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Ripple Effect: What USPSTF Recommendations Mean for State and Territorial Health Law What USPSTF Recommendations Mean for State and Territorial Health Law Andy Baker-White This Health Policy Update highlights how U.S. states and territories are using policy to codify important public health recommendations. The United States Preventive Services Task Force (USPSTF) is a volunteer panel of national experts that issues evidence-based letter-grade recommendations on clinical preventive services. Under the Affordable Care Act, services with an A or B grade must be covered by most private health insurance plans without cost-sharing, with similar requirements for Medicaid enrollees and Medicare beneficiaries. An estimate by the Department of Health and Human Services concluded that in 2020, these services reached approximately 264 million Americans. States and territories implement these recommendations through statutes and rules. ASTHO identified over 200 state and territorial laws referencing the USPSTF, including in insurance statutes, Medicaid rules, disease-specific laws, and state employee health plan requirements. Over the past year, the stability of USPSTF recommendations has come into question. The U.S. Supreme Court's June 2025 ruling in Kennedy v. Braidwood confirmed the HHS Secretary’s authority to block USPSTF recommendations and remove task force members. News reports in July 2025 indicated that HHS Secretary Kennedy intended to remove all USPSTF members, and in May 2026 fired the chair and vice-chair of the task force. Questions are being raised about whether USPSTF recommendations will be rescinded or downgraded and, if so, what the impact would be on states and territories. In addition, if the USPSTF fails to convene in the future, it cannot review newer data on preventive services, meaning existing recommendations could become outdated and USPSTF can’t make recommendations for new services. To meet these challenges, states and territories are taking steps to ensure the continued scientific basis for preventive health services within their own law. Dynamic References to USPSTF Recommendations States and territories often use dynamic references to USPSTF recommendations in regulating health plan coverage of preventive services. This allows the jurisdiction to automatically require coverage for the most current USPSTF recommendations. Laws in West Virginia (state employee health plans), Oregon (regulated health plans), Hawaii (health director standing orders), and Alaska (adult Medicaid enrollees) use this approach. While dynamic references allow jurisdictions to stay up to date with the recommendations, if the task force withdraws any guidance, then those preventive services would no longer require no-cost coverage without additional action from those jurisdictions. Some jurisdictions address this by specifying that certain USPSTF guidance changes will not apply. For example, Guam’s law requires continued no-cost coverage for colorectal cancer screenings and authorizes the health director to adjust diabetes screening recommendations if USPSTF recommendations cease. Illinois specifies that the 2009 USPSTF recommendations for breast cancer screening and mammography are not to be considered current because national medical bodies created differing recommendations for screening. Another way jurisdictions avoid the unpredictability of using dynamic references is locking in the date of the USPSTF recommendations that are used for coverage requirements. For example, Massachusetts requires its state employee health plan to cover USPSTF A and B recommendations that were in effect by July 1, 2023. Using a version of USPSTF recommendations from a specific date maintains a base level of coverage regardless of future changes, though adopting new recommendations or removing outdated recommendations would require separate action. During this year’s legislative sessions, several states enacted or proposed legislation to remove dynamic USPSTF references. For example, Maryland passed legislation (HB 637 and SB 385) to lock in the USPSTF A and B recommendations that were in effect on December 31, 2024. Washington enacted HB 2242 requiring coverage of USPSTF A and B recommendations in effect on June 30, 2025, as well as recommendations adopted by the state insurance commissioner. A bill passed in Delaware, HB 338, would require the use of the USPSTF recommendations from January 1, 2025. Overall, however, neither dynamic nor fixed references to USPSTF recommendations address how jurisdictions can keep up with new scientific data and advances in preventive services in the absence of ongoing USPSTF review and recommendations. To fill this need, some states have enacted legislation that creates processes for reviewing data and establishing recommendations. For example, the new Maryland law mentioned above also authorizes the state’s health secretary to adopt preventive service recommendations that have not been recommended by or that differ from USPSTF. The new process requires notice and a 30-day comment period, an analysis by the Maryland Health Care Commission, and citations to the authoritative medical body upon which the recommendation is based. Disease-Specific Statutes: USPSTF Grades as Care Standards and Thresholds Many states also use USPSTF grades as thresholds for specific preventive services, establishing the standard of care, or issuing standing orders. For example, Arkansas law defines "follow-up colonoscopy" by reference to a colorectal screening assigned an A or B grade by the USPSTF, while Nevada’s law directs primary care providers to use criteria set out in USPSTF recommendations to screen adult women for BRCA mutations. In Hawaii, the state health director is authorized to issue public health standing orders for current USPSTF A and B recommended services, and in Idaho the law uses USPSTF guidance for applying ocular antibiotic prophylaxis to newborns as the standard for medical practice in the state. Some states are considering legislation to distance preventive service coverage requirements from USPSTF recommendations. For example, while New Jersey's current law requires no-cost coverage for colorectal cancer screenings in accordance with the method and frequency recommended by the USPSTF, introduced legislation (A4916 and S4254) would remove the reference to USPSTF recommendations and instead authorize one screening per year for persons aged 33 or older. More broadly, Hawaii considered legislation (HB 1898 and SB 3133) that would have authorized the state’s health department to “make recommendations relating to clinical preventive service recommendations of the [USPSTF] Force that have been assigned a grade of A or B as of July 1, 2025” and require no-cost coverage for the department’s recommendations. However, this legislation did not pass. State Employee Benefit Plans USPSTF recommendations may also be used to establish preventive health services covered by state employee health plans. A West Virginia statute requires the state’s employee health plans to cover mammograms consistent with "current guidelines from the United States Preventive Services Task Force," while the health plan document further states that preventive services are "subject to change as USPSTF…recommendations are updated.” In Ohio, a regulation requires state employee health benefits include all USPSTF-recommended tobacco cessation services and authorizes the state health director to update covered services if USPSTF guidance changes. Missouri law requires full coverage of USPSTF graded A and B recommended prescription and prescribed over-the-counter drugs for state plan members. The Path Forward USPSTF recommendations have helped millions of Americans receive critical health services at no cost, and states and territories have built practices, programs, and standards on that foundation. From adopting fixed-date references to establishing state-level recommendation authority to creating new state review bodies, legislative activity this year reflects a broad effort to address ripple effects from potential future changes to or lack of USPSTF guidance. Health officials may be asked to assess their jurisdiction’s laws and their use of USPSTF recommendations, and coordinate with insurance commissioners, Medicaid directors, and employee benefits administrators to confirm consistent agency interpretation and identify where action is needed. ASTHO will continue to monitor these policies as they develop. article yes

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

This blog describes public health legislation introduced during the Island Areas’ 2024 legislative sessions.

The COVID-19 pandemic has exasperated challenges around access to nutritious and affordable foods. In response, the federal government has taken action to increase funding and access to programs to strengthen food security.

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.

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.

Each year, ASTHO tracks and analyzes key legislation that impacts public health, and highlights the emerging trends for our members. While the bulk of the tracked legislation arises in state legislatures, ASTHO also follows legislation from the territories and Freely Associated States, jurisdictions collectively referred to as the insular areas. The insular areas often face different challenges than the states, while also sharing many common concerns. This post contains a brief look at some of the public health related legislation introduced in the insular areas during their current legislative sessions.

Public health leaders are positioned to prevent illness from the "tripledemic” of COVID-19, Influenza, and RSV with approved vaccines and preventative antibody treatments.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: tobacco, HIV, mental health, PFAS, and opioids.

After years of advocacy, ASTHO and our partners are celebrating the recently signed Consolidated Appropriations Act.

ASTHO has several members from the territories and Freely Associated States—jurisdictions with unique challenges, and do not fall under the category of a state or federal district. This post is a brief look at some of the public health related legislation introduced during recent legislative sessions.

As the Association of State and Territorial Health Officials, ASTHO is committed to the T in our name. The health officials from the territories and freely-associated states are valued members and we are committed to advocating for the unique policy needs and priorities of the Pacific and Atlantic jurisdictions. The insular areas face unique challenges locally but also require a specific strategy here in Washington, D.C. Funding approaches and requirements set for states do not always translate to the unique context of the insular areas.

This Health Policy Update is an overview of policy strategies that states have taken at the executive and legislative levels to increase the healthcare workforce to more effectively and efficiently respond to the COVID-19 pandemic.

ASTHO and NAMD Letter Urging Congress to Fully Fund Medicaid and CHIP in U.S. Territories Dear Chair Wyden, Chair Rodgers, Ranking Member Crapo, and Ranking Member Pallone: Strong, sustainably funded Medicaid and Children's Health Insurance Programs (CHIP) are crucial to addressing health care challenges in the U.S. territories. On behalf of the Association of State and Territorial Health Officials (ASTHO) and the National Association of Medicaid Directors (NAMD), we urge Congress to ensure the fiscal stability of the territories’ Medicaid programs by lifting the annual Section 1108(g) allotment cap for all territories and authorizing a permanent 83% Federal Medical Assistance Percentage (FMAP) for Puerto Rico. Robust Medicaid and CHIP are critical components of strong and resilient territorial health systems. The five U.S. territories—American Samoa, Guam, the Commonwealth of the Northern Mariana Islands (CNMI), Puerto Rico, and the U.S. Virgin Islands (USVI)—vary dramatically in population, health care system capacity, and Medicaid program structure. Despite these differences, they share common challenges, including significantly higher rates of poverty (ranging from 16.8 percent in Guam to 54.6 percent in American Samoa in 2019, compared to 10.5 percent in the United States), higher rates of chronic health conditions, and a lack of health care infrastructure. Medicaid and CHIP programs are crucial to addressing these challenges. Chronic underfunding has impaired territories’ capacity to serve their residents, who are U.S. citizens or U.S. nationals. Historically, the territories have faced two statutory funding challenges: 1) A low, fixed FMAP rate that is not tied to per capita income (as is the case in the states), and 2) Annual funding caps. Prior to FY 2023, Congress supplemented low annual funding amounts with short-term additional investments. The short-term nature of this funding limited territories’ ability to plan, undertake large investments, and efficiently deliver services. In the Consolidated Appropriations Act of 2023, Congress permanently increased the FMAP for American Samoa, Guam, USVI, and CNMI to 83% and authorized a 76% FMAP for Puerto Rico through 2027. NAMD and ASTHO applaud and fully support this structural means of addressing longstanding needs. Congress should continue to build on this foundation by extending the permanent 83% FMAP to Puerto Rico to ensure all U.S. territories have access to sustainable Medicaid and CHIP funding. Over and above this FMAP adjustment, Congress must also address the constraints caused by the allotment cap on the territories’ Medicaid and CHIP funding, established by Section 1108(g) of the Social Security Act. When a territory reaches this cap, they are responsible for funding their Medicaid agency solely with local dollars. Due to challenges generating sufficient local funds, many territories have been forced to cut services after reaching these allotment caps, drastically limiting their ability to offer services and destabilizing local health care providers. For example, CNMI expects to hit its FY 2024 cap by July, leaving the CNMI government with more than two months of unmatched Medicaid costs. Congress should eliminate the annual Section 1108(g) allotment cap to ensure sustained access to high-quality public health and health care services in the U.S. territories. Sustainable, equitable funding will allow territorial programs to make long-term, cost-effective investments that support high-quality and innovative Medicaid programs. The Consolidated Appropriations Act of 2023 directed American Samoa, Guam, CNMI, and USVI to develop four-year strategic plans focused on workforce, program integrity, systems development, and financing. The four territories developed comprehensive plans with ambitious goals, including developing electronic eligibility and enrollment, MMIS, and T-MSIS systems, launching initiatives to expand local provider workforces and territory administrative capacity, and strengthening program integrity processes. These plans are evidence of the momentum and energy that territory leaders bring to their reform agendas. Technical assistance from CMS and other agencies will remain a critical resource for capacity-building efforts in the territories. In addition to lifting the statutory allotment cap and providing Puerto Rico with a permanent 83% FMAP, Congress should also consider providing the territories with targeted, project-specific enhancements to their administrative match rates to facilitate necessary technical assistance and change management. These structural improvements will strengthen the impact of Medicaid dollars allotted to the territories. Thank you for your previous support of the Medicaid programs in the U.S. territories and your ongoing attention to this important issue. If you have any questions or require additional information, please reach out to Jeffrey Ekoma (senior director of government affairs at ASTHO, jekoma@astho.org) and Jack Rollins (director of federal policy at NAMD, Jack.Rollins@MedicaidDirectors.org). Sincerely, Joseph Kanter, MD, MPH Chief Executive Officer, ASTHO Kate McEvoy, Esq. Executive Director, NAMD website yes

Learn about recent public health legislation in the islands areas related to access to nutritional foods, deterring substance use, and promoting healthy aging.

Strengthening Long-Term Care Capacity in Island Jurisdictions Through Policy Using Policy to Strengthen Islands' Long-Term Care Capacity Lana McKinney Explore policy levers island jurisdictions can use to strengthen long-term care capacity like payment flexibilities, workforce, and collaborative partnerships. Acute care facilities in U.S. territories and freely associated states experience significant strains on capacity, driven by: Difficulty transitioning medically stable patients to the next appropriate level of care. Insufficient staff to meet patient needs. Limited transitional or extended care facilities. This creates a bottleneck that compromises the efficiency and stability of health systems. However, there are policy levers available to island jurisdictions that can support appropriate care for patients requiring institutional or home-based services and supports. These include payment flexibilities, workforce initiatives, and collaborative partnerships. Current State Infrastructure Island jurisdictions have limited hospital and long-term care (LTC) facility capacity. While many have government-run hospitals, three jurisdictions — American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), and Palau — have only one hospital, the Federated States of Micronesia has one hospital per state, and the Republic of the Marshall Islands and the U.S. Virgin Islands (USVI) each operate one hospital in both of their most populous islands. Additionally, Guam has just one Medicare-certified skilled nursing facility with 40 Medicare beds, operated by the Guam Memorial Hospital Authority, while Puerto Rico has nine Medicare-certified nursing homes for a population of more than three million people. Without LTC facility capacity, hospitals lack appropriate options for discharge. Geographic isolation, difficulties with recruitment and retention of sufficiently skilled staff (i.e., nursing staff), and supply chain challenges are additional obstacles to establishing and maintaining LTC capacity. Reimbursement Federal health care programs also influence the availability of LTC services in the territories. Medicare and Medicaid may cover LTC services under different circumstances; however, federal funding restrictions limit Medicaid in the territories compared to the states. Unlike the annually calculated, income-based Federal Medical Assistance Percentage (FMAP) for states, the territories have a fixed FMAP. The current permanent FMAP for American Samoa, Guam, CNMI, and USVI is 83%, while Puerto Rico’s is 76% through FY2027. Medicaid funding for the territories also operates under a statutory cap allotment, meaning once the federal allotment is exhausted, the territory must cover all subsequent service costs with local funds. This frequently results in territories expending federal funding mid-year, which leads to service restrictions for residents and financial instability for providers. Finally, while the territories have additional financing restrictions, CNMI and American Samoa are able to operate their Medicaid programs under a special waiver authority. Policy Strategies A number of policy strategies may limit the strain on acute care facilities, address LTC needs, and support the provision of appropriate levels of care in island jurisdictions: Workforce Development Recruitment and retention of health care workers is a challenge in island jurisdictions, but public health and rural health care workforce strategies may help address staffing needs and capacity. Encourage employers and educational institutions to partner with local colleges, vocational schools, and community centers to develop apprenticeship programs and formal career pathways that support skills development, professional advancement, and patient and community needs. Identify available educational programs across the region to support a pipeline for students entering medical, nursing, pharmacy, and behavioral health careers. Promote and support dedicated in person recruitment opportunities as well as broader strategies that support local candidates and students. Develop cross-jurisdictional workforce agreements that allow training completed in one island jurisdiction to be recognized in another. Explore workforce training opportunities through commissions (e.g., Western Interstate Commission for Higher Education), universities (e.g., the Pacific Islands Geriatric Workforce Enhancement Program), and public health associations (e.g., Equipping Community Health Workers to Address Alzheimer’s) as well as curriculum exchange and workgroups (e.g., USAPI Health Workforce Development Technical Working Group). Support partnerships among island jurisdictions to share resources and learnings related to facility development, financial models, and reimbursement strategies. For public employers, decentralize HR functions to create a more efficient hiring process. For jurisdictions with professional schools and programs, develop additional training models (i.e., short-term or extended rural placements) or blended learning. Medicaid and Other Federal Health Programs U.S. territories can also consider Medicaid policies that encourage community supports over institutional care or pursue other program flexibilities through waivers or state plan amendments. For example, states and territories can provide Home and Community-Based Services and use different authorities to achieve their policy goals. Implementing a Section 1115 demonstration allows for significant flexibility but must be budget neutral. In addition, the Money Follows the Person demonstration supports community-based services over institutional care. CMS awarded time-limited planning grants to Puerto Rico and American Samoa for this initiative. Additionally, the Program of All-Inclusive Care for the Elderly helps older adults remain at home and offers comprehensive medical and social services to eligible individuals. Supported Care Transitions Several models support patients moving from hospital to home to control chronic conditions, limit readmissions and emergency department visits, reduce costs, and improve outcomes overall. This includes the Care Transitions Intervention, a short-term training program for patients and caregivers to navigate the move home. The coach’s credentials are flexible and can include nurses, social workers, community health workers, or other professionals. Meanwhile, the Transitional Care Model, provides ongoing care management and is led by an advanced practice nurse. Collaboration Strategic partnerships can drive policies that support healthy aging or aging in place. For example, USVI established a commission on aging, while Guam enacted a senior citizens housing task force, both with multi-sector representation. And in December 2025, American Samoa’s Governor issued an Executive Order establishing a Home and Community-Based Services Commission as part of its Money Follows the Person plan, which includes representatives from a number of governmental agencies and areas of expertise. Legislation Island legislatures have also explored strategies that support older adults and those with complex health care needs and their families: Guam (No. 31-38 (COR)) would establish a regulatory framework for assisted living facilities with the goal of facilitating their development and operation. In 2023, USVI 35-0119 authorized mobile integrated health programs to leverage health care personnel for in-home services and prevent costly hospital readmissions. CNMI considered a resolution to explore several policy strategies, including leveraging Medicaid flexibilities, and prioritizing collaboration and financial support to meet the needs of elderly residents. In 2026, Puerto Rico enacted legislation to improve access to information about the benefits and services available to older adults. Reviewed by - Baker-White, Kearly, Sands Leavitt, Wheatley article yes

How the Emergence of Xylazine Impacts Overdose Prevention Policy overdose prevention policy, overdose crisis, fatal overdoses, emergence of xylazine, illicit drug supply, toxicological testing, withdrawal symptoms, xylazine test strips, drug paraphernalia laws, drug checking, legislative action, drug supply, substance use disorders, controlled substance, opioid use disorder, centers for disease control, health care, harm reduction services, psychoactive substances, department of public health, illegal drug, type of drug, opioid crisis, prescription opioid, astho, association of state and territorial health officials JoAnne McClure, Victoria Pless How states are considering overdose policy changes as xylazine continues to emerge in the illicit drug market. Developing and adopting policies to reduce fatal overdoses can help public health leaders address the ever evolving and complex national overdose crisis. More than 109,000 fatal overdoses occurred in 2022, with the majority involving illicitly manufactured fentanyl. Adding to the overdose challenge is the emergence of xylazine, a non-opioid tranquilizer (i.e., sedative), that is being increasingly mixed with fentanyl in the illicit drug supply. As of November 2022, xylazine was found in the illicit drug supply in 48 of 50 states and Puerto Rico. Xylazine is currently associated with one in ten fatal fentanyl (11%) overdoses, a near-threefold increase from 2.9% in 2019. Toxicological testing for xylazine is not uniform and, as a result, its involvement in fatal overdoses may be underestimated. Some states have taken initiatives such as Indiana (HB 1286) and South Carolina, to improve the consistency of toxicological testing for xylazine. With xylazine’s addition to the overdose crisis, states are beginning to adopt laws to better regulate the supply of xylazine and detect its presence in the illicit drug supply. What is Xylazine? Xylazine, also known as “tranq” or “tranq dope,” is a central nervous system depressant causing drowsiness, slowed breathing, reduced heart rate, and hypotension, which can increase the risk of a fatal overdose. Xylazine is approved for veterinary use in the United States but is not FDA-approved for human medicine. Xylazine, can be added to substances that are ingested orally, snorted, sniffed, or—mostly commonly—injected intravenously, and has been added to or used to cut heroin and fentanyl to prolong their effects. People who use drugs may be unaware of xylazine’s presence, which can put them at a higher risk of fatal overdose. Xylazine use is associated with skin ulcers, lesions, abscesses that left untreated, can lead to amputation. People who develop a physical dependency on xylazine may develop severe withdrawal symptoms. Although symptoms of xylazine use and opioid use are similar—making it difficult to differentiate whether someone has used one or both substances—overdose reversal agents (e.g., naloxone) do not counteract the effects of xylazine. Public health leaders still recommend that naloxone be administered for a suspected opioid overdose because xylazine has been detected in substances alongside fentanyl. For a person experiencing a xylazine-involved overdose, public health leaders emphasize the need to seek treatment beyond naloxone. In addition to public health’s work to address xylazine in the illicit drug supply, some state and territorial legislatures are expanding or protecting access to xylazine test strips as well as steps to limit access to xylazine through the state drug schedule. Legalizing Drug-Checking Equipment Drug-checking equipment, such as fentanyl test strips, are evidence-based interventions that allow a person who uses drugs to test their supply for an adulterated substance. State drug paraphernalia laws historically prohibited drug checking equipment, limiting the possession, distribution and use of items like fentanyl test strips. To make fentanyl test strips more widely available to prevent overdose, legislatures rapidly changed their laws to either explicitly legalize fentanyl test strips or generally legalize drug checking equipment. As of July 5, 2023 more than 33 jurisdictions legally authorize the use of fentanyl test strips, 12 of which (Alaska, Colorado, Guam, Maine, Maryland, Nebraska, New York, the Commonwealth of the Northern Mariana Islands, Pennsylvania, South Carolina, Utah, and Vermont) generally authorize the possession and use of drug-checking equipment. Similar to fentanyl, people may not know whether they are exposed to xylazine when using other substances, increasing the risk for harm. New test strips can detect the presence of xylazine, however state drug paraphernalia laws that criminalize drug checking equipment may limit the accessibility of xylazine test strips to prevent overdose. In 2023, at least three states—Illinois (HB 3203), New Hampshire (HB 287), and Utah (SB 86)—enacted legislation to authorize or decriminalize use of drug-checking equipment for fentanyl and xylazine, ensuring that xylazine test strips are lawful and able to be distributed. Additionally, states that previously passed legislation to allow for fentanyl-specific drug checking are amending their statutes to include all drug checking to ensure the legal possession of xylazine test strips. For example, Delaware enacted (SB 189) that specifically legalized xylazine test strips. Two other states—Vermont (H 222) and New Jersey (SB 3957)—enacted laws expanding the authorization of fentanyl test strips to allow for all harm reduction supplies, including drug checking equipment, which would permit the use of xylazine test strips. The Question of Scheduling Drugs are scheduled based on their acceptable medical use and potential for misuse and severe psychological and/or physical dependence, with drugs in Schedule I being the most tightly regulated. Xylazine is not a controlled substance under the federal Controlled Substance Act so it is not DEA scheduled or controlled. Nevertheless, xylazine is subject to FDA regulation under the federal Food, Drug, and Cosmetic Act and state law. Prior to 2023, only two states directly or indirectly scheduled xylazine. Florida codified xylazine as a Schedule I substance in 2016, and xylazine could fall under Massachusetts’ Schedule VI designation, which applies to prescription drugs. As state and territorial leaders take steps to schedule xylazine, policymakers should consider whether scheduling or other criminal penalties will deter people from seeking care if they fear being arrested for unknowingly testing positive for exposure or xylazine use. Another consideration for leaders before scheduling xylazine is whether scheduling will also make possession of test strips illegal under the jurisdiction's drug paraphernalia law. In 2023 at least nine states–Delaware (SB 189), Illinois (HB 3873), Louisiana (HB 106), Michigan (HB 4913), New Jersey (A 5448), New York (A 5914), Oklahoma (SB 668), Rhode Island (HB 5922), and West Virginia (SB 546)—considered legislation to schedule xylazine as a controlled substance. Of those, Delaware, Rhode Island, and West Virginia enacted laws scheduling xylazine in 2023. In addition to legislative action, at least two governors (Ohio and Pennsylvania) took executive action to schedule xylazine. ASTHO’s overdose prevention and state health policy teams continue to monitor these important public health issues. website yes

Over the past several years, states and jurisdictions have continued to implement important policies to reduce tobacco and nicotine use, including increasing tobacco prices, expanding areas deemed “smoke-free,” limiting the sale of flavored tobacco products, and supporting tobacco cessation programs.

While largely preventable, healthcare-associated infections are the most common complication of hospital care, are a leading cause of death in the United States, and increased significantly during the pandemic. States have proposed legislation to strengthen and sustain infection prevention capacity, implement requirements for data tracking and reporting through national surveillance systems, and prioritize antimicrobial stewardship.

Families who wish to breastfeed in the United States often face barriers in workplace and school settings. To address these disparities, federal, state, and territorial governments are adopting policies to improve lactation accommodations in school and workplace settings.