Displaying 1-20 of 24 results for

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

States Pursue Policy Options to Support Access to Over-the-Counter Contraception State Policy to Support Over-the-Counter Contraception Access Christina Severin Learn about state policy options that can help to support over-the-counter contraception access including levers within Medicaid programs. Effective contraceptive care improves maternal health outcomes by helping individuals plan if and when they become pregnant. Additionally, some contraceptive methods may reduce the risk of certain cancers and protect against sexually transmitted infections. While the most effective methods generally require a visit to a health care provider, over-the-counter (OTC) options may address certain barriers to accessing contraception (e.g., taking time off work for a medical appointment and lack of health insurance or access to health care providers/settings). The New Age of Nonprescription Oral Contraceptives A significant change in the marketplace of OTC options occurred in 2023 when FDA approved the first daily non-prescription oral contraceptive. This progestin-only pill —known as Opill — is considered both safe and highly effective at preventing pregnancy when taken correctly. Opill reached stores in early 2024 and has a suggested retail price of about $20 per month or $50 for a three-month supply. While OTC oral contraceptives like Opill may improve access among individuals not currently using contraception or those using a less effective method, high out-of-pocket costs can be a barrier. One way to limit out-of-pocket costs is to require private health insurance coverage of contraception without cost-sharing. ACA requires most private health insurance plans to do this, but it does not extend to all health insurances or contraceptives. For OTC contraceptives, the landscape is even more complex: While plans are encouraged to cover OTC emergency contraception at no cost and without a prescription, it is not required. HHS and the Departments of Labor and Treasury issued a proposed rule in 2023 that would have required broader coverage of OTC contraception without a prescription or cost-sharing, but the rule was later withdrawn. Without a federal mandate, states can pursue coverage requirements through the health insurance products they regulate. Jurisdictions can also support OTC contraception access in their Medicaid programs. While Medicaid requires coverage of family planning supplies without cost-sharing, jurisdictions have some flexibility in how they design this benefit, and the scope of coverage depends on jurisdiction and state plan-specific factors. Jurisdictions also have flexibility in determining how they provide prescription drug coverage for contraceptive medications and what OTC products are covered. State Legislative Action Legislation is one way for states to promote access to OTC contraceptives, including hormonal contraceptives, through state-regulated plans and provider scope of practice considerations. Since 2024, several states have enacted laws requiring coverage of OTC hormonal contraception, including Delaware (SB 232), which directs insurance carriers to cover FDA-approved OTC contraception with or without a prescription, and Maine (LD 163), which requires coverage of nonprescription oral hormonal contraception. At least two states have clarified the role of pharmacists in supporting access to OTC contraceptives. Massachusetts (HB 4800) allows pharmacist dispensing of OTC oral contraception per a standing order and provides liability protections, while California (AB 50) allows pharmacists to furnish self-administered OTC hormonal contraception without complying with the state’s protocols for prescription-only oral contraceptives. States have also enacted laws to explore or support broader access to OTC contraception, including at least three bills enacted in Maryland since 2024: HB 367/SB 527 requires community colleges to develop an OTC contraception access plan and allows the health department to serve as a resource, including for consultation on vending machine access. HB 1171/SB 944 allows local health department registered nurses to dispense OTC contraception. SB 674/HB 939 creates a collaborative tasked with studying and making recommendations on OTC contraceptive access, with a final report due to the governor and legislature by Jan. 1, 2027. Other Policy Levers Legislation isn’t the only policy lever available to jurisdictions looking to support OTC contraception access. A number of states have taken executive actions to improve access, including (but not exclusively) through Medicaid. While jurisdictions already have the flexibility to support OTC contraceptive access in their Medicaid programs, Medicaid rules require a prescription even for OTC products, which may present a barrier for some individuals. One potential solution is to use standing orders, which allow individuals direct access to OTC products at a pharmacy, without having to visit a separate provider for a prescription first. To ease access to OTC hormonal contraception specifically, several states have recently utilized standing orders that facilitate Medicaid coverage, including Wisconsin, Massachusetts, and New Mexico. Additionally, in 2024, North Carolina announced that it was removing barriers to OTC oral contraception, and would cover condoms and spermicide as OTC products. Outside of Medicaid, several other states have taken action to support access to OTC hormonal contraception: In 2024, the Governor of Arizona issued an executive order directing the Department of Administration to designate Opill and OTC hormonal contraception as a no-cost essential health benefit for state employees, among other actions to expand coverage and access. Also in 2024, Pennsylvania issued guidance to health insurers encouraging coverage of OTC hormonal contraception and highlighting two insurers intending to comply with the guidance. Finally, Michigan’s health agency, in partnership with the Governor’s office, implemented a Take Control of Your Birth Control campaign. This initiative distributed OTC contraception at hundreds of community sites across the state, with a stated goal of connecting individuals to insurance coverage, including Medicaid. While the campaign recently ended, the state distributed more than 400,000 OTC contraceptive resources (e.g., condoms, emergency contraception, and oral contraceptives) and saw an increased number of Medicaid applications. Jurisdictions can play a significant role in connecting public health and health care industry leadership, providers, and other experts — promoting awareness, increasing utilization, and encouraging connection to existing resources. Related Content - Blog - State Policy to Support OTC Contraception Access article yes

Reviewing states' efforts to reduce children's exposure to lead.

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

There are significant disparities in pregnancy-related outcomes in the United States. Many of these deaths considered preventable, so state and federal policy makers are taking steps to improve health outcomes for pregnant people.

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

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.

Responsible for planting, growing, harvesting, processing, and preparing the food we eat, agricultural workers are essential workers during the COVID-19 response to keep the U.S. food supply chain operating efficiently. But farmworkers are particularly vulnerable to COVID-19 due to lack of physical distancing, lack of access to health insurance and sick leave, and poor access to clean water for handwashing throughout the work day.

The movement to address racism through policy change in the U.S. is receiving significant political support at every level of government. Government institutions are acknowledging the systemic oppression of people of color that persists in the United States and elevating racism as an urgent public health emergency comparable to other public health crises.

States have identified different strategies to implement healthy eating approaches and reduce obesity at the school and community levels, as well as through food labeling at grocery stores and food markets.

During the 2022 state legislative sessions, at least 20 states considered bills that would require a religious exemption to a vaccine requirement. As state legislatures continue considering vaccine protocols for COVID-19, HPV, and other diseases—along with what types of exemptions should be given—courts are reconsidering what type of vaccine requirements are constitutional.

As COVID-19 emerged and spread in the U.S., people working and residing in long-term care facilities have experienced a significant burden of COVID-19 cases and deaths. As of Oct. 8, deaths associated with these facilities account for 40% of total COVID-19 deaths in the U.S. Health officials have taken measures to improve their funding and capacity.

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.

ASTHO staff identified a range of evidence-supported policies considered by state legislatures that could prevent ACEs. This report synthesizes these research and policy proposals and is intended for public health practitioners and policymakers who are considering adopting similar policies.

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

State Policies Aim to Eliminate Food Deserts Beth Giambrone Learn how states are working to improve access to healthy foods and eliminate food deserts in this Health Policy Update. The environment where we live, work, and play can shape eating habits and make healthy eating difficult. This is especially true when nutritious foods are costly and unavailable and unhealthy foods are abundant and accessible. More than 47 million people nationwide live in food insecure households, including more than 7 million children. In addition, more than 27 million people live in "food deserts," generally defined as areas where residents do not have a convenient option for affordable, healthy food, like a supermarket or large grocery store. People who live in food deserts may be at higher risk of obesity and chronic disease. Furthermore, children and young adults who live in food insecure households are more likely to have poor academic outcomes. Increasing Access to Healthy Foods In recent years, jurisdictions have taken a multi-layered approach to increasing access to healthy foods. In 2023, the Texas legislature enacted HB 3323, which established a food system security and resiliency planning council, and requires a food system security plan for reasonably-priced food to ensure public health and welfare, economic development, the protection of the state’s agricultural resources, and includes legislative recommendations to facilitate the availability of food in the state. In 2024, Delaware enacted SB 254, establishing the Delaware Grocery Initiative to expand access to healthy foods in the state’s food deserts and areas at risk of becoming food deserts. The bill authorizes the state’s Division of Small Business to award grants and financial assistance to entities that provide or support affordable, accessible, or healthy food, including food banks and pantries, supermarkets, and corner stores. It also directs the Delaware Council on Farm & Food Policy to develop a strategy to address food insecurity in communities throughout the state and issue a report by June 1, 2025. Also in 2024, Colorado enacted HB 24-1416, codifying an incentive program designed to increase access to fresh fruits and vegetables in low-income communities. In 2024, jurisdictions also enacted legislation that makes supplemental nutritional assistance more accessible. California (AB 2786) requires the Department of Food and Agriculture to allow newly created certified mobile farmers’ markets to participate in the Women, Infants, and Children Program (WIC) Farmers’ Market Nutrition Program, if approved by USDA. Connecticut (HB 5003) requires the Department of Agriculture to purchase and make needed equipment available so certain nutrition program participants can make purchases at farmers’ markets. And Pennsylvania (SB 721) established a permanent Women, Infants, and Children State Advisory Board to advise the Department of Health on solutions to increase participation in the WIC program, including increasing access to WIC-authorized stores for participants. Jurisdictions also enacted legislation ensuring students receive healthy school meals through farm-to-school programs. New Hampshire HB 1678 created a pilot program that incentivizes school districts to buy food for school meals that come from local farms and producers. Virginia HB 830/SB 314 established a Farm to School Program Task Force within the Department of Education to increase farm-to-school school programs within the state, including programs where public schools purchase and feature locally produced food prominently in school meals and learning opportunities related to local food and agriculture. Ensuring Students are Fed At the beginning of the 2023-2024 school year, eight states, including California, Colorado, Maine Massachusetts, Michigan, Minnesota, New Mexico, and Vermont, provided free school meals to all public-school students regardless of income. In 2023, Illinois (HB 2471) and Washington (HB 1238) also enacted legislation to provide universal free school meals or expand access to free school meals for public school students. The programs in both states are subject to funding. In 2024, at least two jurisdictions enacted legislation to study and report on the cost and impact of providing free breakfast and lunch to all public-school students. Maryland (SB 579) required the Department of Education to submit a report on the cost of providing free meals to all public school students by December 1, 2024, while Virginia (SB 283) directed the Superintendent of Public Instruction to explore the impact of offering free school meals to all students and identify options to eliminate student and school meal debt and leverage federal and state programs to provide school meals. Virginia’s report was published in November 2024 and, while noting the significant costs and sustainability concerns associated with free school meals for all students, it included several strategies for maximizing existing meal programs in the state. A number of jurisdictions have also expanded eligibility requirements or updated student meal program policies in recent legislative sessions. Two states enacted legislation requiring all public schools to provide a free breakfast and lunch to students who qualify for a reduced-price meal under the Federal School Breakfast Program and Federal School Lunch Program: Louisiana in 2023 (HB 282) and Delaware in 2024 (HB 125). New Jersey (A5684) took a similar approach and also expanded state-based income eligibility criteria to allow more students to receive free meals at school. In 2023, North Dakota (HB 1494) enacted a law requiring schools participating in the federal school lunch program to adopt and publish a school meals policy that prohibits schools from taking action against students who lack funds or have unpaid meal balances, such as taking away a student’s food if they have already been served, requiring the student to work to pay off the debt, or limiting participation in school activities due to an unpaid balance. Several states also enacted legislation to benefit students during the non-school months through summer food programs. In 2023, Maine enacted LD 947, which requires summer food service program rules to allow for maximum flexibility under federal law for mealtimes and packaging of meals to send home with students. That same year, as part of a broader piece of human services legislation, California (AB 120) required the State Department of Social Services to maximize participation in the Summer EBT program, which provides funding to families with school-aged children to buy groceries during the summer. And in 2024, Hawaii (HB 2430) and New Hampshire (SB 499) enacted legislation authorizing participation in the Summer EBT program. ASTHO will continue to monitor and report on this important issue. article yes

Outcomes and Implications of ACIP’s Vote on the Hepatitis B Vaccine for Newborns Implications of ACIP Vote on Hepatitis B Vaccine for Newborns Susan Kansagra, Andy Baker-White, Kim Martin, Jessica Baggett Learn about the outcomes and implications of the December 2025 ACIP vote on the hepatitis B vaccine for newborns. On Dec. 4 and 5, the Advisory Committee on Immunization Practices (ACIP) held a long-anticipated meeting featuring two major topics of discussion: the hepatitis B birth dose and the pediatric vaccine schedule. The committee voted on two questions related to the pediatric hepatitis B vaccine schedule, both of which passed. To briefly summarize the outcome of the meeting, ACIP shifted from recommending a universal birth dose of the hepatitis B vaccine for all newborns to individualized decision-making for newborns born to HBsAg-negative mothers. There was no change to the recommendation for infants born to HBsAg-positive mothers or whose HBsAg status is unknown. CDC has not yet adopted these changes. In the meantime, many states are taking actions to provide clarity to providers and promote public confidence in the vaccine. How States Are Taking Action In response to (and in some cases before) the new ACIP recommendations, several states issued recommendations, guidelines, standing orders, executive directives, and health alerts for providers to provide clarity. States Recommending or Encouraging the Full Vaccine Series Some states are issuing their own guidance and recommendations for the hepatitis B vaccine series or encouraging providers to adhere to the series as is it was before the new ACIP recommendations: The Northeast Public Health Collaborative released a consensus statement before the ACIP meeting recommending the hepatitis B vaccine birth dose and a schedule that aligns with clinical recommendations. Collaborative members also issued statements reaffirming their adherence to established hepatitis B vaccine recommendations, including Connecticut, Maine, Maryland, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island. Maryland also released guidance for parents and caregivers about its childhood immunization recommendations. States in the West Coast Health Alliance issued statements supporting the universal birth dose of the hepatitis B vaccine. These states include California, Hawaii, Oregon, and Washington. Many individual states also issued statements affirming the recommendation for the continued use of the hepatitis B vaccine birth dose, including Arizona, Colorado, Illinois, Michigan, New Mexico, and Vermont. States Issuing Standing Orders and Executive Directives At least two states issued a standing order or executive directive related to the hepatitis B vaccine: The Maryland Department of Health issued a standing order to ensure hepatitis B vaccine access for infants and children in the state. The standing order authorizes qualified health care providers to administer the hepatitis B vaccine and outlines the policies and procedures for administering the vaccine. In New Jersey, the acting health commissioner issued an executive directive recommending the hepatitis B vaccine birth dose and full series. States Issuing Public Health Alerts and Advisories Well before the recent ACIP meeting, the Maine CDC issued a health advisory to providers recommending the hepatitis B vaccine birth dose and full series. Since the ACIP meeting, at least two other states have released provider advisories. Maryland issued a letter to providers laying out the state’s hepatitis B vaccine recommendations, and New Hampshire issued a health alert with a continued recommendation for the full hepatitis B vaccine series and birth dose. In addition, Vermont sent a guidance letter to the providers in the state’s vaccine program. States Reexamine State Statutes and Agency Rules Linking to ACIP Recommendations Over the last several months, many states have proposed and enacted legislation to move away from sole reliance on ACIP recommendations. More recently, Massachusetts adopted H 4761, authorizing the health commissioner — in consultation with a newly established committee on immunization recommendations — to review and issue alternative standards to ACIP recommendations. States are also proposing changes to agency rules related to school and childcare immunization requirements. For example, Colorado’s health department has issued a proposed rule to modify the state’s standards for school and childcare immunization requirements and to align its rules with recent changes to state statute. Additional Considerations for States If CDC adopts the proposed ACIP recommendations, states can consider the following actions. Hepatitis B Screening States should continue to work with health care providers to close gaps in hepatitis B screening and follow-up for infants of HBsAg-positive mothers. Data show the most common cause of perinatal infection occurs when a mother with hepatitis B gives birth and the infant does not receive follow-up postexposure prophylaxis. Insurance Coverage While public and private insurance, including the Vaccines for Children program, are still required to cover the hepatitis B vaccine, such as any birth doses given to infants of HBsAg-negative mothers under shared clinical decision-making, states can consider creating additional coverage requirements. Some states have passed policies on insurance coverage, and other states have proposed legislation related to other vaccine coverage. Implementation of Shared Clinical Decision-Making While health care providers and parents have the flexibility to determine their approach for infants of HBsAg-negative mothers (i.e., continuing to recommend/give a birth dose), ACIP recommendations that rely on shared clinical decision-making have increased provider questions on how to have and document these conversations. States can work with medical associations, provider boards, and health care partners to ensure clinicians understand how to apply shared clinical decision-making recommendations. This includes educating staff in birthing hospitals, community clinics, and pediatric practices on how to counsel parents and document informed discussions. Jurisdictions can also develop or adapt educational materials and decision aids that clearly outline benefits, risks, timing, and follow-up options to support both providers and parents. More information on shared clinical decision-making is available from CDC and Common Health Coalition. States can also encourage providers and birthing institutions to examine workflows, Immunization Information System documentation, and follow-up to ensure scheduling of future doses. Implications for Vaccine Supply States can examine vaccine supply through the Vaccines for Children program to understand how the new recommendations impact supply of single antigen hepatitis B vaccines. If a significant percentage of the population receives vaccines on a different timetable, it could impact supply and timing for other vaccinations, given the reliance on combination vaccines for hepatitis B dose two and three, which can include DTaP, polio, and Hib vaccines. Supplemental Resources Common Health Coalition: Vaccine Resources December 2025 ACIP Meeting: Hepatitis B Updates for Health Leaders (PDF) Vaccine Integrity Project – Hepatitis B by Centers for Infectious Disease Research and Policy Understanding the Benefits of Vaccines: Common Questions by HealthyChildren.org Childhood Vaccinations (PDF) by Your Local Epidemiologist Hep B Birth Dose Media Toolkit by Hepatitis B Foundation Reframing the Conversation About Child and Adolescent Vaccinations by Frameworks Institute CDC: ACIP Shared Clinical Decision-Making Recommendations ACIP Meeting Materials for Public Posting: Hepatitis B Birth Dose Briefing Document (PDF) Hepatitis B Birth Dose Vaccination (PDF) article yes

Learn how state legislation is expanding access to drug checking equipment and screening in this Health Policy Update.

As COVID-19 spread across the country, governors and health officials invoked their emergency powers to order physical distancing measures designed to reduce social interactions and slow the spread of the disease. Several of these measures, such as stay-at-home orders, business and school closures, public gathering limits, face covering requirements, and others, are being challenged in federal and state courts. Many of the legal challenges include claims of executive overreach and misuse of emergency power as well as allegations of violating individual rights protected by the U.S. Constitution.

A once obscure public health issue that’s gotten more attention in recent years, polyfluoroalkyl substances (PFAS) are a group of synthetic chemicals used in products such as nonstick cookware, water-repellent clothing, stain resistant fabrics, cosmetics, and firefighting products. During production and use, PFAS can migrate into soil, water, air, where they persist. Because they remain in the environment, PFAS can accumulate in humans and animals and can be found at low levels in many food products. Exposure to PFAS can lead to harmful health effects, including an increased risk of kidney and testicular cancer and a decreased vaccine response in children.