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In an effort to help meet demand, some states and territories have joined interjurisdictional licensing compacts that allow a mental health care provider licensed in one state to provide care in another state—without needing to gain licensure in multiple states. These agreements also offer guidance on patient privacy for services rendered remotely or from out-of-state.

Adopting a public health approach to substance use by implementing harm reduction policies across all levels of government can help communities address the overdose crisis. This post analyzes e

Partnering with Community Action Agencies Can Improve Trust in Vaccines astho, association of state and territorial health officials, association of state and territorial health officials astho, state health official, public health official, territorial health official, island jurisdictions, state health, health department, public health, state and territorial health, social determinants of health, johns hopkins, advance health equity, socially determined, health inequities, race ethnicity, covid-19 vaccines, health disparities, vaccine supply, high income countries, vaccine equity, vaccine distribution, vaccine hesitancy, immunization, centers for disease control, community action agencies, covid19 pandemic, at-risk populations, healthy equity Geetika Nadkarni Learn how community action teams are working to improve COVID-19 vaccine acceptance and uptake in their own communities. In the current climate surrounding vaccinations and other large-scale public health measures, it’s more important than ever for public health to engage communities. One way to do this is through working with community action agencies (CAAs), local entities that work to reduce poverty and reduce disparities among the populations they serve. Funded through the Community Services Block Grant (CSBG), CAAs are an ideal complement to public health’s mission to address the social determinants of health and achieve greater equity. With support from CDC, ASTHO is working with the National Community Action Partnership and five CAAs in the Partnering for Vaccine Equity project, which aims to increase acceptance and uptake of vaccines among racial and ethnic minority groups and in rural communities. ASTHO chose to partner with CAAs as trusted community agents for this project because of their existing relationships within communities through programs such as Head Start, food banks, federal nutrition programs, and employment and housing assistance. Through their internal and external partnerships, they can reach people who may be concerned about vaccine safety and/or lack access to vaccination sites. Through this project, CAAs are partnering with residents, faith-based organizations, local schools and universities, state and local public health departments, and non-profits active in the community. They are also engaging a range of local providers, such as federally qualified health centers (FQHCs), physicians, community health workers, medical and nursing students, and emergency medical technicians (EMTs). These community action teams are working together to improve vaccine acceptance and uptake and to customize evidence-based strategies to their own communities and neighborhoods. article yes

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

State and federal actions to expand the doula workforce and improve maternal health.

The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

Infographic depicting findings on a survey around opioid use among pregnant people.

Recap the state legislative sessions in 2025 thus far, spanning maternal health, infectious disease, and other important public health issues.

State Legislatures Moving to Increase Rural Health Care Access How States Are Incentivizing Health Care Providers to Practice in Rural Areas Lana McKinney Hospital closures and fewer care options in rural areas cause worse health outcomes for Americans in those areas. Read about state policies aimed at bringing providers to back to rural America. People living in rural areas face greater health risks than those living in urban areas. Rural populations not only experience increased poverty and higher rates of chronic disease; they are also older and have less access to both health care providers and health insurance. States are exploring several strategies to improve health care access for rural residents, including recognizing a new hospital type, exploring alternative methods or sources of health services, and offering financial support for health care facilities and the rural health workforce. Access to Care Among many factors contributing rural areas accessing health care, hospital closures are a major one. Almost 200 rural hospitals have closed since 2005. When rural hospitals close, people living in those communities must travel farther for care. Rural areas may also experience shortages of and less access to health care professionals, including specialty care, as compared to urban areas. To reduce the number of hospital closures and provide support for existing hospitals in rural areas, the Consolidated Appropriations Act of 2021 created a new Medicare provider type known as the Rural Emergency Hospital (REH). These facilities offer a more limited scope of services than acute care or critical access hospitals and have their own conditions of participation and Medicare reimbursement structure. There have been 36 REH conversions in 16 states since 2023. Jurisdictions continue to explore legislation to formally recognize REHs under state law, State recognition of REHs is crucial for establishing licensure, defining service scope, and enabling participation in state health care programs like Medicaid, ensuring these facilities can legally operate and provide necessary care. with Florida (SB 644) enacting legislation in 2024, and Hawaii (HB 1179) considering legislation so far in 2025. A number of other jurisdictions have recently received approval to amend their Medicaid State Plans and define the payment methodology for REHs serving Medicaid recipients, including Iowa, Kentucky, Nebraska, Nevada, New Mexico. States are also exploring other policies to financially support rural hospitals during the 2025 legislative session. Alabama (HB 86) is considering a rural hospital investment program that would create tax credits to incentivize donations to those hospitals that could support service delivery. And bills to establish grant programs to support rural hospitals are before the legislatures in both Oklahoma (HB 2754) and Indiana (HB 1274). States are also exploring the role of technology, and community needs and resources, to support rural access to care. In 2024, Colorado enacted at least two bills with a rural population focus, including SB 24-168 to invest in remote patient monitoring to support rural health facilities and requires reimbursement. SB 24-055 creates an agricultural and rural community behavioral health program to understand the relevant issues and improve access to care. So far in 2025, at least two states are exploring ways to better serve people in rural communities. Hawaii (SB 1004) is considering legislation that would establish a pilot program to utilize community health workers in rural areas, while North Dakota (HB 1567) is proposing a legislative management study focused on improving access to oral health care, and would require review of telehealth options for reaching rural areas and workforce incentives for dental providers. Rural Health Care Workforce Jurisdictions are also using financial supports—including scholarships, tax incentives, and loan cancelation programs—to increase the number of health care providers in rural areas. At least three states modified financial support programs for practitioners working in rural and underserved areas in 2024. Mississippi’s S 2729 expanded the scope and responsibilities of its rural physician and dentist scholarship programs and their respective governing commissions. And Georgia (HB 872) amended its cancelable loan program to include dental students. California (SB 909) amended the requirements for its physician corps program, which provides financial assistance to those who practice in underserved areas, removes the limit on the amount of loan repayment available, and reduces the duration of service obligation from three to two years. Jurisdictions have also pursued tax policy changes aimed at supporting rural health care providers, including state tax credits for individual practitioners working in rural areas. In 2024, Georgia (HB 82) amended its rural physician tax credit to include dentists living and working in rural areas. In 2025, at least two states are considering expansion of tax credits for providers serving rural communities. In New Mexico, HB 52 would expand the state’s rural health care practitioner tax credit to include additional provider types, including speech language pathologists and occupational therapists. And Oregon is considering several bills to expand existing rural provider income tax credits, including HB 2549 to add pharmacists and HB 2204 to add podiatrists. Finally, legislatures are continuing to consider other policy initiatives to bolster the rural health care workforce in 2025. Acknowledging a shortage of nurses in rural communities and barriers for rural nursing students, Washington SB 5335 would establish a rural nursing education program in the state health department with a goal of improving nursing care in rural areas of the state. And in Nebraska, LB 119 would formally enact the state’s rural health opportunity program, which provides tuition waivers for students from rural areas pursuing health care careers, into law. ASTHO will continue to monitor this issue and provide any necessary updates. article yes

2026 State Legislative Session Update 2026 State Legislative Session Update Learn about state legislation from FY26 focused on hot public health topics in this Health Policy Update. ASTHO’s 2026 Legislative Prospectus Series announced the top five public health state policy issues to watch this year. With at least 30 states scheduled to conclude their legislative sessions by the end of May, state legislatures focused on many of these public health topics. Expanding Access to Care As expected, a number of states considered legislation to expand access to care, including policies that promote community-based services and rural health care access. Doula birthing support services continue to be a topic for state legislatures with at least a dozen states considering legislation to expand coverage or access. Oregon enacted SB 1568, expanding coverage for birth and postpartum doulas and lactation counselors. Virginia enacted two bills that support access to doulas: HB 328 requires the Bureau of Insurance to select a new essential health benefits benchmark plan that includes doula care coverage starting in 2029, while HB 838 expands Medicaid coverage to include incentive payments for doulas to provide linkage to care visits in the postpartum period. For other licensed health care professionals, interstate compacts allow health care professionals licensed in one member state to practice in another without additional credentials. This year, legislatures have considered more than 100 health care professional compact bills so far, with at least six states enacting legislation: Arizona (HB 2190), North Dakota (HB 1622), and South Dakota (HB 1146) adopted the Physician Assistant Licensure Compact. New Mexico adopted the Interstate Medical Licensure Compact (SB 1) and the Social Work Licensure Compact (HB 50). Mississippi (SB 2543) adopted the Dentist and Dental Hygienist Compact. Washington (HB 2088) adopted the Dietitian Licensure Compact. Finally, at least two states enacted legislation to expand telehealth. Virginia HB 1284 specifies that its Medicaid provider-to-provider consultation provision includes services provided via telehealth, and Kentucky HB 424 eases the requirements for social worker telehealth practice. Behavioral Health Legislatures are also continuing to explore policies that address mental health and substance misuse. This includes legislation that supports people across the care continuum, explores the use of psychoactive substances in mental health treatment, and regulates emerging substances. At least seven states have enacted legislation to establish or enhance the continuity of care for people in a behavioral health crisis. This includes Maine LD 1216, which requires the Department of Health and Human Services to establish crisis intervention support services in all counties. Virginia enacted HB 453, which specifically allows amendments to the state’s Marcus Alert plan supporting the state’s comprehensive crisis system and requires state agencies and local partners to align their policies accordingly. States also continue to promote the availability of opioid reversal drugs through legislative action. Virginia SB 257/HB795 requires certain health insurance plans to include at least one opioid antagonist with limited cost-sharing on their drug formularies. Kansas HB 2534 requires schools to stock naloxone and establish polices to support its administration, and Utah SB 87 clarified its immunity provisions for administering opioid antagonists and will allow expired — but still effective — opioid antagonists to be dispensed and administered in certain situations. Another trend this legislative session is the legalization and regulation of use, medical study, and reclassification of certain psychedelic drugs for therapeutic purposes. Several states considered legislation to allow psilocybin for therapeutic purposes, including Oregon HB 4040, which already allows psilocybin service centers and expanded its licensing criteria for psilocybin service facilitators. At least 23 states considered, and five states (Mississippi SB 2056, South Dakota HB 1099, Utah SB 83, Virginia SB 379, and West Virginia SB 906) enacted legislation that would automatically reschedule psilocybin or certain formulations, pending federal approval and/or rescheduling. Finally, at least 10 states considered bills to support access or research into ibogaine, which is being studied in relation to PTSD and substance use disorder. States include Washington (SB 5204), Oregon (HB 4110), Tennessee (SB 2149/HB 2075), Louisiana (SB 43), Oklahoma (HB 3834), and Georgia (HB 1296), with Mississippi enacting HB 314 to allow the state health department to participate in a consortium supporting clinical trials for ibogaine drug development. A number of states are also taking action to address kratom, a plant-based substance with the potential for serious side effects, including substance use disorder and withdrawal symptoms. As of January 2026, 31 jurisdictions regulate kratom, with at least five states enacting legislation this year. New York (A 9472/S 8814), Virginia (HB 360), and West Virginia (SB 985) established or enhanced prohibitions on selling kratom to people under 21, while Nebraska (LB 901) enacted an excise tax on kratom products. Utah enacted two bills (HB 385 and SB 45) that regulate processors and retailers and New York mandated warning labels on certain kratom products (A 9443/S 8780). Healthy Food and Chronic Disease States continue to prioritize chronic disease by advancing policies recognizing the importance of prevention and how food impacts health. In 2026, a number of states considered legislation to address food insecurity, improve school nutrition, and promote chronic disease screening and prevention. At least 10 states considered legislation to limit ultra-processed foods or promote access to healthy foods, with Nebraska LB 940 prohibiting public schools from offering foods that contain certain color additives and Tennessee SB 2423/HB 1853 taking a similar approach but for any artificial food dye. States are also exploring ways to accommodate student dietary preferences. Minnesota (SF 2970), New Jersey (S 1676), New York (A 1834), and Washington (S 5878) introduced legislation that would mandate plant-based options in school cafeterias. Illinois enacted HB 1607, creating a health department task force to review state efforts to eliminate food deserts and requiring a report with recommendations by January 2028. Finally, state legislatures are taking action to support access to early detection and chronic disease management through insurance regulation. Mississippi enacted HB 565 to require Medicaid and other health plans to cover biomarker testing for the diagnosis, treatment, management, or monitoring of patients when supported by medical evidence. Additionally, Oregon enacted SB 1527, which limits out of pocket costs for medically necessary cervical cancer screenings and follow-up examinations. Finally, Alabama (SB 19) will prohibit certain insurance plans from imposing cost-sharing for prostate cancer screening of all men over 50 and younger men at high risk. Infectious Disease Prevention With recent changes to the membership and recommendations of the Advisory Committee on Immunization Practices (ACIP), a number of state legislatures have considered changes to vaccine policy in 2026. Several states enacted legislation to modify the role of ACIP, including Colorado (SB 26-032), Connecticut (HB 5044), Maine (LD 2146), Maryland (HB 637), New Mexico (HB 156), Oregon (SB 1598), Vermont (H 545), and Washington (HB 2242). Many of these bills address other components of vaccine policy, including: Vaccine Schedule Recommendations: Colorado, Connecticut, Maryland, New Mexico, Vermont, and Washington substitute or add state health agencies and/or organizations like the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Academy of Family Physicians, and American College of Physicians as sources for vaccine recommendations. Insurance Coverage: Connecticut, Maryland, New Mexico, Oregon, Vermont, and Washington require health insurance plans to cover vaccines recommended by health agencies or other organizations, rather than ACIP alone. Pharmacist Scope of Practice: Maryland and Vermont substitute or remove ACIP recommendations as an authority for pharmacists to administer vaccines, and Colorado allows pharmacists to prescribe vaccines independently. Funding: Colorado, Maine, and Vermont expand vaccine purchasing programs to include vaccines recommended by bodies other than ACIP. Liability Protections: Colorado, Maine, and Vermont include liability protections for certain providers administering vaccines according to state or medical organization recommendations. Public Health Funding Legislatures in thirty-one states, the District of Columbia, and three U.S. territories will enact budgets for the 2027 fiscal year, while legislatures in three more states will enact biennial budgets for the 2027 and 2028 fiscal years. With reductions in federal funding, states continue to find ways to leverage state funds to invest in public health and public health infrastructure while adhering to balanced budget requirements. Eleven states have enacted FY 2027 budgets and three states enacted biennial budgets for FY 2027-FY 2028, with several states increasing public health funding, including Kansas (HB 2513), New Mexico (HB 2), and Wyoming (SF 0001). Additionally, three states passed FY 2027 supplemental budgets featuring public health provisions: Maine LD 2212 appropriates funding to support access to affordable prescription drugs in rural and underserved areas, Washington SB 6003 increases funding for the state’s Drinking Water State Revolving Fund, and Nebraska LB 1071 shifts funds to children’s health insurance, community-based aging services, and mental health operations. States have also

ASTHO Helping Agencies and Providers Advance Vaccine Equity vaccine equity toolkit, community-based vaccine outreach, public health vaccine partnerships, increasing vaccine confidence, vaccine equity strategies, vaccination rates, improving vaccination, community based organizations, health equity, vaccination coverage, trusted messengers, health care, health and human services, disease control and prevention, vaccine preventable diseases, centers for disease control, increasing vaccine, covid-19 pandemic, vaccination program, immunization program, public health departments, build vaccine confidence, control and prevention cdc, united states, health systems, ASTHO, Association of State and Territorial Health Officials Shalini Nair ASTHO | Highlights of ASTHO toolkit that helps health agencies and providers advance equity in their communities. Over the past several years, views on vaccination have fluctuated, with periods of widespread demand followed by waves of declining sentiment due to the spread of mis- and disinformation—ultimately contributing to worsening health disparities. Addressing immunization equity is essential to mitigating the effects of vaccine-preventable diseases among vulnerable individuals and communities who may be at higher risk for adverse outcomes. The COVID-19 pandemic response provided many lessons to take forward for health equity initiatives, specifically in highlighting the importance of community-centered outreach in addressing the health care divide. Introducing: Vaccine Equity Toolkit ASTHO’s Championing Change: A Toolkit for Addressing Vaccine Equity Through Community Mobilization helps state and territorial health agencies, community leaders, and health care providers advance vaccine equity in their communities. For the past three years, ASTHO’s award-winning Partnering for Vaccine Equity initiative has supported boots-on-the-ground efforts to increase vaccine confidence, drive demand for vaccines, and facilitate vaccine uptake. Alongside the Community Action network and a diverse group of advisors, ASTHO and national and local partners have collated this comprehensive resource, which highlights the promising strategies, lessons learned, outcomes, and more from the novel collaborative. Lille Seels_ASTHO Helping Agencies and Providers Advance Vaccine Equity From the Field Snapshot The Championing Change toolkit highlights the work of five local community action agencies across Alabama, Arkansas, California, Georgia, and South Carolina, to increase uptake of vaccines in their jurisdictions. Each agency took a slightly different approach to implementation, emphasizing the importance of tailoring interventions to local community needs. The toolkit includes in-depth case studies on the standout strategies, including: Partnering with health care and public health: Palmetto Community Action Partnership engaged with their health department and a regional federally qualified health care center to help maximize the reach and impact of their services in rural South Carolina. Meeting people where they are with fact-based messaging: Enrichment Services Program leveraged the power of targeted messaging campaigns to address the underlying opinions and attitudes of community members, and cultivate discussion around vaccination across three counties in Georgia and Alabama. Leveraging existing programming and partnerships to expand reach: Community Action Program for Central Arkansas looked to their internal programmatic initiatives around early childhood education and outreach for individuals experiencing homelessness to help amplify their vaccine equity work. Since the project’s inception, ASTHO’s community action partners have held more than 450 events, engaged more than 1.5 million community members in their efforts, and administered at least 5,500 vaccinations including those for COVID-19, influenza, Tdap (tetanus, diphtheria, and pertussis), shingles, and more. Susan Bailey_ASTHO Helping Agencies and Providers Advance Vaccine Equity Using the Toolkit State and territorial health agencies work to promote, improve, and maintain health for all. However, their ability to fulfill these responsibilities sustainably depends largely on public trust in public health institutions. One of the most effective ways to build trust is by engaging the communities most affected and leveraging existing, trusted organizations to help address the issues. Every site participating in ASTHO’s Vaccine Equity Project cultivated partnerships with their state or local health department to aid in their outreach efforts, which can transcend into other areas and stages of public health interventions. Aurora GrantWingate_ASTHO Helping Agencies and Providers Advance Vaccine Equity In Conclusion Jurisdictions can learn more about the innovative structure and outcomes from this project and implement similar partnerships that further the pursuit of equity in their communities. Access the Championing Change toolkit now. Special Thanks-Blog - ASTHO Helping Agencies and Providers Advance Vaccine Equity Padding - small 1 NU21IP000598 website yes

During the the 2021-2022 legislative sessions, several states have enacted laws addressing flu prevention efforts.

People exposed to adverse childhood experiences are at risk for negative physical and/or mental health outcomes, substance use disorders, and unfavorable social outcomes in adulthood. One known risk factor for ACEs is caregiver stress, including economic hardship. State legislatures have considered several policies in recent years that can improve the overall health of caregivers and reduce ACEs. Read more in this week's Health Policy Update.

Learn how health agencies can pursue public health partnerships with Community Action partners to strengthen immunization infrastructure.