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Learn how health agencies can improve access to critical medications by preparing for drug shortages and working with a diverse set of partners.

Under the Tenth Amendment, states have the power to protect the health and welfare of their populations, including the authority to implement isolation and quarantine orders to limit the spread of disease. This post is an examination of state public health authority for isolation and quarantine.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: mental and behavioral health, rural health, e-cigarettes and flavored tobacco products, HIV and PFAS.

Vaccines are one of the greatest public health achievements of the last century, as well as some of the most powerful and cost-effective tools to prevent disease, disparities, disability, and death among children and adults. The COVID-19 pandemic and the unprecedented development and distribution of the vaccines against the novel coronavirus have generated much focus on state laws related to vaccinations. As state and territorial legislatures prepare to convene in the coming weeks, we can already identify several topics within vaccine law that policymakers across the country will consider.

Reconciling the tension between public health and civil liberties is one of the most significant challenges of public health law and ethics. The Supreme Court of the United States historically upheld state authority to enact and enforce public health laws that temporarily limit a person’s civil liberties, such as quarantine and isolation powers that restrict a person’s freedom of assembly in order to prevent the spread of contagious disease. There have been many legal challenges to the public health orders issued to slow the spread of COVID-19—many of the claims asserting violations of First Amendment rights of assembly, association, and expression—but they’ve largely been rejected by the courts. However, courts have treated claims asserting violations of the free exercise of religion more favorably, which may indicate an impending shift in how courts analyze the impact state and territorial actions may have on religious organizations.

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.

Several states and territories, as well as many local governments, are going beyond recommendations and requiring individuals to wear face coverings when they are in public settings and spaces (i.e. grocery stores, retail stores, restaurants, public and private transportation services, parks, etc.). Ongoing research and evidence suggests the relationship between mandatory face coverings and declines in daily COVID-19 growth rates is statistically significant.

Good news and bad news on tobacco use: smoking rates are down but e-cigarette use continuing rapid rise among youth. Read how states are combating the problem.

Three ways policymakers are addressing access to care are through telehealth, safety net and emergency services, and adjusted reimbursement rates to Medicaid-enrolled providers.

To address the youth tobacco epidemic, jurisdictions filed lawsuits against JUUL to end their marketing practices aimed at youth and to obtain compensation from the financial toll experienced by communities.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

This ASTHOReport serves as a primer for state and territorial health agencies seeking to assess the public health impacts of lead exposure in drinking water.

In-depth analysis on state health policy surrounding immunization. This is part of ASTHO's annual legislative prospectus series.

This blog post discusses mitigating risks of AI use in government agencies, emphasizing privacy, transparency, and ethical concerns.

Earth Day is a natural time to examine current and future climate change policies that impact human health, including clean air, safe drinking water, access to food, and secure shelter.

Assessment of Foundational Capabilities Assessment of Foundational Capabilities in Public Health Grace Gorenflo, Brian Lentes, Melissa Touma, Anna Bradley Learn how state health departments are implementing the Foundational Public Health Services model to bolster their public health work in this report. The Foundational Public Health Services model serves as the core framework for defining cross-cutting capabilities essential for public health departments to deliver a minimum standard of service. This report compiles examples and assessments from 25 states to illustrate the implementation and progress of these foundational capabilities. Highlighting the importance of public health infrastructure, the report also includes a summary of state activities, showcases models and strategies for modernization and transformation, and reference tools such as cost assessments, legislation, and funding mechanisms used to strengthen public health systems nationwide. Dive into the full report to access these resources. Download the Report (PDF) article yes

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

States Continue to Address PFAS in U.S. Food and Water Supply States Continue Addressing PFAS in Food and Water Supplies Heather Tomlinson, Beth Giambrone Read how federal and state actions aim to tighten regulations to reduce PFAS exposure in the U.S. food and water supply. Use of per- and polyfluoroalkyl substances (PFAS), manufactured chemicals that resist water and heat, has steadily increased since they were first developed in the 1940s. PFAS are present in a wide variety of consumer products. PFAS do not degrade easily and can result in increasing concentrations of contamination in water and soil. PFAS exposure has been linked to a variety of health impacts, causing state and federal governments to enact legislation and create policies that reduce their presence in consumer products. States are also working on ways to address and communicate about PFAS contamination and elimination. PFAS in Food and Food Packaging FDA has been evaluating potential dietary exposure by testing foods most commonly eaten by the U.S. public for PFAS through the Total Diet Study (TDS). The initial findings indicate that the vast majority do not — 97% of the 810 fresh and processed foods samples, to be precise. Nevertheless, some specific food subtypes have shown a higher prevalence, with over half of TDS seafood samples detecting at least one type of PFAS. As part of their technical assistance to states, FDA can test foods produced in areas with known environmental contamination to evaluate potential contamination of human and animal food. One recent example came from two dairy farms in New Mexico with known PFAS groundwater contamination; this sampling resulted in milk samples from one farm showing PFAS levels at a potential health concern threshold and lead to them being discarded prior to entering the food supply. Consumers can also be exposed to PFAS through food packaging. As of February 2024, FDA announced that grease-proofing materials containing PFAS are no longer sold for food packaging in the United States, eliminating the primary source of dietary exposure from food contact surfaces. At least 17 states have introduced legislation in their 2025 sessions to prohibit selling food packaging that contains PFAS, with bills in seven states seeing significant movement. In April 2025, New Mexico enacted HB 212, which prohibits selling food packaging and other products containing PFAS starting January 1, 2027. Bills in California SB 682, Illinois SB 1531, and New York S 187 that would prohibit manufacturing, distributing, and/or selling products containing PFAS (including food packaging) advanced in the first chamber. Regulating Drinking Water In April 2024, EPA used their authority under the Safe Drinking Water Act to establish Maximum Contaminant Levels (MCLs) for PFAS found in drinking water. This National Drinking Water Regulation (NPDWR) established individual MCLs for PFOA,PFOS, PFNA, PFHxS, and GenX and a Hazard Index MCL for mixtures of two or more PFAS (specifically PFHxS, PFNA, GenX Chemicals, and PFBS). Under the rule, public water systems must complete initial monitoring for PFAS by 2027 and continuously monitor thereafter. In addition, they must inform the public about PFAS levels in their drinking water and, beginning in 2029, any public water system that exceeds one or more of the MCLs must reduce the PFAS levels and notify the public of the violation. A recent announcement from EPA stated that while they intend to retain the current MCLs for PFOA and PFOS at four parts per trillion (ppt), they will “rescind the regulations and reconsider the regulatory determinations for PFHxS, PFNA, HFPO-DA (commonly known as GenX), and the Hazard Index mixture of these three plus PFBS.” The agency will also propose to give drinking water systems until 2031 to come into compliance with the PFAS rule. A proposed rule is planned for a fall release, with finalization in the spring of 2026. Finally, EPA plans to establish a framework for exemptions and provide assistance to drinking water systems through the PFAS OUTReach Initiative. EPA delegates responsibility for enforcing regulations for public water systems to states that meet certain requirements. Under the current federal rule, states have two years to establish regulations that are at least as stringent as current EPA standards. At least 20 states currently have regulatory standards for at least one PFAS in drinking water, and so far in the 2025 sessions, at least six states introduced legislation to establish new or updated MCLs: Indiana (HB 1366), North Carolina (SB 384), and West Virginia (HB 3475) introduced bills directing their health departments to establish MCLs for certain PFAS contaminants. North Carolina’s bill also requires the Commission on Public Health to consider adopting MCLs for PFAS contaminants not listed in their legislation if at least two other states have set MCLs or issued guidance. The New York state Senate recently passed S 3207, which would tighten MCLs for PFOS and PFOA from 10 ppt to 4 ppt, and establish MCLs of 10 ppt for PFNA, PFHxS, and HFPO-DA. The measure is currently in the Assembly for consideration. Pennsylvania HB 578 would establish MCLs for PFAS at 10 ppt, and would allow MCLs established by the Environmental Quality Board or executive order of the governor to supersede current MCLs. Vermont H 286 would establish MCLs for PFOS, PFOA, PFHxS, PFNA, perfluoroheptanoic acid (PFHPA), and perfluorodecanoic acid (PFDA) at zero ppt, and MCLs for any other testable PFAS at 20 ppt. Two states also introduced legislation modifying requirements for monitoring or reporting PFAS. Maine recently enacted LD 1326, which codifies the requirements to monitor and report PFAS compounds in accordance with EPA’s final rule and requires public notification of the type and level of PFAS in drinking water if they exceed the federal standard. Delaware SB 72 would require the Department of Health and Social Services to create a website where residents can access information related to the level(s) of PFAS in public drinking water systems, and require water utility companies to provide notice of excess PFAS levels to residents who receive water from that system. The measure passed the Senate in May and is currently in the House for consideration. PFAS is a cross-cutting issue, impacting health departments, agricultural agencies, environmental agencies, and the public. State and territorial health agencies can collaborate with community groups to create a broad coalition that can work together across their respective areas to address PFAS contamination. Many states have created internal cross-agency workgroups to evaluate and address PFAS exposures. ASTHO will continue to provide updates on PFAS elimination and MCL implementation. article yes

Tobacco use causes 480,000 premature deaths each year, making it the leading cause of preventable death in the United States. In collaboration with CDC, ASTHO is leading an effort to explore how states can use Medicaid data to quantify tobacco use within this population, identify related best practices, and make recommendations for scaling.