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This brief examines the ways states can support certification for community health workers.

Health providers have widely used telehealth to mitigate the spread of COVID-19 infection and to improve access to healthcare services thanks in large part to policy changes and regulations. This brief explores how state and territorial health agencies (S/THAs) are responding to COVID-19 through telehealth policy and operational changes, as well as how telehealth has quickly emerged as a tool to improve health equity.

Opportunities for Public Health Agencies to Advance Sustainable Financing of Community Health Worker Programs Advancing Sustainable Financing of Community Health Workers Explore how health officials can play key roles as funders, administrators, and policy designers to advance sustainable financing of community health workers. Many states face upcoming funding gaps for community health worker (CHW) positions, with COVID-19 related grant funding streams expiring. Concurrently, many states are rapidly beginning to cover CHW services under Medicaid. In addition, Medicare launched a new reimbursement opportunity for CHWs in January 2024. These factors create an opportunity for state and territorial health agencies to develop or contribute to equitable reimbursement and robust implementation. This report details how health officials can play key roles as funders, administrators, and policy design champions to ultimately advance sustainable financing of CHW services. Get the Report (PDF) website yes

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

Learn how states have increased and/or allocated funding to continue supporting core public health services.

In-depth analysis on state health policy surrounding the public health workforce. This is part of ASTHO's annual legislative prospectus series.

ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on data modernization and privacy.

Public Health Approaches to Preventing Suicide and Promoting Mental Well-Being Public Health Approaches to Preventing Suicide Caitlin Langhorne Griffith, Arnelle Toffey Learn how to execute public health approaches to preventing suicide, which requires understanding the dynamics of policymaking and implementation. Despite ongoing prevention efforts, suicide remains a leading cause of death and disability among Americans of all ages, racial and ethnic groups, geographic regions, and socioeconomic statuses. While suicide affects populations at all levels, it continues to be the second leading cause of death in individuals under 44 and disproportionately impacts veterans, individuals with lower income and educational attainment, and residents in rural areas, among other groups. Approximately 6% of the U.S. population has a Serious Mental Illness (SMI) (e.g., bipolar disorder, major depressive disorder, and schizophrenia), and a 2022 study found that almost 10% of people who die by suicide had a known SMI. In addition, individuals with or without SMI can experience suicidal ideation or attempts. Factors such as adverse childhood experiences, limited access to health care, and economic instability can contribute to suicide risk. Public health approaches that expand treatment access and address the drivers of suicide risk can help foster mental well-being in communities and reduce the risk of individuals dying by suicide, including those with SMI. However, executing these approaches requires understanding the dynamics of evidence-based strategies in policymaking and implementation. Population-Based Approaches Expanding access to mental health care is critical for reducing risk and managing symptoms of mental illness, as only 50% of young adults (18 to 25 years old) and 53% of adults (26 to 49 years old) with any mental illness received treatment in 2024. However, barriers to mental health care — such as availability of providers, access to telehealth, cost, and other systemic factors — can prevent individuals from receiving treatment, especially during serious declines in mental health. Population-based approaches can fill this gap by focusing on non-clinical interventions and activities that address chronic stressors and other factors contributing to mental health declines, improving mental health outcomes. Examples of these policies include: Addressing structural determinants of suicide risk (e.g., economic security). Promoting access to clinical services (e.g., Medicaid expansion and state mental health parity laws). Limiting access to lethal means for suicide (e.g., child access prevention laws and access to high-risk medications). 988 Suicide & Crisis Lifeline State health agencies can also consider approaches that provide and enhance direct crisis support. The 988 Suicide & Crisis Lifeline is a nationwide hotline that provides emotional support to individuals experiencing suicide, mental health, or substance use crises. Since its launch in July 2022, call volumes have steadily risen in all states, and the Lifeline has been shown to improve callers' mental well-being as well as reduce suicide risk. Implementation of the 988 Lifeline occurs at both the state and local levels, resulting in variations in funding and infrastructure across communities. In the most recent legislative session, jurisdictions enacted legislation to fund and sustain 988, ensuring consistency in quality and access across all communities. For example, North Dakota SB 2200 allocates funding for 988 operations from a community health trust fund, while Texas HB 5342 established a trust fund outside of the state treasury to support the 988 Lifeline. States also enacted legislation either consolidating (Colorado SB 236) or ensuring interoperability with 988 and 911 emergency lines (Nebraska LB 362), streamlining services and accessibility for those in need of mental health support. In addition, 12 states have adopted a 988 telecom fee — similar to fees that support 911 infrastructure in every state — to create a sustainable financing source for 988. Adolescent Mental Health Support at School Schools are a critical setting to support adolescent mental health, particularly for children with serious emotional disturbances who are at elevated risk of suicide. Several states have mandated suicide prevention training requirements for school personnel as part of ongoing professional certification requirements. Federal funding — such as the Suicide Training and Awareness Nationally Delivered for Universal Prevention Act, which focuses on evidence-based programs for students — can help states and tribes establish/expand training for school staff and equip them with the education to recognize warning signs and connect students to resources, alongside student-directed programs that increase mental health literacy and foster peer support. In the 2025 legislative session, at least three states enacted legislation focused on preventing youth student suicide. Kentucky (HB 48) and Montana (SB 369) mandate training for school staff on suicide awareness and prevention, while Virginia HB 2055 requires school staff to provide materials to parents on suicide prevention (including the safe storage of firearms) if they believe a student is at imminent risk. At least three additional states enacted legislation that requires student identification cards to include mental health information and suicide crisis resources, including the 988 Lifeline (Colorado SB 326, Illinois HB 3000, New Jersey A 4897). Georgia HB 268 requires public schools to provide at least one hour of suicide awareness prevention and training to students in grades 6-12. Conversely, an Idaho bill (SB 1199) that would amend a 2024 law to allow minors to access medical treatment when calling the 988 Lifeline without parental consent passed the Senate but did not advance in the House. Jurisdictions have also incorporated policies that provide additional safeguards for adolescents and their use of the internet: Utah recently enacted SB 98, which requires the state Board of Education to create a video presentation for parents outlining the safety and legal issues students may encounter while using technology. Maryland's SB 310 expands the state's Youth Suicide Prevention School Program to include instruction to students on the relationship between gambling and youth suicide. At the federal level, Congress is considering the Kids Online Safety Act, which requires platforms, applications, and streaming services that connect to the internet to exercise care in creating and implementing design features to prevent and mitigate harm to minors. Looking Forward It is important to understand suicide prevention approaches nationwide, including how jurisdictions formalize and strengthen suicide prevention infrastructure as well as promote healthier environments. Strategies for policymakers include the following: Analyzing and comparing suicide prevention infrastructure laws nationwide to identify gaps and guide jurisdictional changes. Building protective environments that address upstream social and structural risk factors (e.g., access to clinical services and food insecurity), while advancing policies that reduce access to lethal means. Strengthening school-based prevention efforts by leveraging available funding to expand evidence-based programs, train school staff, establish student-directed programs, and connect students to needed resources. Promoting safer online spaces for youth with policies that limit harmful design features, strengthen parent engagement, and increase online platform transparency. Continuing investments in crisis services to expand and sustain programs like the 988 Lifeline. Prioritizing economic support policies to strengthen families and reduce ACEs, supporting healthier development and well-being. Leveraging these legal and policy frameworks can reduce suicide risk, support mental well-being, and build a stronger public health system for all. article yes

Cases of sepsis and septic shock can be prevented with strong health policies as shown in New York. Several states have taken action to enact mandatory early detection and treatment protocols.

Thousands have been diagnosed with cyclosporiasis, which can cause explosive diarrhea and be tough to track. Learn the latest outbreak and investigation details.

The opioid crisis continues to claim the lives of thousands across the United States and has cost the economy billions in health care, mortality, and criminal justice costs. In 2018, it’s estimated that 67,367 people died of overdose, with opioids (prescription opioids, heroin, and other synthetic opioids other than methadone) made up almost 70% of overdose deaths. Provisional data for the twelve-month period ending December 2019 shows that there were 71,130 overdose deaths, with 50,178 overdose deaths attributed to opioids. The COVID-19 pandemic has also exacerbated the drug overdose crisis. Data shows that in the time of continued lockdowns and social distancing that overdose rates have increased, indicating a sustained need to support people with substance use disorder.

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.

During the early months of the COVID-19 pandemic, the federal government enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act, temporarily expanding the use of telehealth technologies by removing various requirements and waiving certain restrictions. Many states also expanded telehealth access through changes to state Medicaid laws. These temporary policy changes created an uptick of telehealth use that improved access to care for millions of Americans—but questions remain about which policy changes will stick around beyond the pandemic. Currently, states are making decisions about what temporary policies to permanently implement and which policies to end without disrupting the delivery of care and further exacerbating health disparities.

When rural hospitals close, it increases the distance people must travel for essential healthcare services. The COVID-19 pandemic has highlighted and magnified the factors leading to rural hospital closures across the country. Many healthcare facilities suspended elective procedures to conserve critically needed personal protective equipment and reduce the risk of exposure to COVID-19 by patients and hospital staff. For many rural hospitals, however, the suspension of elective procedures with the reduced the use of non-urgent services by apprehensive patients meant a loss of revenue and the furloughed healthcare staff. Since the onset of the COVID-19 pandemic, approximately half of all rural hospitals are experiencing negative operating margins due to reduced outpatient revenue. The rate increases in states that have not expanded Medicaid. Unfortunately, these kinds of challenges are not new to rural hospitals.

In 2020, the COVID-19 pandemic exacerbated barriers to care and treatment for individuals experiencing opioid use disorder. Experts estimate a record-setting 90,000 people died of a drug overdose in 2020. Additionally, as the pandemic continues, it has understandably diverted attention, funds, and personnel usually focused on the opioid crisis. State and local public health departments are experiencing an all-time low in staffing, especially among Maternal and Child Health programs.

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.

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.

This Health Policy Update is an overview of state legislative activity to increase financial stability for families during the COVID-19 pandemic which may help to prevent adverse childhood experiences.

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

Why Kentucky Chose to Pursue Community Health Worker Certification astho, association of state and territorial health officials, certification program, kentucky department for public health, community health worker, public health workforce, kentucky association of community health workers, national association of community health workers, health affairs, cultural competence of service, professional certificate, community health workers chws, department for public health, range of activities, kentucky department for public, chronic disease, centers for disease control and prevention, public health worker, builds individual and community, covid-19 pandemic, health care, public health Shelby Rowell ASTHO | Kentucky shares how they collaborated with the CHW workforce to develop a CHW certification process. Community health workers (CHWs) play a critical role in improving public health outcomes by serving as a bridge between systems of care and the communities they serve. They are often trusted members of the communities they work in and can provide culturally appropriate and linguistically accessible health services and information to individuals who may have limited access to traditional health care settings. Many states are considering certifying CHWs to ensure they have the necessary training and skills to provide high-quality care. Given every jurisdiction’s varied needs and policies, determining whether to pursue CHW certification should be discussed state-by-state. Kentucky and Louisiana are examples of states that have taken two different approaches to supporting the CHW workforce. While Louisiana chose not to pursue CHW certification, Kentucky has opted to develop a CHW certification program. ASTHO spoke with Laura Eirich, Kentucky Office of Community Health Workers administrator, to discuss the state’s decision-making process behind implementing CHW certification and how the Kentucky Office of CHWs has maintained shared decision-making with their state’s CHW workforce. When did Kentucky develop a CHW program within its state health department? Kentucky has funded several programs to deploy CHWs across the state, including the first Kentucky CHW program in 1994 called Kentucky Homeplace and a CHW program that served migrant farm workers with outreach and case management services. In 2014, the Kentucky Department for Public Health (KDPH) dedicated part-time staff to form a CHW Advisory Workgroup, which established three sub-committees (Certification, Curriculum, and Evaluation) that met monthly to draft a state CHW certification manual, core competencies, and a code of ethics. The work group brings together CHWs, representatives from state and local public health departments, federally qualified health centers, community-based organizations, universities, and other organizations who want to employ or otherwise advance the CHW workforce. By 2017, KDPH formed the Kentucky Office of Community Health Workers (KOCHW) and hired an administrator. What was the process for determining if Kentucky would have a certification program? The CHW Advisory Workgroup held formal discussions regarding a potential certification program beginning in 2014. The workgroup reviewed other states’ CHW training curricula and certification processes to develop Kentucky’s draft core competencies. In 2018 and 2019, Kentucky participated in a technical assistance project with ASTHO to renew its focus on CHW efforts. With ASTHO’s assistance, Kentucky conducted a statewide survey of CHWs to gather insight into attitudes towards the CHW profession and certification, which showed widespread interest in pursuing certification. Nearly half of the respondents identified as CHWs. Between 2019 and 2022, KOCHW launched an approval process for CHW training organizations and instructors to be certified, as well as an official Continuing Education Unit approval process. In 2022, Kentucky’s legislature passed legislation that outlined statutory requirements for CHW certification, continuing education, certification renewal, and associated duties of KDPH. Kentucky Administrative Regulation authorized KDPH to promulgate administrative regulations for CHW certification. How did Kentucky work with CHW groups to develop a CHW certification process? Kentucky CHWs were initial advocates for pursuing certification. They were instrumental in helping with outreach, conducting research, and drafting a certification manual, policies, code of ethics, and core competencies. One of the top priorities of KOCHW was to ensure that the certification process was developed in partnership with Kentucky CHWs so that any resulting certification program would effectively meet their needs. The launch of the Kentucky Association of Community Health Workers (KYACHW) provided an opportunity to connect and collaborate with more CHWs in the state. Staff from KOCHW have attended association meetings across the state to share updates and request KYACHW members to approve, deny, or suggest alternative wording or changes. For instance, we shared each iteration of the draft certification manual in-person at these KYACHW meetings and virtually to increase opportunities for feedback. What were the benefits of certification that you identified in your discussions? The most significant benefits and drivers of certification include the following: Increased recognition and respect for the profession. Increased confidence for individual CHWs. Opportunities for professional growth. Potential for future Medicaid reimbursement and financial sustainability of the profession. However, it is important to note that the Centers for Medicare & Medicaid Services does not require certification as a requirement for Medicaid reimbursement; this decision is made on a state-by-state basis. What measures do you take to ensure all interested CHWs can participate in your certification program? Each year, KOCHW sends a survey to all known CHWs, providing an anonymous space for feedback. All formal and informal CHW feedback is cataloged, and KOCHW periodically holds discussions to dive deeper into concerns or issues. When we make changes to the CHW certification manual and process, KOCHW is transparent about the reasoning behind the changes. It is worth noting that CHWs had (and currently have) the power to approve or reject any proposed changes. Soliciting and incorporating changes based on CHW feedback helps demonstrate that certification is for all CHWs. It’s important for CHWs to know that this is their certification and their voice matters. For example, KDPH and the CHW Advisory Workgroup suggested charging a fee for certification and renewal. KYACHW members felt it was important to assess a fee, but they decided on the price. To avoid creating a financial barrier, a fee of $50 for initial certification and $25 for renewal was decided upon by CHWs. These fees are now in the Kentucky statute. One way to make certification more accessible was to change the GED/High School Diploma requirement to a “strong recommendation,” which allows those without formal degrees to become certified. Additionally, KOCHW does not perform background checks on applicants pursuing CHW certification, which allows those who have experience with the justice system to use that lived experience to assist others. Did you communicate with states with existing CHW certification programs to inform your decision? Yes! We met with representatives of several states, including Massachusetts, Texas, and Connecticut. We also learned from state and national experts, such as Carl Rush, MRP, and were fortunate to participate in two ASTHO learning communities supported by HRSA. These projects were integral to understanding the national CHW landscape, identifying best practices, and formalizing the process in Kentucky. What advice would you give to states and territories currently assessing if a certification program is right for them? Talk to your CHWs! Initiating and building relationships with existing programs and associations is essential to ensuring CHW voices are heard. Take advantage of the existing plethora of resources! Talk to states and territories that have opted in and out of pursuing certification. The beauty of CHW work is that each state and territory is different, and there is no wrong path. Consult subject matter experts, such as ASTHO and the National Association of Community Health Workers (NACHW) who have a wealth of knowledge and can help convene groups, identify goals, and formalize your process. State comments have been edited for length and clarity. 2 UD3OA22890-10-00 website yes