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Partnering with Legislative Staff to Improve Long COVID Outcomes Partner with Legislators to Improve Long COVID Outcomes Amelia Poulin and Sidnie Christian Learn how health departments can secure legislative understanding and support for Long COVID recovery efforts. Long COVID challenges public health systems, impacting individuals’ health, workforce participation, and community well-being. State and territorial health departments are leading efforts to track, understand, and mitigate the health and economic effects through surveillance, education, and coordinated care initiatives.  To maintain and expand these efforts, health department programs can secure legislative understanding and support. This requires cultivating longstanding, trust-based relationships with legislators and their staff. Strategic engagement helps legislators view health departments as indispensable partners in addressing complex public health issues with broad social and economic implications. Build Longstanding Relationships with Legislative Staff Legislative staff are often the most consistent points of contact in a lawmaker’s office and play a central role in shaping policy advice. Regular engagement strengthens trust and visibility, helps maintain productive relationships, and ensures consistent communication with legislative offices. Health agencies can achieve this by: Engaging early and often: Identify key legislative staff for health department programs to brief on emerging Long COVID data, evolving needs, and program outcomes throughout the year. These conversations provide context and set the stage for trust before policy requests. Over time, they can lead to invitations for health department representatives to provide expert input. Positioning the program as a trusted, nonpartisan source: Health department leaders can provide timely, objective information about Long COVID’s impact on local hospitals, schools, and employers. Demonstrating responsiveness: Following up on constituent inquiries related to Long COVID testing or benefits shows legislators that the health department is directly addressing concerns in their districts.   Program staff can play a key role by developing briefing materials, success stories, and district-level data to share internally with leadership or policy offices for dissemination to legislators.   Note: Health department staff should align engagement with internal communication protocols. They may centralize outreach through a legislative or government affairs office that coordinates messaging and ensures compliance with statutes and lobbying restrictions. Identify Objectives and Tailoring Asks Before reaching out to legislative staff, health department leaders should clearly define their goals (e.g., funding for post-COVID clinics, data infrastructure, or research partnerships). When health departments align requests with legislative priorities, those proposals may seem more feasible or be more likely to gain support. Keys to doing so include: Understanding legislator priorities: Review voting history, public statements, and committee membership (e.g., health, workforce, budget). Identify shared interests such as workforce participation, economic productivity, or small business resilience. Choosing the right messenger: Personal narratives from constituents affected by Long COVID related to the sub-issue (e.g., a small business owner struggling to return to work, a teacher navigating disability benefits, or a parent managing caregiving responsibilities) can be effective. Consider pairing stories with district-specific data to illustrate scope. State health departments can also amplify impact by working with local health jurisdictions to paint a larger picture of how Long COVID impacts communities in the region. For example, drawing connections between workforce impacts across multiple counties can demonstrate to legislators that Long COVID affects the state’s overall economic resilience, not just isolated communities. This approach can help legislative staff see statewide trends and understand how targeted investments could yield system-wide benefits. Crafting the message: Use plain, non-technical language to describe Long COVID (e.g., “lingering symptoms after COVID infection” rather than “post-acute sequelae”). Consider emphasizing economic impacts (e.g., missed work or school days, productivity losses, and long-term disability claims) and framing the health department as a problem solver that helps businesses/families recover and navigate challenges, rather than a requester for resources. Communicate Effectively Legislators are often time constrained. Clear, concise, and locally relevant messages are most effective. To build an effective ask of a legislator’s office, health department staff can: Use their language: Translate public health concepts into legislative priorities (e.g., “economic competitiveness,” “community stability,” “health care access”). Incorporate local data: Share district-level statistics on Long COVID cases or workforce absences, as data allows (e.g., “in your district, an estimated 5,000 workers have missed more than two weeks of work due to Long COVID”). Combine data with moral resonance: Pair values-based appeals (e.g., “every resident and their family deserve the chance to live and work at their full potential”) with supporting evidence (“yet one in four adults in this district continue to experience symptoms six months after infection, limiting their ability to contribute to the workforce and community”). Leave behind resources: Provide one-page infographics or briefing sheets summarizing data and program activities. Follow up to reinforce conversations with updates, success stories, and progress metrics. Anticipate Policy Dynamics and Counterarguments Legislative discussions may surface alternative policy ideas or misconceptions about Long COVID and health agency program roles. Consider preparing for opportunities to: Answer questions: Public health leaders should be prepared to clearly explain the department’s legal authority, the evidence base for Long COVID programs, and the partnerships that support implementation. Consider explaining how scientific research, emerging epidemiologic data, and best practices inform Long Covid programs and how partnerships with hospitals, clinics, and community organizations help ensure effective service delivery. Clear, concise explanations help legislators understand the health department’s scope and role, build credibility, and preempt misconceptions that could undermine support for program priorities. Acknowledge unintended consequences: Demonstrate awareness of policy trade-offs and propose pragmatic solutions. For example: A proposal to expand Long COVID benefits might raise concerns about budget constraints. Health department leaders could suggest phased implementation or pilot programs in high burden areas. Understand alternatives: Be prepared to discuss other proposed interventions and show how the health department’s approach complements them. For example: If a legislator suggests employer-led sick leave policies as the primary solution to Long COVID, the health department could explain that monitoring Long COVID prevalence and providing patient support can help ensure workers’ safe return to their jobs, complementing workplace policies. Leverage rulemaking: When statutory change is limited, use administrative rulemaking and public comment to align implementation with public health intent.   Conclusion Building lasting, credible relationships with legislative staff allows health departments to move from reactive engagement to a proactive strategy. By pairing constituent stories with district-specific data, aligning messages with economic and moral values, and maintaining year-round communication, public health leaders can secure sustained support for Long COVID initiatives. These strategies not only advance Long COVID priorities but also strengthen the overall policy capacity and visibility of public health agencies, positioning them as trusted, solutions-oriented partners in state governance.   article yes

This brief highlights legislative actions that states are taking to remove financial burdens for women who struggle to afford period products and mitigate existing stigma.

Increasing tobacco taxes in states is an effective method for encouraging cessation among youth. This brief outlines leading tobacco taxation strategies implemented by New York state, Washington, D.C., and Connecticut.

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.

States have largely dismissed weakening policies, but legislatures are likely to continue considering vaccine-related bills, which may allow public health leaders to work collaboratively toward improving vaccination rates and bolster the positive impact vaccines have on population health.

Colleen Arceneaux and Jantz Malbrue from the Louisiana Department of Health to discuss why forgoing community health worker certification was the right course of action for their state.

How states are using 1115 waivers to improve health equity for people on Medicaid.

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

Health Agencies Keeping Cottage Foods Safe Heather Tomlinson Rows of homemade jams at the local farmer’s market and a neighbor’s birthday cake on social media have something in common: they are both cottage (or homestead) food products. Cottage foods are home-based, home-made food products prepared outside of a commercial kitchen and sold to the public. Cottage food producers operate on a small scale, often from a home kitchen, selling goods locally. Although cottage foods provide opportunities to small, locally owned businesses, they also create complexity in selling food products to the public that are not inspected and may not meet basic food safety standards. And while home kitchens are not considered food establishments in the FDA Food Code, states are able to define “food establishments” by amending provisions in their food code adoption process or enacting legislation or regulations. In addition to regulating, state health agencies can play a role in keeping cottage foods safe through education, training, and other mechanisms. Cottage Food Regulation Currently, all 50 states and Washington, D.C. allow the sale of cottage food products directly to consumers. Several foodborne illnesses have been linked to products improperly prepared at home, such as botulism outbreaks in home-canned products and E.coli contamination of jerky. Many foodborne illnesses can be prevented by safely preparing, processing, and storing foods, processes often outlined by health regulations. Health agencies use a variety of tools to regulate cottage food production. Types of Foods: The types of foods permitted can vary across jurisdictions with some allowing only non-time/temperature controlled for safety (TCS) foods (e.g., baked goods, jams, candies), while others allow a wide range of products including TCS foods and items that require specialized processes (e.g., pickled vegetables). Some jurisdictions may use an exhaustive or illustrative list outlining permitted foods, while others limit specific food production processes but allow all other food items. Licensing and Inspection: Cottage food producers must follow a variety of rules in the form of permits, licenses, and registration. Although cottage foods are exempt from many inspection requirements, at least fifteen states require an initial inspection of home kitchens before they can sell items. All states allow the investigation of foodborne illness complaints; some states require annual licensure. Food Safety Training: States can require a food safety course to ensure that all cottage food producers understand the basic food safety requirements. Sales Caps: Gross sales caps limit the scale of operations allowed without full food safety precautions. After a cottage food operation exceeds their gross sales cap, they would be required to register as a food establishment and permitting rules would take effect. Sales Venues: States typically only allow direct-to-consumer sale of cottage foods (e.g., farmers’ markets) but some states permit online sales. Federal food safety regulations, which prohibit cottage foods, apply when food products are sold across state lines. Cottage food sales, whether in-person or online, should remain within the state they were created to avoid violating federal regulations. Labeling: All states have a labeling requirement for cottage foods. These labels can vary but typically include the food producer’s name and address, the product name, an ingredients list, allergens, product weight, date of production, and a disclaimer identifying that the product was prepared in a home kitchen that is not inspected. Recent Cottage Foods Legislation in the States Legislators often face tension in weighing the balance between maintaining food safety regulations and supporting small cottage food businesses by reducing the entry barriers (e.g., leasing commercial kitchen space). In recent years, there has been an increase in legislation expanding cottage food parameters ranging from product and preparation inclusions to modifying the gross sales cap. The Arizona House of Representatives passed and the Senate is currently considering HB 2864, which would expand the state’s cottage food item list to include precut and processed freeze-dried fruits and vegetables. Arizona enacted HB 2042, which expands the definition of cottage foods to include foods that require time and temperature control if they're exempt under federal regulations. The Hawaii legislature passed HB 2144 which is now awaiting action from the Governor, which would expand the definition of cottage foods to include pickled products and non-hazardous products that do not contain dried meat or seafood, permit the sale of products in retail stores, and allow for customer delivery via third party vendors or shipping. Several states have introduced legislation to increase the gross sales cap for those who qualify as a cottage food producer. Mississippi (MS SB 2638) and Washington (WA SB 5107) introduced bills that proposed to increase the annual gross sales cap, but both failed in session. There has also been legislation surrounding cottage food preemption. Massachusetts is considering S 2761, which would establish a cottage food regulatory framework and prohibit local health agencies from being able to establish their own cottage food regulations. Microenterprise Home Kitchens In expanding cottage food production, there has been increased legislation on microenterprise home kitchens. Microenterprises typically allow the production of more types of foods, including fully prepared hot meals, but also require stricter regulations (such as preparing and selling the food on the same day). Minnesota (MN SF 4501) and Hawaii (HI HB 1591) have introduced legislation that would allow microenterprise home kitchens and establish a regulatory framework for licensing and safety standards. Raw Milk Considerations Raw milk is an animal milk that has not gone through pasteurization (process of heating milk to a specific temperature for a set period of time) to kill harmful bacteria. Raw milk can carry dangerous bacteria that can cause food poisoning and has recently been shown to test positive for the recent highly pathogenic avian influenza (HPAI) virus. As of March 2024, 30 states allow the interstate sale of raw milk. This session, West Virginia passed legislation (WV HB 4911) and at least six states, Michigan (MI HB 5603), Hawaii (HI HB 1989), Missouri (MO HB 1711), Massachusetts (MA S 43), Louisiana (LA HB 467), and New Jersey (NJ A 1086), considered legislation that would allow unpasteurized, raw milk to be sold to consumers. How State Health Agencies Can Keep Cottage Foods Safe Health agencies consider cottage food inclusions based on food production risks. For instance, many agencies will allow baked goods but do not permit pickling due to the botulism risk associated with pickling. Health agencies evaluate food science to educate their legislatures on the considerations of cottage foods and where they would recommend public health regulations. Health agencies also ensure cottage food guidance is easily accessible and written in plain language, so producers have the needed information to follow regulations. Relevant information may include the permitted products, how to become a cottage food producer, and food safety considerations when preparing home-made foods. For example, the Illinois Department of Health, in collaboration with a diverse collection of stakeholders, created a robust cottage food guide to help producers and regulators understand state requirements and cottage food safety standards. Author card spacing 4 State policy surrounding cottage foods is constantly evolving. ASTHO will continue monitoring these changes and provide relevant updates. website yes

Public health policies that support healthy transportation options for nonmotorists.

Centering the Community’s Voice in State-Led Health Equity Initiatives health equity, public health departments, health outcomes, michigan public health institute, health disparities, underserved populations, marginalized communities, people of color, indigenous people, premature deaths, minority health, cultural competency, public health, life expectancy, improving health, american indians, health service, african american, native american, social determinants of health, sexual orientation, mortality rate, socioeconomic status, covid-19 pandemic, higher rates, alaska natives, group of people, racial groups, social economic, population health, department of health, astho, association of state and territorial health officials Lana McKinney, Jessica Fepelstein Establishing the community voice in health policy discussions. Over the past two years, ASTHO has worked directly with state public health departments and their communities to build capacity for improving health outcomes. These public health departments are building a culture of health equity through policies, practices, and quality improvement measures. This includes the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative—a 10-state learning community hosted by ASTHO, the CDC Foundation, and the Michigan Public Health Institute. STRETCH supports states in operationalizing health equity and preventing the constant pressures caused by negative health outcomes on their communities. For example, poverty can create constant pressures just as water pushes against a dam, which can build to the point of breaking and push people into poverty. Additionally, ASTHO supports state and territorial recipients of CDC’s COVID-19 Health Disparities grant to improve the health of high-risk and underserved populations disproportionately impacted by the COVID-19 pandemic. Health disparities impact the quality-of-life and financial well-being of communities, with the economic burden of health disparities increasing from $320 billion in 2014 to $451 billion in 2018. This includes associated costs of excess premature deaths, lost labor market productivity, and excess medical care for Americans of color as compared to their white counterparts. Events in recent years, such as the COVID-19 pandemic, revealed the pressures that Black, Indigenous, People of Color (BIPOC) and other marginalized communities experience because of health disparities. Aligned with the technical assistance received by public health departments, several states have taken concrete steps to achieve optimal health for all by supporting training of public health staff and increasing engagement of under-represented and underserved communities in the policy process. Promoting Staff Health Equity Training Ensuring that public health staff and other leaders are equipped with the knowledge, skills, and attitudes necessary to provide culturally competent and equitable care to all patients, regardless of their social background or identity can improve health outcomes. In recent years, states have worked to expand access to cultural competency and humility training for health system workers. Nevada enacted legislation (AB 267) requiring the state Board of Health to establish the frequency for medical facilities and dependent care facilities to conduct cultural competency training for employees who have direct patient contact. It also (1) requires the Office of Minority Health and Equity and Department of Health and Human Services to establish and maintain a public-facing list of approved courses for cultural competency training, and (2) require nurses, psychologists, marriage and family therapists, counselors, social workers, and behavioral analysts to complete a minimum of three hours of cultural competency training to successfully renew their license. At least four other states—Illinois (SB 2427), Massachusetts (S 1413), Virginia (SB 1440), and Vermont (H 512)—considered bills expanding access to cultural competency training for health care professionals. Vermont’s bill would implement the recommendations of the Health Equity Advisory Commission to provide training and continuing education for health care providers to improve cultural competency, cultural humility, and antiracism in Vermont’s health care system. Public health agencies can also promote health equity training by allocating funding and providing training. For example, the Arizona Department of Health Services leveraged funding from CDC’s COVID-19 Health Disparities grant to establish the Advancing Health Equity, Addressing Disparities (AHEAD AZ) program with the University of Arizona Center for Rural Health, which supports the health care and public health workforce, including support for Arizona’s 17 Critical Access Hospitals health equity strategic plans, and implementing a COVID-19 testing program that provided testing to communities most in need regardless of socioeconomic or immigration status, including those living in correctional facilities and unhoused people. Health Equity Commissions Health equity commissions play a critical role in advancing optimal health for all by bringing together experts, stakeholders, and policymakers to draw on evidence-based approaches that address the root causes of health disparities and to develop strategies to prevent them. At least two states proposed legislation related to health equity commissions in 2023. Colorado passed a law (SB 23-151) extending its Health Equity Commission through 2029. New Jersey is considering S 3136, which would establish and require a Commission on Health Equity to, among other things, recommend implicit bias training requirements for health care providers. Empowering Community Members to Engage in the Policy Process Hearing directly from community members, particularly those with lived experience, provides health agencies with unique insights into the community’s needs and daily life, and helps gain support from those most affected by the policy. There can be several barriers to holistic community engagement, particularly for community members who have fewer resources. Policymakers can take steps to lower these barriers by providing access to childcare, supporting transportation costs to a meeting, and/or compensating community members for their time and effort supporting the policy development process. In 2022, Washington enacted SB 5793 to compensate community members with lived experience for their time and expertise when serving on boards, commissions, councils, committees and other similar policymaking groups. The law directed the state’s Office of Equity to develop equity-driven compensation guidelines for all state agencies, which Washington’s Department of Health used to create and implement its Community Compensation Guidelines. These compensation guidelines outline how and when community members can be paid for their time and expenses when engaging in the policy process. Such methods are particularly valuable because the communities facing the most inequity are also the ones most systemically marginalized. Similarly, in 2023 Oregon’s legislature considered SB 694 to create a Task Force and Work Group Stipend Fund. The fund would provide for providing members who do not otherwise receive compensation for their participation to be compensated for their time and travel for task force or workgroup related work. ASTHO will continue to monitor policy developments supporting health equity programs and initiatives, providing relevant updates. Special thanks to Maggie Davis, JD, ASTHO’s director of state health policy, for her contributions to this blog. Additional Resources to Help Public Health Leaders Increase Community Engagement ASTHO’s Programmatic Health Initiatives and Strategies Georgia Health Policy Center’s Guide to Funding Navigation to help communities design and sustain equity-advancing investment. <!-- Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative framework. --> website yes

Federal and state legislation can play a role in promoting positive infant mental health by providing funding and policies that support early intervention, caregiver assistance, and the creation of nurturing environments conducive to their emotional well-being.

To address the youth tobacco epidemic, jurisdictions filed lawsuits against JUUL to end their marketing practices aimed at youth and to obtain compensation from the financial toll experienced by communities.

Three ways policymakers are addressing access to care are through telehealth, safety net and emergency services, and adjusted reimbursement rates to Medicaid-enrolled providers.

Responding to Disruptions in Access to Controlled Substance Medications: A Guide for State Health Departments and Their Partners Responding to Disruptions in Access to Controlled Substance Medications astho, association of state and territorial health officials, public health official, state health, territorial health, island areas, island jurisdictions, opioid prescriptions, access to opioid prescriptions, opioid rapid response program, opioid therapy, withdrawal symptom, rapid response, opioid crisis, opioid overdose, mental health, prescription monitoring, united states, discontinuation of opioid, opioid withdrawal, symptoms of withdrawal, opioid use disorder, type of drug, opioid medications, department of health, stop drinking, drinking alcohol, prescription drugs, opioid prescribing, drug withdrawal, opioid pain, physical dependence ASTHO | A guide on responding to disruptions in access to opioid prescription. Responding to Disruptions in Access to Controlled Substance Medications: A Guide for State Health Departments and Their Partners (2025) provides important updates to the 2022 edition and ASTHO’s 2020 document Responding to Pain Clinic Closures: A Guide for State Health Departments. This guidebook reflects the current state and federal landscape regarding disruptions, shares updated recommendations on strategies states might use to mitigate risks to patients affected by a disruption, and includes additional state examples. These updates are informed by the CDC’s Opioid Rapid Response Program (ORRP) and states’ coordinated responses to ORRP notifications since the program was formally established in late 2020, as well as tabletop preparedness exercises ASTHO has conducted with states. Get the Report (PDF) Content Updated - Report - Responding to Disruptions in Access to Controlled Substance Medications website yes

Policy Options to Improve Data Sharing Between State and Local Health Departments Organizational policies on data sharing between state and local public health agencies. This report explores organizational policies related to data sharing between state and local public health departments. ASTHO, in collaboration with the National Association of County and City Health Officials and the Network for Public Health Law developed this report, which aims to serve as a guide for state and local public health leaders as they consider organizational policy options to improve state and local data-sharing efforts. Get the Report (PDF) website yes

State Health Agencies’ Role in Implementing Pharmacist-Prescribed Contraception Health Agencies’ Role in Pharmacist-Prescribed Contraception Sophia Durant, Brittany Lee Learn about three primary barriers to successful implementation of pharmacist-prescribed contraception and actionable solutions. State health agencies lay the groundwork for sustainable and equitable contraceptive access. They play a pivotal role in expanding access to contraception by supporting the implementation of pharmacist-prescribed contraception (PPC). This report walks readers through three major areas for doing so: Mechanisms That Expand Pharmacist Roles in Contraceptive Access: Learn about policy levers jurisdictions can utilize to support pharmacists playing a more active role in contraceptive care, including collaborative practice agreements and standing orders. Payment for Services: Explore legislative, Medicaid, and commercial insurance strategies to address payment for services as a key barrier to PPC programs. Workforce, Education, and Consumer Awareness: Delve into final considerations that can impact the implementation of PPC from workforce development to pharmacy/regional champions and education. Get the Report (PDF) Padding Block - Large Related Content - Report - State Health Agencies’ Role in Implementing Pharmacist-Prescribed Contraception article yes

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.

Learn how Hawaii and Iowa have leveraged policy change to improve overdose prevention.

Learn how state health agencies can support brain health and caregiving through policy and innovation.