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This ASTHOBrief contains three key recommendations for improving the 2013 CDC/CSTE Cancer Cluster Investigation Guidelines.

Improving Community Access to Care Through Health Disparities Grant Learn how states have addressed COVID-related health disparities and improved health equity in their jurisdictions in these case studies. In 2021, as part of the COVID-19 pandemic response, CDC distributed critical funding to state, territorial, and freely associated state health departments through the OT21-2103 COVID Health Disparities grant to promote health equity initiatives. ASTHO, in partnership with the National Association of Community Health Workers and the National Organization of State Offices of Rural Health, created state stories highlighting how some health departments have deployed this funding to advance health equity in their jurisdictions. The following state stories demonstrate how Utah, Virginia, and Texas worked to strengthen public health initiatives in rural communities, empower community health workers, and build stronger bridges between communities and health care. website yes

Supporting Resilience in Rural Areas Through Cross-Sector Partnerships ASTHO, Association of State and Territorial Health Officials, rural health, public health, public health partnerships, health in all policies, government agencies, community organizations, academic institutions, rural populations, infrastructure improvement, healthcare systems, environmental determinants, climate change, sustainable practices, environmental challenges, extreme weather, environmental health risks, protective factors, engaging rural partners, building trust, idaho department of health and welfare, michigan department of health, health equity, austin climate equity plan, healthy start oregon, kansas department of commerce, wisconsin broadband access, chesapeake housing mission Ali Aslam The key to making rural communities more resilient is for public health to partner with community organizations, governmental agencies, and other critical partners. Working across sectors of government agencies, community organizations, businesses, and academic institutions is critical to address public health challenges in rural communities. Using a Health in All Policies (HiAP) approach helps public health agencies better address the interconnected social, economic, and environmental determinants of health impacting rural communities and improve community well-being. HiAP brings together a multitude of perspectives to develop holistic strategies that can support infrastructure improvements, sustainable land use practices, diversified economic opportunities, safer and healthier home environments, and robust health care systems in rural communities. Through community leadership and collaboration, this cross-sector approach can enhance the capacity of rural communities to build resilience, adapt to climate change, and foster long-term sustainability to improve public health outcomes. Learn how states are implementing HiAP strategies to improve health in their rural communities in this report. Get the Report (PDF) website yes

Social determinants of healthcare are the conditions in which people are born, live, work, play, worship, and age. Read how these issues affect population health.

This toolkit is designed to support public health leaders in leveraging the policy development process to achieve health equity in their jurisdiction.

Following disruptions to daily life caused by the COVID-19 pandemic, emergency departments saw an increase of mental health-related visits. A June 2021 study showed a significant increase of mental health-related visits among 12–17-year-olds compared to the previous year. States and territories that implement a comprehensive public health approach to suicide prevention across all domains of life—an approach known as the socio-ecological model—can reduce contributing risk factors.

Every year in mid-July is National Youth Sports Week—in 2021 it falls on July 19-23. It’s an important health observance because youth sports create strong connections with peers and caring adults, as well as promote socio-emotional skills and positive well-being. The Office of Disease Prevention and Health Promotion’s National Youth Sports Strategy outlines policies and strategies that support access to youth sports. NYSS Champions, including ASTHO, work to promote participation and recognize the positive health outcomes sports can have on youth, such as limiting the impacts of adverse childhood experiences and building resiliency.

Two rising health trends are negatively affecting women’s health across the United States: maternal mortality (death from pregnancy or delivery complications) and severe maternal morbidity (mental and physical health consequences from a pregnancy or delivery.) Maternal mortality review committees (MMRCs) are one of the best ways to gather information on why pregnancy-related deaths occur and how to prevent them. Studies show that MMRCs can reduce maternal mortality by 20-50% since they examine the underlying causes of maternal mortality, use data to identify gaps in care, and inform a focused approach to prevent deaths and reduce disparities.

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.

States Support Postpartum Health with Medicaid Expansions astho, association of state and territorial health officials, 2023 state legislative session, medicaid expansions, postpartum health, the consolidated appropriations act, national women s health week, postpartum coverage, affordable care act, premium tax credits, affordable care, 12 weeks, united states, extended postpartum coverage, health a priority, medicaid program, national women s health, mother s day, 2023 legislative, vaginal birth, physical activity, women s health week, postpartum care, coverage for 12 months, 60 days, state plan amendment, care act, postpartum depression, health care Sowmya Kuruganti National Women’s Health Week reminds us that postpartum care is critical for the long-term health of the birthing parent and baby. National Women’s Health Week’s 2023 theme—Women’s Health, Whole Health: Prevention, Care and Wellbeing—is a reminder that postpartum care is critical for the long-term health of the birthing parent and baby. The first year after pregnancy can be full of physical, emotional, and mental health challenges that have long-term or even life-threatening health impacts without timely diagnosis and treatment. In September 2022 CDC reported that 23% of pregnancy-related deaths occur from seven to 42 days postpartum, and 30% of deaths occur 43-365 days postpartum. Among all pregnancy-related deaths occurring from 2017 to 2019, approximately 84% were deemed preventable. Black and American Indian and Alaskan Native <!--(AI/AN)--> women have two to three times higher rates of pregnancy-related death compared to white women. These disparities, like others, are driven by social and economic factors that are rooted in structural and systemic racism and discrimination. Health insurance coverage is one such factor that supports positive maternal health outcomes by facilitating access to care before, during, and after pregnancy. In the United States, 40% of births are covered by Medicaid, which is the primary source of health coverage and access to care for those of low income. Organizations like ASTHO and the Association of Maternal and Child Health Programs support extending Medicaid coverage through one-year postpartum to combat disparities in maternal health outcomes. Federal Legislation for Postpartum Coverage under Medicaid For the majority of states that have adopted Medicaid expansion under the Affordable Care Act (ACA), all people with income up to 138% of the federal poverty level (FPL) are eligible for Medicaid. In states without Medicaid expansion, pregnant people can be eligible for coverage during pregnancy and up to 60 days postpartum under federal law. After 60 days postpartum, these people may lose coverage for the rest of the year-long postpartum period based on general state Medicaid eligibility requirements. Prior to 2021, states could extend Medicaid coverage to postpartum people through a section 1115 demonstration waiver or through state funds. The enactment of the 2021 American Rescue Plan Act, gave states another option to extend Medicaid coverage to 12 months postpartum via state plan amendment for five years. So far in 2023, CMS has approved the State Plan Amendments for five states (Alabama, Arizona, Colorado, Oklahoma, and Rhode Island) implementing a 12-month postpartum expansion. To date, a total of 33 states have expanded Medicaid coverage to 12 months postpartum via Section 1115 demonstration waiver or state plan amendment. 2023 State Legislative Session Depending on states rules for modifying Medicaid coverage the legislature may need to direct the health department to submit a state plan amendment. So far in 2023, three states enacted legislation related to expanding coverage to 12 months postpartum. In Mississippi, SB 2212 authorizes the state’s Division of Medicaid to provide 12 months continuous postpartum coverage to people who qualify. Utah’s SB 133 extends coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. In Wyoming, HB 4 temporarily extends Medicaid coverage for qualifying pregnant women for 12 months postpartum, ending March 31, 2027. Other states introduced bills to extend postpartum coverage during this session. The Alaska Legislature passed legislation (SB 58) directing the Department of Health to submit a state plan amendment extending postpartum coverage to 12 months, and to raise the household income level for eligibility to 225% of the FPL. The bill is currently awaiting action by the governor. Iowa introduced legislation (SF 57) to enact postpartum coverage for 12 months postpartum by Medicaid State Plan Amendment. This would extend the current 60-day postpartum coverage for Medicaid beneficiaries. The Missouri legislature passed (SB 45) that would extend MO HealthNet postpartum coverage from 60 days to 12 months postpartum for women who are either currently receiving or eligible to receive aid to families with dependent children, or eligible to receive benefits via the income eligibility standard. Pregnant women eligible for MO HealthNet and receiving mental health treatment for postpartum depression, related mental health conditions, or substance abuse treatment within sixty days of giving birth would remain eligible for benefits for those services for an additional 12 months. The bill is currently awaiting action by the governor. Nebraska introduced legislation (LB 419) to extend postpartum coverage for 12 months postpartum that would extend the current 60 day postpartum coverage. Texas introduced legislation (HB 12) to extend postpartum coverage to 12 months; it has passed in the House and is now pending in the Senate. Its passage would significantly change the current coverage structure, which uses state funds to provide postpartum people a limited package of postpartum services through the Healthy Texas Women program under HB 133, and subsequently submitted 1115 waivers to draw down federal funds for the program and extend coverage to six months postpartum. Wisconsin introduced companion bills (AB 114/SB 110) extending postpartum coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. This action would extend coverage from the current 60 days and amend the previous 90-day Section 1115 Waiver submitted in 2021. Studies have demonstrated numerous benefits of extending Medicaid coverage for postpartum people and, given these positive impacts, ASTHO expects that more states will take action to extend Medicaid to 12 months postpartum. ASTHO will continue to monitor and report on this essential maternal public health issue. website yes

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.

Looking to the future, states are improving access to care, providing subsidies for tuition costs, expanding hours of licensed facilities, increasing access, and meeting the needs of both parents and children.

ASTHO Awards Public Health Leaders and Agencies for Service BETHESDA, MD—The Association of State and Territorial Health Officials (ASTHO) presented several awards during its 2019 Annual Meeting and Policy Summit this week to commend public health leaders and agencies for their service and dedication to improving our nation’s health. “We’re pleased to recognize this distinguished group of health professionals and agencies,” says Elke Shaw-Tulloch, state health officer at the Idaho Department of Health and Welfare, past ASTHO president, and chair of ASTHO's Nominations, Awards, and Membership Committee. “The excellence we highlight today touches millions of lives and represents just a small sample of our nation’s dedicated public health professionals, who continuously strive to promote the public’s health and well-being.” The 2019 ASTHO awardees include: John Wiesman, DrPH, MPH, Secretary of Health, Washington State Department of Health Arthur T. McCormack Award Dr. Wiesman has served as Washington state’s health official since 2013 and currently co-chairs the Presidential Advisory Council on HIV/AIDS. Under his leadership, the Washington State Department of Health is spearheading the End AIDS Washington program, developing the Healthiest Next Generation initiative, identifying and funding foundational public health services, implementing the governor’s executive order to reduce suicide and prevent firearm injuries and deaths, and addressing the public health impacts of climate change. Stephanie C. Williams, RNP, MPH, Senior Deputy, Arkansas Department of Health Noble J. Swearingen Award As deputy director for public health programs at the Arkansas Department of Health, Ms. Williams oversees and guides the work of the agency’s four operational centers: Health Advancement, Health Protection, Local Public Health and Public Health Practice. She also oversees the state public health laboratory and the state offices of Health Communication and Minority Health. Ms. Williams also advises and assists the state health official in setting policy and programmatic direction for the department and serves as state health official in his absence. Janae Price, MPH, Senior Epidemiologist, Illinois Department of Public Health State/Territorial Excellence in Public Health Award Ms. Price served the Illinois Department of Public Health from April 2016 to March 2019 as a member of the U.S. Public Health Service Commissioned Corps. She led or co-led more than five nationally-funded statewide projects, ten committees or workgroups, and numerous complex multi-year projects. Price’s contributions led the health agency to strengthen its chronic disease epidemiology capacity by integrating evaluation and performance monitoring for chronic disease programs, developing critical partnerships, improving data collection and reporting quality, and using innovative methods to assess public health needs. Paul K. Halverson, DrPH ASTHO Alumni Award Dr. Halverson served as the state health official for the Arkansas Department of Health from 2005-2013. He oversaw the development of Arkansas’ statewide trauma system, which has become a model for other states, and he greatly enhanced the effectiveness of the Arkansas Public Health Preparedness Program and the Arkansas Public Health Laboratory. As a state health official, Dr. Halverson was a mentor to many new state health officials and a trusted colleague to his peers. After transitioning to his position as founding dean of the Indiana University Richard M. Fairbanks School of Public Health, he has remained active as an ASTHO alumnus, serving as president of the ASTHO Alumni Society. Increasing Immunization Capacity in Texas Emergency Responder Facilities—Texas Department of State Health Services ASTHO Vision Award, First Place, Category A (Programs ≥ $250,000) ASTHO recognizes Texas Department of State Health Services for its work raising immunization rates for Texas emergency responders. Implementation of the New York State Prevention Agenda 2013-2018—New York State Department of Health ASTHO Vision Award, Second Place, Category A (Programs ≥ $250,000) ASTHO recognizes New York State Department of Health’s for its work developing a six-year state health improvement plan, which aims to make New York the healthiest state. Developed in collaboration with the Ad Hoc Committee to Lead the Prevention Agenda and more than 140 statewide organizations, the plan identifies New York’s most urgent health concerns and recommends ways statewide organizations and local health departments, hospitals, and partners from the health, business, education, and nonprofit sectors can work together to address them. Office of Grants Management—Northern Mariana Islands Commonwealth Healthcare Corporation ASTHO Vision Award, First Place, Category B (Programs less than $250,000) ASTHO recognizes the Northern Mariana Islands Commonwealth Healthcare Corporation for establishing the Office of Grants Management to improve coordination of the administration of all of the health agency’s federal programs and external funds. The office was created to oversee the financial and record keeping aspects of the annual grant-making process for the corporation and its divisions for all grants received or awarded. It also collaborates closely with all program managers to streamline and improve grant applications, implementation, administration, compliance, performance, and reporting requirements on all grants. Local and Tribal Public Health System Improvement Program—Montana Department of Public Health and Human Services ASTHO Vision Award, Second Place, Category B (Programs less than $250,000) ASTHO recognizes Montana Department of Public Health and Human Services for its efforts to improve Montana’s local and tribal public health infrastructure. As part of this work, the health agency has strengthened partnerships between the healthcare sector and public health agencies; accelerated the use of the Public Health Accreditation Board’s national standards for public health practice by state, local, and tribal public health agencies; and strengthened local boards of health. ASTHO Press Release Boilerplate website yes

In this episode, two maternal healthcare veterans share approaches for bringing providers into the process, as well as how state health officials can promote risk appropriate care strategies and address challenges in achieving equitable risk appropriate care.

Health Officials Combat Nation’s Maternal Mortality Rates ARLINGTON, VA—State and territorial health officials are assessing maternal care programs within their states to address the rise in maternal deaths across the nation. According to a new Centers for Disease Control and Prevention (CDC) Vital Signs report, each year more than 700 women in the United States die during pregnancy, delivery, or up to a year postpartum, with three out of every five of these deaths being preventable. The Association of State and Territorial Health Officials (ASTHO) and its members are committed to protecting the health of mothers through multidisciplinary efforts to address preventable deaths, such as closing gaps in access to quality preconception and prenatal care, care for chronic conditions, missed diagnoses, and maternal education. “Across the country, state and territorial health officials are continually analyzing women’s health data, programs, and outcomes to address and prevent maternal mortality and morbidity,” says Michael Fraser, CEO of ASTHO. “As with all public health issues, officials take this trend very seriously, and we know that tackling this issue involves addressing the unique social, economic, and healthcare challenges that impact women’s health on multiple levels in every state.” The causes of maternal mortality and morbidity vary widely, depending on many local factors and stage of pregnancy or post-pregnancy. For example, weakened heart muscles (cardiomyopathy) are the leading cause of death between one week and one year postpartum. Postpartum care, however, often focuses on the infant—not the mother. Providing and covering high-quality care for mothers the first year following birth would ensure prompt follow-up care and communication about issues like severe bleeding, high blood pressure, and infection. “The majority of deaths from pregnancy-related complications are absolutely preventable,” says Nicole Alexander-Scott, MD, MPH, director of the Rhode Island Department of Health and president of ASTHO. “We also know that significant racial and ethnic disparities exist in the rates of fatalities from pregnancy-related complications. Health systems, healthcare providers, and public health professionals need to continue taking measures to improve access to and coordination and delivery of quality care for all women, regardless of their ZIP code. We also need to engage patients and communities in this work so that everyone knows that their voice matters, and that they are being heard.” Many states are assessing maternal and perinatal levels of care and the standardized capabilities of individual hospitals to ensure pregnant women deliver at facilities equipped for a range of medical outcomes. Some of these efforts include: Indiana passed a perinatal levels of care law (SB 360) last year so the state health department could establish a program to certify perinatal levels of care designations for licensed hospitals and birthing centers. The Indiana State Department of Health also works alongside the Indiana Hospital Association, the Indiana Rural Health Association, and the Indiana Family and Social Services Administration’s Office of Medicaid Policy and Planning to investigate opportunities to keep rural hospitals and obstetric units open, as 35 of Indiana’s 92 counties either have no hospital or have a hospital without obstetric services. The Texas Department of State Health Services (DSHS) established a multidisciplinary Maternal Mortality and Morbidity Task Force to review cases of pregnancy-related deaths and severe maternal morbidity, identify trends and disparities, examine best practices, and make recommendations to reduce the incidence of pregnancy-related deaths and severe maternal morbidity. Additionally, Texas DSHS is leading the statewide TexasAIM initiative to help hospitals and clinics in Texas carry out maternal safety projects. The North Carolina Maternal Mortality Review Committee identified significant racial disparities in maternal deaths, causing the state to place a greater emphasis on addressing the non-medical issues responsible for exacerbating these disparities. These efforts led to a reduction in disparities in pregnancy-related deaths over a 10-year period. North Carolina continues to work to confront the remaining increased risk of pregnancy-related deaths among black women. ASTHO Press Release Boilerplate website yes

Approximately 700 women die annually in the U.S. between 2007-2016 as a result of pregnancy or its complications, according to CDC data. This is one of the highest maternal mortality rates in the developed world. On top of that, there are stark disparities along racial lines, with Black and American Indian/Alaska Native women having higher rates of pregnancy-related deaths compared to white women.

The need for food and nutritional assistance is growing. Based on Feeding America’s food insecurity projections released in March, it is anticipated that 42 million people may experience food insecurity this year—up from 35 million pre-pandemic. The job loss in communities as businesses had to shut down or reduce capacity has left many families across the country relying on food banks. In fact, food banks in the Feeding America network distributed 6.1 billion meals to individuals and families during this pandemic, an increase of 43% from 2019. Many of the people who have fallen into food insecurity are experiencing it for the first time in their lives, as our food pantry partners across the country report that 35% or more of the people they’re serving today had never received charitable food prior to the pandemic.

As the nation grapples with the ongoing COVID-19 pandemic, community health workers are being recognized for the role they play in improving health outcomes of our most vulnerable communities. In fact, the recently enacted American Rescue Plan Act of 2021 allocates funding for the recruitment, hiring, and training community health workers by public health departments.

During the early spread of COVID-19, the National Rural Health Association senior vice president Brock Slabach stated: “Before the pandemic, rural hospitals were struggling for survival. COVID-19 has put a spotlight on the fractures that already existed within rural communities in terms of their healthcare delivery.” These fractures also exposed the desperate need for ethical transformational leadership within rural healthcare delivery systems. The time to build these capacities is now.

Policy Trends Shaping Access to Care in 2026 Policy Trends Shaping Access to Care in 2026 Learn about policy trends shaping access to care in 2026, including supporting community health workers and improving rural health care. Public health agencies have a role in supporting access to care, which means assuring timely access to covered health care services provided by a qualified workforce. However, many communities experience challenges in accessing health care services, providers, facilities, or affordable care. Gaps in access to services that prevent chronic disease, address maternal health and behavioral health challenges, and other health goals undermine public health’s ability to improve community health. Strategies to improve access to care can include focused attention on underserved or at-risk communities or populations, including rural populations. To support access to comprehensive health care services, state legislatures continue to explore laws that strengthen clinical and community-based health workforces, support rural health care facilities, and promote access to care across the lifespan, including for women. Access to Supportive and Community-Based Health Services Community health workers (CHWs) are frontline public health workers who serve as a link between health and social services and the community, and can help address the social and behavioral health drivers of health outcomes. Many jurisdictions pursued policies to support CHWs by defining the workforce, establishing training or certification programs, and pursuing financial sustainability including through Medicaid programs. In 2025, more than a dozen states considered legislation related to CHWs, with several states enacting laws that recognize CHWs as providers and/or authorize Medicaid coverage and reimbursement. This includes Arkansas HB 1258, which establishes a state certification for CHWs, defines their role, and requires compensation for certified CHW services from both Medicaid and certain regulated health plans in the state. Montana (HB 850) and Oklahoma (SB 424) enacted bills to regulate CHWs but both bills were vetoed by their respective governors. In Oklahoma, the legislature overrode the veto. Rhode Island (S 0705) considered legislation that would require regulated health plans to cover CHW services, and Virginia enacted SB 981 which requires the health department to report on the status of the CHW workforce and future needs. Doulas are non-medical professionals who support individuals during pregnancy, birth, and the postpartum period. Doula care has been shown to reduce the rate of both cesarean sections and postpartum anxiety or depression, and may be cost effective, particularly for Medicaid programs. A majority of states are either pursuing or already offering doula coverage in their Medicaid programs. At least fourteen jurisdictions considered legislation in 2025 to recognize or provide coverage of doula services by Medicaid programs or private insurance. At least six states enacted laws regarding Medicaid coverage of doulas, including Louisiana (HB 454), Montana (SB 319), Utah (SB 284), and Vermont (S 53). In Maine, LD 1523 directs the health department to begin the rate development process for future coverage of doula services, establish a doula council to support that process and provide other advice to the department, and issue a report on the overall progress by February 2027. Arkansas (HB 1252) established a scope of practice for certified community-based doulas and requires compensation by both the Medicaid program and other health benefit plans in the state. Stabilizing and Growing Rural Health Care Access Rural communities face a number of health care challenges, including limited health care providers and financial strain on hospitals and other rural health care facilities. Several states explored strategic initiatives to support rural health care access, both broadly and for specific populations. California enacted SB 338 which establishes a virtual health hub to expand access to health services for farmworkers in rural communities. Iowa enacted HF 972, directing the health department to seek CMS approval for a hub-and-spoke model to support the state’s rural health providers. Finally, Texas enacted HB 18 which creates a rural hospital officers academy to support the education and development of these leaders, includes additional financial support for rural hospitals with obstetrics and gynecology services, and codifies current state programs and offices supporting rural hospitals. More than a third of U.S. counties are considered maternal care deserts, which are places where there are no obstetric providers or facilities. Several states enacted legislation to expand access to pregnancy and maternal health care in rural and underserved areas, including California which enacted SB 669 to create a pilot program for five rural hospitals to provide perinatal services on a standby basis. Arizona (HB 2332) will establish an advisory committee to make recommendations that will ensure the availability of “obstetrics, gynecology and maternal mental health services in low-volume, high-risk rural communities.” And in Connecticut, the governor signed several bills aimed at increasing access to maternal health care, including HB 7102 which requires the development of a strategic plan to increase the number of obstetric facilities in underserved areas of the state. Leg Prospectus-2026 - Access - Rural Health Expanding Support for Mid-Life Women's Health Care Women may experience a number of disruptive symptoms during perimenopause — the transition period before menopause — including difficulty sleeping, memory lapses, hot flashes, and general pain and discomfort. Following menopause, low hormone levels can increase the risk of chronic diseases like osteoporosis, heart disease, and stroke. Lack of knowledge about menopause and its wide range of symptoms, along with stigma, can prevent women from seeking treatment or other supports. Recognizing a growing need to address women's health across the entire lifespan, not just the reproductive years, state legislatures are exploring laws that address the menopause transition and its impacts through education and tailored health care access. In 2025, several jurisdictions — including Texas (HB 3961), Arizona (HB 2734), and Connecticut (AB 6593) — considered legislation directing the development, coordination, or distribution of educational programs and resources on menopause or perimenopause for women or providers, with Maine (LD 1079) enacting a measure requiring the health department to work to create and disseminate informational materials on perimenopause and menopause. Several other states have explored insurance coverage requirements, including New Jersey (A 5278/S 4148) and New York (A 5444) that would require certain health insurers and plans to cover menopausal and perimenopausal care and treatment. California (AB 432) would have required prescription coverage of drugs relevant to perimenopause and menopause care and treatment, and incentivize menopause-specific education for physicians, but the governor vetoed the bill and called for the state health and human services agency to propose policy changes for next year’s budget that address concerns about cost. Looking Ahead ASTHO expects states and territories to continue considering policies related to access to care, including legislation that: Increases coverage of and access to community-based health professionals like doulas, CHWs, and peer support specialists. Improves access to over-the-counter contraception. Recognizes telehealth's role in the health care system to ensure continued access to remote health care, particularly in rural communities. Supports access to reproductive care and women’s health services across the lifespan, including additional funding or other flexibilities to address anticipated changes in the federal funding landscape (e.g., Title X). OE22-2203 PHIG article yes