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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.

Policy Trends Shaping Behavioral Health in 2026 Policy Trends Shaping Behavioral Health in 2026 Learn about the policy trends shaping behavioral health in 2026, including improving access to naloxone, mobile crisis units, and more. Public health efforts remain focused on reducing mental health-related harms and preventing substance use disorder and overdose. In 2024, an estimated 23.4% of U.S. adults — about 61.5 million people or more than one in five — experienced a mental illness, underscoring the widespread and urgent nature of mental health challenges nationwide. After years of rising fatalities, the United States saw its first notable decline in overdose deaths in 2023, followed by a nearly 24% decrease in 2024, with approximately 87,000 deaths reported over a 12-month period. While this progress is promising, overdose is still a leading cause of death in the United States, underscoring the need for sustained prevention, treatment, and recovery efforts. To continue strengthening behavioral health systems and advancing overdose prevention, state and territorial legislatures are considering measures that promote mobile crisis units, support access to overdose prevention tools and treatment, and address the increased use of unregulated substances. Mobile Crisis Response Over the past decade, federal and state policy has emphasized community-based behavioral health crisis response. Building on early local models, the 2021 American Rescue Plan Act created a new Medicaid option for states to fund mobile crisis intervention services with a time-limited enhanced federal matching rate. States also integrated mobile crisis teams into broader crisis response systems aligned with the 988 Suicide and Crisis Lifeline. As implementation expands, state legislatures are considering measures to strengthen service coordination, sustain funding beyond the enhanced federal match period, and address workforce and capacity needs. During the 2025 legislative session, at least 13 states considered and six enacted measures related to behavioral health mobile crisis services. Rhode Island (HB 6118) will require insurance coverage for mobile response and stabilization services for children and adolescents under 18. In Washington, HB 1813 directs additional planning and coordination among service providers to promote access to crisis stabilization services for Medicaid enrollees. Leg Prospectus-2026 - SBH - SAMHSA CMS Naloxone Availability Naloxone is a life-saving medication that quickly reverses opioid overdoses. Approved for over-the-counter sale by FDA in 2023, its expanded availability has increased opportunities for timely intervention. To support access for people at risk for overdose, many states are advancing policies to make naloxone available in public settings — such as schools, libraries, and community centers — to empower bystanders to respond to and prevent overdose deaths. At least eight states have considered legislation to increase naloxone availability with a focus on youth. Colorado enacted SB 25-164 to advance youth overdose prevention, clarifying access to naloxone in school communal areas, like buses, and giving the state board of health authority to establish what entities can receive naloxone for distribution. Michigan is considering SB 404, which would require schools receiving naloxone from the health department to adopt policies regarding administration and explicitly limit liability of school employees administering naloxone. Montana enacted SB 503, which extends liability protections for those who administer expired opioid antagonists — like naloxone — including in schools. Leg Prospectus-2026 - SBH - MOUD Therapeutic Substances for Mental Health Diagnoses Psilocybin and ibogaine are naturally occurring psychoactive substances being studied for their potential to treat mental health and/or substance use disorders. As interest in their therapeutic applications grows, several states are considering legislation to expand access for clinical research and regulated therapeutic use. In 2025, more than two dozen states considered and seven states passed measures related to psilocybin. Arizona (SB 1555), Colorado (HB 25-1063), and Nebraska (LB 72) enacted laws that would allow psilocybin prescribing pending FDA approval, though this approval has not occurred. Iowa (HF 383) and Virginia (SB 1135) passed similar provisions but both governors vetoed the bills, citing the need to wait for FDA approval and DEA rescheduling before taking state-level action. At least 10 states considered legislation to study ibogaine or fund clinical trials exploring its potential to treat PTSD, depression, opioid use disorder, and related conditions. Washington considered SB 5204, which would support the study of ibogaine-assisted therapy for adults with opioid use disorder. And several states — including Nevada (AB 378), New York (S 4664), and Oregon (HB 3817) — considered legislation focused on supporting research and trials that improve the health of veterans and first responders. Finally, Texas enacted SB 2308 to establish a consortium focused on ibogaine research and trials to support FDA approval of the drug for treatment of various mental health and substance use disorders. Kratom Regulation Public health leaders are examining ways to reduce the potential misuse of unregulated substances, including kratom, a product derived from the leaves of a tropical tree that can act as both a stimulant and sedative, and that carries the risk of addiction and abuse. Kratom is not a scheduled drug under federal law, but the FDA has reiterated that there are no legally marketed drugs containing kratom and that it is not an appropriate dietary supplement or approved food additive. While FDA explores a scheduling action for 7-OH, a concentrated byproduct of kratom, a number of state legislatures are considering measures to regulate kratom products. At least 34 states considered and 11 states passed legislation regarding kratom in 2025, including Louisiana (SB 154) which criminalizes the possession and distribution of kratom. Another six states — Colorado (SB 25-072), Mississippi (HB 1077), Nebraska (LB 230), Rhode Island (SB 792), South Carolina (S 221), and South Dakota (HB 1056) — passed legislation restricting the sale of kratom to people under the age of 21 and establishing product labeling standards. Looking Ahead ASTHO anticipates states and territories to continue considering and adopting laws to prevent substance misuse and overdose and reduce mental health-related harms, including those that: Enhance support and capacity for behavioral health mobile crisis units and improve care coordination and entry across the behavioral health care continuum. Expand coverage for peer support specialists and establish baseline standards for peer support specialists in treatment and social support recovery services. Develop measures to study and decriminalize some psychoactive substances for potential mental health and substance use treatment. Develop innovative policies to link recently incarcerated persons to substance use disorder treatment. Improve access to medications for opioid use disorder by expanding telehealth availability, prohibiting prior authorization requirements, and ensuring comprehensive insurance coverage. Explore state regulatory frameworks for commercially available substances with the potential for misuse, including kratom and hemp-derived cannabinoids like Delta-8. OE22-2203 PHIG article yes

Policy Trends Shaping Healthy Food and Chronic Disease in 2026 Policy Trends Shaping Healthy Food & Chronic Disease in 2026 Learn about policy trends shaping healthy food and chronic disease in 2026, such as regulating ingredients and modifying SNAP. A growing focus on links between nutrition and public health outcomes is driving legislative efforts across the country, with states actively responding to rising rates and the cost of chronic disease. As state legislatures consider ways to combat chronic diseases, they are also implementing policies aimed at addressing the food environment by introducing and enacting bills that regulate ultra-processed foods (UPFs), adjust SNAP benefits, and improve access to healthy food. Regulating Food Ingredients and Ultra-Processed Foods While efforts to define and regulate UPFs are still in development at the federal level, several states have decided to move forward with legislation targeting the use of specific artificial dyes and chemical preservatives in food products. West Virginia enacted HB 2354, prohibiting the sale or manufacturing of any food containing a list of specified dyes and certain preservatives. Similarly, Vermont is considering H 260, and New York is considering companion bills S 1239/A 1556. These bills aim to ban the manufacture, sale, or distribution of food containing a core group of chemicals (e.g., potassium bromate, propylparaben, and Red 3). Meanwhile, North Carolina introduced HB 440, which would prohibit additional color additives and ban the sale of food products containing nine specific dyes and chemicals. Pennsylvania introduced HB 1134, which focused on warning labels and would require foods with dyes Blue 1, Blue 2, Green 3, Red 40, Yellow 5, or Yellow 6 to include a label that states, “This product contains synthetic colors, which may have an adverse effect on activity and attention in children.” Leg Prospectus-2026 - CD - CA Restricting Ingredients in School Meals While previous years have focused on access to school meals, a growing wave of recent state legislation aims to eliminate UPFs, synthetic dyes, and chemical preservatives from children's diets. Several states have enacted or advanced bans on specific chemical additives in school meals: Utah’s HB 402 and Virginia’s HB 1910 prohibit schools from offering food containing common food dyes (Blue 1, Blue 2, Green 3, Red 3, Red 40, Yellow 5, and Yellow 6) or certain preservatives like potassium bromate and propylparaben. Similarly, Texas enacted SB 314 prohibiting specific additives in free or reduced-price school meals and SB 25, which mandates warning labels and expands state nutrition curriculum. In addition, other jurisdictions have introduced but not passed numerous bills proposing similar restrictions including South Carolina's HB 4339, which would prohibit certain additives in school meals. Modifying SNAP SNAP is the nation's largest federal food assistance program, providing benefits to low-income households. While the program is federally funded and administered by USDA through its Food and Nutrition Service, individual state agencies operate and manage eligibility and distribution. Since SNAP is governed by federal law, states must obtain a USDA waiver to implement changes that deviate from the federal rules. Several states are exploring waivers to limit the use of SNAP funds for purchasing candy and sweetened beverages or soft drinks, with Arkansas (SB 217), Idaho (HB 109), and Texas (SB 379) having passed legislation. Arkansas's new law requires the Department of Human Services to request a waiver to exclude candy and soft drinks, and reapply annually if denied. This dual ban was also the subject of bills introduced in Wyoming (HB 323) and South Carolina (HB 4061). Indiana (HB 1486) considered broader restrictions on “accessory foods,” aiming to prohibit the use of SNAP benefits for items like chips, energy drinks, sweetened beverages, soft drinks, and prepared desserts while New Jersey (A 5697/S 4348) introduced a narrower set of proposed restrictions, focused on soft drinks (including soda and sugary/sweetened beverages). Expanding Detection and Coverage for Chronic Diseases In response to high chronic disease rates — including diabetes, cardiovascular disease, cancer, and respiratory illnesses — states are enacting and proposing legislation focused on treatment coverage, awareness, and prevention. Several states are directly addressing obesity and pre-diabetes by mandating insurance coverage. Colorado (SB 25-048) enacted legislation requiring large group health plans to cover treatment for obesity and pre-diabetes, including medical nutrition therapy and metabolic/bariatric surgery. In Nevada, AB 555 caps patient cost-sharing for a 30-day supply of insulin for people with state-regulated commercial health plans. To aid early detection of diabetes, New Hampshire (SB 102), Louisiana (SB 26), and Florida (SB 958) enacted new laws requiring the creation of informational materials on Type 1 diabetes risk factors, warning signs, and screening available to students and parents. To reduce financial barriers to necessary cancer screenings, several states have enacted bills to mandate insurance coverage and/or lower the cost of diagnostic breast exams and supplemental testing. Virginia (HB 1828), Florida (SB 158), and Oklahoma (HB 1389) have enacted bills to limit or lower the cost of such breast imaging. Meanwhile, Colorado enacted HB 25-296, clarifying that health insurers cover medically necessary diagnostic and supplemental breast imaging that goes beyond routine screening. Looking Ahead ASTHO expects state and territories to continue advancing legislative proposals that focus on the prevention of chronic diseases and access to healthy foods in 2026. Future legislative action may include: Establishing policies to address food insecurity and promote access to nutritional foods by targeting food deserts. Exploring policy and leadership options to discourage the consumption of high-sugar drinks. Developing and adopting standards for healthy food procurement policies for state agencies and public institutions to increase the demand for nutritious products. Continuing to enact insurance coverage mandates for comprehensive chronic disease screenings and treatment. OE22-2203 PHIG article yes

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.

In the current legislative cycle, there are several policy strategies that support the development and integration of community health workers into the public health workforce, including dedicated federal funding and state laws supporting workforce development programs, certification standards, and Medicaid coverage.