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This report identifies and breaks down seven core value areas that emerge from taking a health in all policies approach to policymaking and programming.

Support for programs and policies that encourage positive mental health in early childhood and provides support for parents and caregivers to have the best chance to improve mental health across the life course.

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

PHIG Recipients Accelerating Procurement Processes Melissa Touma Learn how PHIG recipients are advancing procurement processes to advocate for continued public health infrastructure investment, using thoughtful targets and tracking progress. Timely procurement is a cornerstone of effective public health infrastructure. Under CDC’s Public Health Infrastructure Grant (PHIG), recipients are encouraged to strengthen their procurement systems so that resources reach communities swiftly and efficiently. As jurisdictions continue to modernize their systems, several PHIG recipients are leading innovative practices that not only reduce procurement cycle times but also enhance transparency, accountability, and collaboration. By setting thoughtful targets and tracking progress, agencies can demonstrate improvements in procurement efficiency and make a strong case for continued investment in public health infrastructure. Best Practices for Setting Targets for the PHIG Procurement Timeliness Measure The PHIG performance measure A2.2: Procurement Timeliness tracks the median number of calendar days from when procurement documentation is received to when a contract is fully executed. It helps agencies assess and improve the efficiency of their procurement processes, particularly those funded by federal awards. Setting realistic and meaningful targets for procurement timeliness is essential for tracking progress and driving improvement. Clear, data-informed targets help agencies identify bottlenecks, allocate resources effectively, and measure the impact of process changes over time. When targets are both ambitious and achievable, they can motivate teams, guide continuous improvement efforts, and support accountability across departments. To get on track: Start with a baseline. Use historical data to establish a procurement cycle time. If data is not yet available, begin with a small sample and refine over time. Segment by procurement type. Consider setting distinct targets for various types of procurement (e.g., contracts vs. purchase orders) if they follow different timelines. Engage stakeholders. Collaborate with procurement, finance, and program staff to understand bottlenecks and set achievable goals. Align with system improvements. Adjust targets to reflect expected gains in efficiency, especially when implementing a new contract lifecycle management system or process improvements. Document assumptions and limitations. When setting targets, note any contextual factors (e.g., staffing shortages, policy changes) that may affect procurement timelines. Review and adjust regularly. As systems mature and data quality improves, revisit and refine targets to reflect new capabilities and expectations. Best Practices from PHIG Recipients Several PHIG recipients have adopted replicable strategies to improve procurement timeliness, aligning with best practices from the National Association of State Procurement Officials and principles of collaborative procurement partnerships that emphasize cross-functional coordination and interagency engagement. Here are some best practices and examples of how PHIG recipients are moving to improve their procurement systems: Establish a robust and effective data collection system that offers automated data capture, comprehensive coverage, regular audits, and validation. For example: Illinois Department of Public Health currently uses Smartsheet to streamline procurement tracking and plans to implement DocuSign’s Contract Life Management (CLM) system to track procurement in 2026. Seattle & King County Public Health utilizes Agiloft, a Contract Lifecycle Management platform, to manage procurement from planning to closeout. Connecticut Department of Public Health built a custom Grants Management System using Dynamics 365 and Power BI, enhancing visibility and reporting. Tennessee Department of Health developed a low-code Contract Tracking and Reporting Application using Caspio, improving efficiency and data accuracy. Utilize a CLM System to improve efficiency, enhance transparency and accountability and ensure compliance and risk management. For example: Iowa Department of Health and Human Services is rolling out Cobblestone, a full-spectrum CLM system that guides users through procurement pathways and supports contract execution and management.  Connecticut Department of Public Health utilizes its new Grant Management System built into Dynamics 365 and Power Bi.  Seattle & King County Public Health utilizes Agiloft, a CLM platform. Establish a dedicated, centralized team that oversees and executes procurement activities for the entire agency. For example: Illinois centralized its procurement function by assigning a team of five people to improve collaboration and consistency across the agency. Connecticut is building a centralized team to support program staff through the procurement process. Institutionalize procurement capacity building, training, and customer support. For example: Louisville Metro Department of Health and Wellness placed a trainer on the procurement and contracting team to build the capacity of all grants/contract managers across the agency. Training materials and documents are available for staff to reference and build programmatic capacity. Connecticut established a customer support team within its Operational Support Unit to assist staff with procurement needs. Foster a working relationship with external agencies or divisions that play a role in the procurement approval process. For example: Illinois includes state purchasing officers in weekly procurement meetings to enhance communication and problem-solving. Foster cross-functional collaboration and learning through internal procurement meetings and engagement. For example: Santa Clara Public Health Department created a Grants/Fiscal Community of Practice to foster cross-functional learning. Procurement as a Strategic Lever for Public Health Improving procurement timeliness is more than a technical fix — it's a strategic investment in public health readiness and resilience. By embracing data-driven tools, centralizing expertise, fostering collaboration, and exploring emerging technologies, public health agencies are reducing delays while building the infrastructure to respond swiftly to community needs, emergencies, and long-term health goals. As these best practices continue to spread and evolve, they offer a roadmap for other jurisdictions to modernize procurement and maximize the value of every public health dollar. Next, explore how two state recipients are transforming procurement and grant management — ultimately delivering faster, more reliable services to the communities that need them most. As more PHIG recipients work to modernize their procurement systems, sharing strategies and lessons learned becomes increasingly valuable. What strategies has your agency found most effective in improving procurement timeliness? We invite you to join the conversation and contribute your insights to help strengthen public health infrastructure nationwide. Send us an email at phig@astho.org! article yes

Tennessee and Connecticut Are Transforming Procurement and Grant Management Systems States Transform Procurement and Grant Management System Melissa Touma Learn how Tennessee and Connecticut are transforming their procurement and grant management systems with new tools, smarter workflows, and transparency. Behind every public health initiative — whether it’s expanding rural care, funding local clinics, or responding to emergencies — there’s a complex system working to move contracts, track spending, and ensure accountability. For many health departments across the country, CDC’s Public Health Infrastructure Grant (PHIG) is a critical resource to modernize these foundational systems that power public health. In Tennessee and Connecticut, this investment is already paying off. With new tools, smarter workflows, and a focus on transparency, both states are transforming how they manage procurement and grants. As a result, they’re delivering faster, more reliable services to the communities that need them most. Tennessee Department of Health In Tennessee, innovation took root through a homegrown solution: the Contract Tracking and Reporting Application (CTRAC). The Tennessee Department of Health’s (TDH’s) Operations Analysis Office and Procurement Management Office built CTRAC using Caspio, a low-code platform that allowed the team to design a fully customized application without extensive programming. What began as a manual, email-based process using internal contract processing worksheets is now a fully automated, digital workflow. CTRAC streamlines how TDH initiates, reviews, and tracks contracts, making procurement more efficient and transparent. The system automates the collection of all required documentation for procurement processing, enforces validation rules to ensure data quality, and provides comprehensive reporting capabilities that meet CDC’s PHIG performance measures. It has also been expanded to support Federal Funding Accountability and Transparency Act reporting and invoice management, making it a central hub for multiple financial and administrative functions. Additionally, CTRAC integrates critical control mechanisms that strengthen financial compliance and oversight: Budget review and monitoring tools ensure that funding sources are correctly cited and aligned with contract terms. Fiscal review processes, which are embedded into the workflow, reduce the risk of errors and improve compliance with federal and state regulations. Automated data capture reduces human error and ensures timely, consistent entries. Monthly audits and validation checks maintain data integrity and support continuous improvement. PHIG funding offset TDH’s initial Caspio costs, covering the expenses that supported procurement timeliness improvements. It also enabled the development of internal dashboards that track processing times at key stages. These visual tools improved communication with stakeholders across the department and supported efficient, data-driven decision-making. In parallel, TDH enhanced several Caspio user interfaces to streamline navigation and improve the overall user experience for staff. In addition, PHIG funding supported the expansion of CTRAC to manage post-award grant functions for 22 grantees as part of the Rural Healthcare Resiliency Program project, including tools for electronic reimbursement submissions, real-time budget tracking, and status updates. Connecticut Department of Public Health For the Connecticut Department of Public Health (CTDPH), PHIG funding has been vital to advancing a more transparent, efficient, and data-informed grants and procurement ecosystem. At the core of this transformative effort is a new, agency-wide grants management system, developed using Microsoft Dynamics 365 and Power BI. PHIG’s support enabled CTDPH to hire a dedicated data engineer to design and implement the system’s foundational database, an essential technical capability that underpins the success and sustainability of the initiative. This integrated platform streamlines workflows and enhances accountability and tracking across the grant and procurement lifecycle. By centralizing data and automating reporting, CTDPH can now: Track procurement and contract status in real time, reducing delays and improving responsiveness. Ensure compliance with federal and state requirements through built-in validation and audit trails. Generate dynamic dashboards that provide leadership with actionable insights into spending, timelines, and bottlenecks. Standardize documentation and approvals, reducing variability and increasing transparency across departments. To further strengthen and sustain these improvements, CTDPH is establishing a centralized procurement support team that guides program staff through the often-complex procurement process — ensuring consistency, reducing redundancy, and ultimately improving the speed and quality of contract execution. For health program staff in the agency, this system transformation means less time navigating administrative hurdles and delays, and more time focusing on public health outcomes. Another key focus area for CTDPH is procurement timeliness, an important component of achieving public health goals. CTDPH reported a median procurement cycle time of 137 days in PHIG Reporting Period 4 and set a target to reduce this to 80 days. This commitment aligns with PHIG’s broader goal of improving foundational capabilities and reflects CTDPH’s proactive approach to building a more agile and accountable public health infrastructure. Conclusion Both Tennessee and Connecticut exemplify how PHIG funding can catalyze meaningful change in procurement and grants management. Whether through custom-built platforms like CTRAC or enterprise-grade systems like Dynamics 365 and Power BI, these states are laying the groundwork for more efficient, transparent, and accountable public health operations. As PHIG continues to support foundational improvements, Tennessee and Connecticut’s successes offer a roadmap for other states seeking to modernize their systems and accelerate public health impact. Next, learn about best practices and strategies for procurement PHIG peers are implementing. article yes