “[a]n immunization that is recommended by the federal Centers for Disease Control and Prevention Advisory Committee on Immunization Practices for individuals who are not less than eleven (11) years of age.” In California, the medical director at a skilled nursing facility can issue a standing order influenza and pneumococcal immunizations when the standing orders “meet the

Researchers estimate more than 140,000 children in the United States experienced the death of a parent or grandparent caregiver between April 1, 2020 and June 30, 2021. The study highlights disturbing disparities in caregiver deaths by race and ethnicity. Hispanic, Black, and American Indian/Alaska Native children were at 1.1 to 4.5 times higher risk of losing a caregiver than non-Hispanic White children. These inequities result from structural and social conditions such as discrimination, living in under-resourced neighborhoods, barriers to accessing healthcare, experiencing food insecurity, and economic instability.

In the Public Health Review podcast debut, host Robert Johnson speaks with public health officials from Alaska, Kentucky, and West Virginia about the ongoing opioid epidemic in the U.S. and its intersections with other epidemics like neonatal alcohol syndrome and hepatitis C.

The Suicide, Overdose, Adverse Childhood Experiences Prevention Capacity Assessment Tool (SPACECAT) compiled a national report and accompanying infographic, that break down the biggest findings from the data, and highlight the biggest barriers facing health agencies today.

Basic PDF Accessibility Remediation Demonstration How to Remediate a PDF for Accessibility This video is a demonstration of basic PDF remediation techniques using Adobe Acrobat Pro. The methods in the video address some of the most common fixes needed to make a PDF converted from Microsoft Word accessible. This includes: How to access document properties, and which fields you should fill out. How to run the accessibility checker and why it is always necessary to check the checker’s results. The difference between tag structure and logical reading order. How to create new sections in a PDF. How to move and change tags. Speaker Emily Lapayowker, Assistant Director, Web Content, ASTHO Transcript - Video - Basic PDF Remediation Demonstration   Adobe Remediation Cheat Sheet This section serves as a quick reference for the skills included in the demonstration. Note that both the demonstration and this resource use a mouse to navigate Adobe Acrobat Pro. The processes will be different for those using keyboard navigation. Document Properties Menu Document Properties (toward the bottom of the Menu) Description Tab: Title Author (optional) Subject & Keywords – These fields make it easier for screen reader users to search for and identify your document. Advanced Tab: Language (in the Reading Options section) - Make sure the language selected matches the language in which your document is written. This is how screen readers know what language to use. Save changes by selecting the OK button on the Document Properties dialog box. Accessibility Checker The Adobe Acrobat Pro version used in this demonstration is 2026.001.21529. Other versions may have a different layout, but the functionality for all recent versions should be roughly the same. Click on All Tools in the header menu. From the All Tools menu pane, choose “Prepare for Accessibility.” Note that it may be necessary to select “View More” on the menu pane if Prepare for Accessibility is not immediately visible. In the Prepare for Accessibility menu, choose “Check for Accessibility.” A dialog box of Accessibility Checker Options will open. Set the desired parameters and click the “Start Checking” button. An Accessibility Checker pane will appear on the opposite side of the window. It will catalog all of the accessibility issues it detects. Open each item to get more information. Some items must be manually approved. These include Logical Reading Order and Color Contrast. The checker cannot check these for you. To manually pass something, right-click on the item and choose “Pass” from the context menu (i.e., the right-click menu). It is vital to check the checker. All checkers start with the assumption that the document or page in question has been created already using best practices and cannot check some elements as thoroughly as a human can. They are a great starting place, but should not be considered the final word. Tags Tags are the structure of a PDF. They should be the first stop when remediating a document. To open the tags, check the far side of the Accessibility Checker pane. There will be a button with an icon shaped like a gift tag. Click on the icon and the Accessibility Tags will replace the checker results in the pane. All tags should be listed under a top-level Tags item with the PDF icon next to it. Under that will be a Document tag — in almost every instance, the rest of a PDF’s tags will live under the Document tag as well. Tips Clicking on a tag in the structure will highlight the corresponding section in the document. The relevant area will be enclosed in a purple box. Make sure the document structure is correct. This means: Headings are used in order, none are skipped. In almost every case, there will be only one H1 per PDF. H2s should be used as section headings, H3s as subsections, and so on, down to H6. Empty tags can and should be deleted. Right-click on an empty tag and select Delete Tag from the context menu. The context menu has an option to Delete Empty Tags. This is faster, but it is important to check the results. Creating New Tags in the Tags Pane All page content should have a corresponding tag. If a tag is missing, create a new one. Click on a tag near where the new one should go. Click the three dots in the upper right corner of the Tags pane. Select “New Tag” from the context menu. Set the correct tag type by using the dropdown field. In the demonstration video, it is Section. The empty Sect tag will appear in the Tags pane. If it is not in the right place, click on the tag and drag it to the correct location. Add content to the new tag by clicking on the relevant content and dragging it into the new tag. If this is done correctly, the content will appear under and slightly to the right of the new tag (much like a subitem in a list). Nested Tags: Lists Lists are an example of when to use nested tags. The top-level tag in a list should be List, which shows up in the tag order as an L. Under that, each list item should be labeled LI. Within each LI should be two sub-tags: Lbl (or label — a bullet or a number) and LBody, which will contain the text for that list item. Create new tags, change tag type, and/or drag-and-drop content to correct any tagging errors. Nested Tags: Tables Tables are another common type of nested tag. When evaluating tables: Make sure everything is nested under a Table tag. The top row of content should always be nested under a heading tag (THead). Though the sub-tag for the row will be a normal TR, the individual header cells in the row should be tagged as TH. The rest of the table content should be nested under a TBody tag. These will be split up by row (TR). Individual cells should be tagged as TD. Note that if the first column should also be treated as a heading, the tags will still be nested under TBody and inside a TR tag, but the first cell in the row will be a TH. Only use tables for data, not for styling. Try to avoid empty and merged cells. Screen readers go through tables top-to-bottom, left-to-right, one cell at a time. Changing Tag Types Incorrectly categorized tags can be changed (e.g., the title is tagged as a regular paragraph when it should be an H1). Right-click on the existing tag and choose Properties from the context menu to open the Object Properties dialog box. Use the dropdown menu in the Type field to select the correct tag type. Note that tag types are listed alphabetically. Select the “Close” button to save the changes. Reading Order Reading order should be adjusted after the Tags. Typically, it will mirror what you see in the Tag pane, but not always. As the name implies, it is the order in which a screen reader will read the document. To access the Reading Order pane, look at the far end of the Tags pane and there should be an icon that looks a bit like a Z — that is the Reading Order button. Click on it and Reading Order will replace the Tags. The Reading Order content is divided up by page, which makes it easier to stay on track. Removing Items from the Reading Order In the demonstration example, there are three decorative lines inserted in the content to help visually break up the content. Each is marked as a Figure and each generated a flag from the accessibility checker because there was no associated alt text. No alt text is needed for these lines because they are decorative (meaning they do not give the reader any additional information). The best way to remove them from the reading order is to mark them as “background/artifact.” Right-click the decorative item in the Reading Order pane. Choose “tag as background/artifact” from the context menu. The item will disappear from the reading order, but the decorative line will remain visible on the page. Note that sometimes this does not work and you end up with empty or erroneous items in the reading order. Known Conversion Errors It is possible to create a completely accessible document in Microsoft Word and still have errors when it is converted to a PDF. Some of these problem areas may be the result of known conversion errors, such as: Images (or figures) moving to the bottom of the reading order, regardless of where they are placed on the page. Empty P tags where the author has used the Enter/Return key to move to a new line. Unfortunately, these are not preventable issues. Any fixes have to be done by Adobe, so it is important to watch out for them when remediating a document. article yes

One Big Beautiful Bill Law Summary Learn how the recently passed One Big Beautiful Bill impacts key public health initiatives in this legislative alert. On July 4, 2025, President Trump signed the One Big Beautiful Bill Act (OBBBA) into law. This legislation was initially passed by the House on May 22 by a 215-214 vote and was received in the Senate and passed with an amendment by a 51-50 vote. The amended bill passed the House by a 218-214 vote on July 3. This budget package will have sweeping impacts across Medicaid, the Affordable Care Act (ACA), food nutrition programs, and more. The Congressional Budget Office (CBO) estimates the bill’s health provisions will result in 11.8 million people losing health coverage by 2034. The CBO also estimates that an additional 5.1 million people would lose health coverage due to two policy changes outside the bill including: 1) the final 2025 CMS marketplace rule implementing eligibility changes and 2) the expiration of the ACA expanded premium tax credits. In total, CBO estimates 16.9 million people could lose coverage. The new law may impact states in several ways: Increased Medicaid and ACA coverage loss for noncompliance with work requirements, eligibility changes (Medicaid), and limits on coverage for certain noncitizens (ACA and Medicaid). Limited ability to fund the state share of Medicaid and overall decreased federal funding for state Medicaid programs. Increased administrative burden for state eligibility staff and increased costs for technology systems to implement work requirements. Note: Not all provisions apply to U.S. territories, such as work requirements for expansion adults, financing (provider tax and state-directed payments), and certain eligibility changes. ASTHO is closely monitoring the anticipated impact. Resources The legislative text of the final bill is 870 pages and was modified throughout the legislative process. For more detailed information, we encourage state and territorial health officials to utilize these resources in addition to the summary of relevant public health provisions below. Full Text — H.R. 1 Congressional Budget Office — Information Concerning the Budgetary Effects of H.R. 1, as Passed by the Senate on July 1, 2025 Kaiser Family Foundation — Health Provisions in the 2025 Federal Budget Reconciliation Bill Rural Hospitals This provision was not included in the initial House-passed bill but was included in the Senate-amended (and ultimately enacted) legislation. This program seeks to address potential impacts of CBO-predicted reductions to Medicaid spending due to the Medicaid provisions in this legislation. Establishes the Rural Health Transformation Program: The Rural Health Transformation program appropriates $10 billion per fiscal year to the Centers for Medicare and Medicaid Services (CMS) for 2026-2030 ($50 billion over five years) to disperse to eligible states. States must submit an application to CMS by Dec. 31, 2025, that includes a detailed rural health transformation plan and a certification that includes specifics on the expenditure for the funding under the program. States selected for funding will receive payments for five years, and the amount each state receives is determined by the state’s rural population, the number of rural health facilities, and an analysis of the state hospitals. State Eligibility: States must submit an application that includes a rural health transformation plan detailing how the state will improve health care access and outcomes, prioritize the use of new technologies, initiate collaboration between rural health care providers, enhance the supply of health care providers through economic incentives, outline strategies for the long-term financial solvency of rural hospitals, and identify risk factors for rural hospital closure. The state must also certify that no funding would be spent on intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-federal share of expenditures required under any provision of law. Funds can be used toward a list of criteria, such as promoting evidence-based interventions to improve prevention and chronic disease management including technology-based solutions, paying providers for health care, recruiting and training rural health workforce, and other activities as designated by the Secretary. The bill does not specify which state agency should be the applicant and custodian of these funds. Medicaid Work Requirements Overview: Requires able-bodied adults aged 19-64 to work (or perform other qualifying activities) for at least 80 hours a month. There are mandatory exemptions for certain individuals (e.g., pregnant women, those with serious medical conditions, tribal members, parents/caregivers of a dependent child 13 years and under or with a disability). States may issue optional hardship waivers for specific individuals facing short-term hardship (e.g., inpatient care, related outpatient care, natural disasters, high unemployment rate within their county). Verification: States will be required to conduct a “look-back” to determine if an individual meets requirement within the three months prior to applying. States would be required to verify an individual's compliance with work requirements within one or more months of enrollment and one or more months before redetermination. Implementation Dates: June 1, 2026: HHS to release interim final rule with implementation requirements. Dec. 31, 2026 (or earlier at state option): States must implement work requirements. However, the final bill allows the Secretary to exempt states from compliance with new requirements until Dec. 31, 2028, if they demonstrate a good faith effort toward compliance. Funding: Provides $200M for HHS implementation funding and $200M for states in FY2026 (an increase from $50M and $100M, respectively, from the initial House version). Expansion Expansion FMAP for Emergency Medicaid: Effective Oct. 1, 2026, limits federal matching payments for Emergency Medicaid to the state’s regular FMAP for individuals who would otherwise be eligible for coverage through Medicaid expansion if not for their immigration status. Sunsetting increased FMAP incentive: Effective Jan. 1, 2026, states that newly adopt Medicaid expansion will no longer have provisions for the temporary incentive. In addition to the federal government providing 90% federal financing for the expansion population under a state’s Medicaid expansion, the American Rescue Plan Act provided states that expand Medicaid after March 2021 a temporary boost in FMAP — a two-year, five-percentage-point increase in FMAP for all non-expansion population. Modifying cost sharing requirements for certain expansion individuals under Medicaid: Effective Oct. 1, 2028, states are required to impose cost sharing of up to $35 per service on expansion adults with incomes 100-138% FPL. Exempts primary care, mental health, and substance use disorder services, along with services provided by federally qualified health centers (FQHCs), behavioral health clinics, and rural health clinics. Maintains the previous law that out-of-pocket costs cannot exceed 5% of family income. Provides $15M in implementation funding for 2026. The final legislation adds exemptions to cost-sharing services provided by FQHCs, behavioral health clinicals, and rural health clinics. Provider Taxes Freezes provider taxes at current levels by disallowing increases in any new provider taxes or increases on current tax amounts. Amends the hold harmless “safe harbor” threshold, which is currently 6%. In non-expansion states: Remains at 6%. In expansion states: Phases down hold harmless threshold from 6% to 3.5% by 0.5% annually starting in FY 2028. Exempts long-term care facilities. State Directed Payments Caps state directed payments for expansion states at 100% and non-expansion states at 110% of the Medicare rate. This may limit a state’s future options to incentivize high-quality care or improve access to care. Eligibility Coverage for Noncitizen Alien Medicaid Eligibility: Effective Oct. 1, 2026, Medicaid eligibility of qualified aliens who are humanitarian entrants (i.e., refugees, asylees, and humanitarian parolees), is cancelled, thus leaving Lawful Permanent Residents, certain Cuban/Haitian entrants, and Citizens of Freely Associated States in place as the only categories of noncitizens eligible for Medicaid. The final legislation includes language defining Alien Medicaid eligibility. The text restricts the definition of qualified immigrants for the purposes of Medicaid and CHIP eligibility. HHS system to prevent duplicate state enrollment: By Oct. 1, 2029, requires HHS to establish a system to prevent enrollment in multiple states. Requires states to update enrollee addresses using certain datasets by Jan. 1, 2027. Eligibility verification using Death Master File: By Jan. 1, 2028, requires states to use the SSA Death Master File to verify eligibility on a quarterly basis. Home equity cap for Long-Term Services and Supports: Effective Oct. 1, 2028, lowers the home equity cap for long-term services and supports eligibility to $1M. Limits on Retroactive Coverage: Effective Jan. 1, 2027, limits retroactive coverage to up to one month for the expansion population and two months for traditional enrollees and CHIP. Home and Community Based Services (HCBS) Effective July 1, 2028, allows states to expand home-and-community-based services program eligibility criteria and waive the requirement that individuals require nursing home level of care. This would allow a greater number of individuals with less severe needs to access HCBS programs; however, many states already face waitlists so may be unable to expand enrollment. The bill provides implementation funding including $50M in FY2026 and $100M in FY2027. CMS Eligibility/Long-Term Care Staffing Rule Delays Prohibits CMS from implementing or enforcing eligibility rules for Medicaid, CHIP,

In this episode, leaders in Louisiana discuss how they’re providing more support for women across the span of their reproductive life, and the challenges they still face. The National Council for Behavioral Health also outlines how states can provide integrated systems of care for pregnant women.

Learn about legislation in island areas from the past year to strengthen infrastructure, prevention strategies, health care oversight, and more.

This brief highlights legislative actions that states are taking to remove financial burdens for women who struggle to afford period products and mitigate existing stigma.

This report focuses on promising strategies in four different policy areas to address rising congenital syphilis rates. While no single policy solution will address the structural challenges to diagnosing and treating syphilis among people who are pregnant, public health leaders can leverage several policy options that may reduce barriers to care.

About the Peer Networks About ASTHO's Peer Networks Learn about the different peer networks that support the development of state and territorial agencies through services such as events, skill-building workshops, online discussion boards, peer-to-peer mentoring, and technical assistance. ASTHO regularly convenes peer networks that support the development of state and territorial agencies (S/THAs) through services that include in-person and virtual events, skill-building workshops, online discussion boards, peer-to-peer mentoring and coaching, and technical assistance. Chief Financial Officers and Financial Leaders Chief Financial Officers and Financial Leaders Peer Network provides a forum to share expertise, information, peer experiences, and emerging issues on public health financing and grant management. It promotes best practices in health economics, financial and grant management, and budgeting; builds leadership and operational management skills; and strengthens relationships and coordination with other senior health officials. Titles may include but are not limited to: Chief Financial Officer, Director of Finance, Chief of Administration, Chief Operational Officer and those who are leaders in their health agency finance department. Other titles are included on a case-by-case basis. Clinical Service Leaders Clinical Service Leaders Peer Network is a space for state and territorial health agency leaders with broad oversight of public health-based clinical services. Peers connect on emerging issues and share strategies related to public health and health care partnership, access to care, and healthcare service delivery. ASTHO provides this peer network with timely updates on federal funding and policy initiatives related to public health’s role in safety net service provision and access to care. Titles may include but are not limited to: chief medical officers, state medical directors, or chief nurses. Directors of Public Health Preparedness and its Executive Committee Directors of Public Health Preparedness and its Executive Committee (DPHP EC) provide jurisdictional-based expertise and leadership for all-hazards public health preparedness and response. The network provides a forum to develop and share strategies, tactics and sound practices and maintain communications regarding common operational issues in state/territorial public health preparedness and response. The group convenes regularly with federal and organizational partners to provide feedback on emerging and existing programmatic and policy issues. Informatics and Data Modernization Network Informatics and Data Modernization Network (IDMN) provides a forum for S/THA informatics and data modernization leaders, such as informatics directors and data modernization directors, as well as staff who support the informatics and data modernization efforts in their health department. ASTHO’s goal is to include leaders across public health informatics and data modernization for each jurisdiction. Through quarterly meetings and the my.ASTHO online community, the IDMN provides a venue for members to learn, share, and discuss timely and emerging informatics and data modernization efforts, innovations, opportunities, resources, and best practices. Additionally, ASTHO relies on this group to provide and validate information and data related to data modernization and informatics efforts at their agency and nationally (e.g. public health data standards). Titles may include but are not limited to: Informatics Director, DMI Director, DMI Lead, DMI Champion, State Epidemiologist, Chief Data Officer, Chief Information Officer, Chief Informatics Officer, Chief Public Health Informatics Officer, Chief Data Officer, Information System Manager, Chief of Innovation, Data Management Director, Data Governance Program Manager, Health Statistics and Informatics Division Director, Health Data and Informatics Director, Technology and Resources Director, DMI Coordinator, Health Informatics Program Manager, DMI Project Manager, Deputy Director, Surveillance and Informatics Supervisor, ELC Information Specialist. Medical Countermeasures Coordination Network Medical Countermeasures Coordination Network, along with its online platform on my.ASTHO, serves S/THA staff working in medical countermeasures and representing the 62 PHEP awardee jurisdictions. It enables them to engage in programmatic practices and areas of policy, share materials and resources, foster peer-to-peer discussion, and request and receive technical assistance from ASTHO. Primary Care Office Directors State and Territorial Primary Care Office Directors meet as a peer network to form one collective voice when engaging with HRSA and to share information and promising practices relating to the HRSA PCO cooperative agreement. ASTHO supports a PCO National Committee, comprised of ten PCOs representing each HRSA region, as well as hosts regular peer-sharing calls and a highly interactive my.ASTHO discussion board. These activities provide resources that can orient new PCO directors and staff into their role, mentoring relationships, and form a coordinated PCO voice. Public Health Communicators Peer Network Public Health Communicators Peer Network will help develop public health communication professionals to build strong and effective relationships with their leadership teams including the state and territorial public health officials, so they are able to collectively communicate strategically, build trust in public health, and create a culture of partnership and collaboration in support of their state public health agencies and state and territorial public health official. Through this network, you can: Access valuable resources and training sessions on crisis communication, media relations, and more. Join quarterly peer-to-peer conference calls, participate in leadership development programs, and attend annual meetings with fellow communicators. Get help with the development of communication plans and other products. connect with peers through an online community designed for sharing best practices and capacity-building opportunities. Titles may include but are not limited to: public information officers, directors of communications, communications managers, and deputy communications directors; however, other related titles may be considered on a case-by-case basis. Public Health Lawyers Public Health Lawyers provides a forum for attorneys representing state and territorial health departments to share legal expertise and best practices as well as offer peer-to-peer support on emerging legal topics impacting these departments. Public health lawyers may be employees of the health department or may sit within a jurisdiction’s attorney general’s office or department of justice. Titles may include but are not limited to: assistant/associate/general counsel, attorney, assistant/associate/chief counsel, assistant/senior assistant attorney general, or legal/policy specialist. Senior Deputies Senior Deputies provides a forum for support, education, and networking opportunities to advance the ASTHO mission and support senior staff’s needs in S/THAs. The senior deputy is identified by and usually reports to the state/territorial health official and can hold responsibility for public health programs, finance, operations, or some combination thereof. Titles may include but are not limited to: Deputy Director, Deputy Secretary/Commissioner, Chief of Staff, Chief Public Health Officer. State Environmental Health Directors State Environmental Health Directors is comprised of environmental health leadership from U.S. state, territorial, and freely associated state health agencies, including Washington, D.C. The group weighs in on and drives environmental public health policy issues forward, such as food safety issues, risk communication challenges for both regulated and unregulated drinking water contaminants, childhood lead poisoning prevention, and health risks posed by excessive heat, and participates in internal and external environmental health-related committees or workgroups. In addition to these topics, the group meets regularly to discuss environmental public health topics like natural disasters (e.g., hurricanes, wildfires, and tornadoes), climate and health, and emerging chemical contaminants (e.g., Ethylene Oxide). Titles may include but are not limited to: Environmental Health Program/Section Manager, State Toxicologist, State Epidemiologist. State and Territorial Legislative Liaisons State and Territorial Legislative Liaisons connect health agency staff who serve as the liaison between their agency and their legislature. ASTHO engages with the community to provide technical assistance, share policy updates, emerging trends, and facilitate peer-to-peer sharing of information and best practices. State Tribal Liaisons State Tribal Liaisons (STL) peer group is committed to the sharing of approaches that recognize the sovereignty of and enhance the optimal health of American Indians and Alaska Natives (AI/AN). Peer group convenings serve as a forum for Liaisons to network and share information related to key public health issues impacting Tribal communities within their jurisdiction. Titles may include, but are not limited to: Tribal Liaison, Director, First Nations Health and Wellness Program, Tribal and Indigenous Health Equity Strategist, Manager Constituent & Tribal Services. Telehealth Policy Telehealth Policy Peer Network is a learning collaborative that provides opportunities for state and territorial public health department staff to gain subject matter expertise on emerging telehealth topics, policies, and priorities. The network facilitates peer networking opportunities, connections to telehealth subject matter experts, and resource sharing. Titles may include, but are not limited to: Deputy Director, Director [Office of Telehealth], Telehealth Clinical Specialist, Program Coordinator, Policy Analyst.