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Learn about how five jurisdictions approached self-measured blood pressure monitoring programs to reduce hypertension and uncover systemic barriers to care.

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

Breastfeeding and early child nutrition are crucial for promoting healthy early brain development. This infographic details how skin-to-skin breastfeeding and breast milk promote infant brain development, higher educational performance, and cognitive and socio-emotional health. This brief explores the linkages between breastfeeding and early brain development. It discusses how home visiting programs provide breastfeeding support, foster healthy early brain development, and improve overall child health and well-being.

ASTHO engaged Oklahoma public health officials, members of the Oklahoma Harm Reduction Alliance, Health Minds Policy Initiative, and representatives of the Southern Plains Tribal Health Board, and others in a Boundary Spanning Leadership workshop.

This infographic highlights 10 high-level strategies to advance work in school behavioral health.

Use this toolkit to incorporate flexible funding strategies into your public health agency's operational and project management procedures.

Tobacco control has been a public health success in states across the nation, but there is still work to be done, especially surrounding the popularity of menthol and other types of flavored tobacco.

States Support Postpartum Health with Medicaid Expansions astho, association of state and territorial health officials, 2023 state legislative session, medicaid expansions, postpartum health, the consolidated appropriations act, national women s health week, postpartum coverage, affordable care act, premium tax credits, affordable care, 12 weeks, united states, extended postpartum coverage, health a priority, medicaid program, national women s health, mother s day, 2023 legislative, vaginal birth, physical activity, women s health week, postpartum care, coverage for 12 months, 60 days, state plan amendment, care act, postpartum depression, health care Sowmya Kuruganti National Women’s Health Week reminds us that postpartum care is critical for the long-term health of the birthing parent and baby. National Women’s Health Week’s 2023 theme—Women’s Health, Whole Health: Prevention, Care and Wellbeing—is a reminder that postpartum care is critical for the long-term health of the birthing parent and baby. The first year after pregnancy can be full of physical, emotional, and mental health challenges that have long-term or even life-threatening health impacts without timely diagnosis and treatment. In September 2022 CDC reported that 23% of pregnancy-related deaths occur from seven to 42 days postpartum, and 30% of deaths occur 43-365 days postpartum. Among all pregnancy-related deaths occurring from 2017 to 2019, approximately 84% were deemed preventable. Black and American Indian and Alaskan Native <!--(AI/AN)--> women have two to three times higher rates of pregnancy-related death compared to white women. These disparities, like others, are driven by social and economic factors that are rooted in structural and systemic racism and discrimination. Health insurance coverage is one such factor that supports positive maternal health outcomes by facilitating access to care before, during, and after pregnancy. In the United States, 40% of births are covered by Medicaid, which is the primary source of health coverage and access to care for those of low income. Organizations like ASTHO and the Association of Maternal and Child Health Programs support extending Medicaid coverage through one-year postpartum to combat disparities in maternal health outcomes. Federal Legislation for Postpartum Coverage under Medicaid For the majority of states that have adopted Medicaid expansion under the Affordable Care Act (ACA), all people with income up to 138% of the federal poverty level (FPL) are eligible for Medicaid. In states without Medicaid expansion, pregnant people can be eligible for coverage during pregnancy and up to 60 days postpartum under federal law. After 60 days postpartum, these people may lose coverage for the rest of the year-long postpartum period based on general state Medicaid eligibility requirements. Prior to 2021, states could extend Medicaid coverage to postpartum people through a section 1115 demonstration waiver or through state funds. The enactment of the 2021 American Rescue Plan Act, gave states another option to extend Medicaid coverage to 12 months postpartum via state plan amendment for five years. So far in 2023, CMS has approved the State Plan Amendments for five states (Alabama, Arizona, Colorado, Oklahoma, and Rhode Island) implementing a 12-month postpartum expansion. To date, a total of 33 states have expanded Medicaid coverage to 12 months postpartum via Section 1115 demonstration waiver or state plan amendment. 2023 State Legislative Session Depending on states rules for modifying Medicaid coverage the legislature may need to direct the health department to submit a state plan amendment. So far in 2023, three states enacted legislation related to expanding coverage to 12 months postpartum. In Mississippi, SB 2212 authorizes the state’s Division of Medicaid to provide 12 months continuous postpartum coverage to people who qualify. Utah’s SB 133 extends coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. In Wyoming, HB 4 temporarily extends Medicaid coverage for qualifying pregnant women for 12 months postpartum, ending March 31, 2027. Other states introduced bills to extend postpartum coverage during this session. The Alaska Legislature passed legislation (SB 58) directing the Department of Health to submit a state plan amendment extending postpartum coverage to 12 months, and to raise the household income level for eligibility to 225% of the FPL. The bill is currently awaiting action by the governor. Iowa introduced legislation (SF 57) to enact postpartum coverage for 12 months postpartum by Medicaid State Plan Amendment. This would extend the current 60-day postpartum coverage for Medicaid beneficiaries. The Missouri legislature passed (SB 45) that would extend MO HealthNet postpartum coverage from 60 days to 12 months postpartum for women who are either currently receiving or eligible to receive aid to families with dependent children, or eligible to receive benefits via the income eligibility standard. Pregnant women eligible for MO HealthNet and receiving mental health treatment for postpartum depression, related mental health conditions, or substance abuse treatment within sixty days of giving birth would remain eligible for benefits for those services for an additional 12 months. The bill is currently awaiting action by the governor. Nebraska introduced legislation (LB 419) to extend postpartum coverage for 12 months postpartum that would extend the current 60 day postpartum coverage. Texas introduced legislation (HB 12) to extend postpartum coverage to 12 months; it has passed in the House and is now pending in the Senate. Its passage would significantly change the current coverage structure, which uses state funds to provide postpartum people a limited package of postpartum services through the Healthy Texas Women program under HB 133, and subsequently submitted 1115 waivers to draw down federal funds for the program and extend coverage to six months postpartum. Wisconsin introduced companion bills (AB 114/SB 110) extending postpartum coverage for 12 months postpartum for women eligible for Medicaid during pregnancy. This action would extend coverage from the current 60 days and amend the previous 90-day Section 1115 Waiver submitted in 2021. Studies have demonstrated numerous benefits of extending Medicaid coverage for postpartum people and, given these positive impacts, ASTHO expects that more states will take action to extend Medicaid to 12 months postpartum. ASTHO will continue to monitor and report on this essential maternal public health issue. website yes

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

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.

A mid-session legislative update on five of ASTHO's top 10 public health state policy issues to watch in 2023: data privacy and modernization, reproductive health, health equity, strengthening public health agencies, and immunization.

Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots Legislative Snapshot: Suicide Prevention Infrastructure and AI Chatbots JoAnne Deehr Suicides continue to be a critical public health issue — learn how states are leveraging policy to improve suicide prevention. Suicide remains a persistent public health challenge, affecting people of all ages, racial and ethnic groups, geographic regions, and income levels in the United States. Despite ongoing prevention efforts, more than 49,300 Americans died by suicide in 2023. National suicide rates steadily rose from 2003 until 2018 and have remained high since then, reflecting an enduring and widespread impact. While all communities are affected by suicide, certain demographics face higher risks. Disproportionately higher rates of suicide are seen among elderly Americans, Veterans, individuals with lower income, less education, and those living in rural areas. People in certain industries, such as mining, construction, and public safety, are also at elevated risk. At the same time, emerging technologies like chatbots powered by artificial intelligence (AI) have raised new considerations related to safety, oversight, and appropriate use in mental health settings, underscoring the need for thoughtful state approaches to suicide prevention. Policymakers are responding to these challenges in multiple ways, including establishing state suicide prevention infrastructure and regulating AI chatbot use in mental health. Suicide Prevention Infrastructure Legislation Suicide prevention efforts are most effective when states and territories have dedicated infrastructure — such as suicide prevention offices, coordinators, commissions, and fatality review processes — to support coordination, surveillance, and implementation of evidence-based strategies. These structures enable state and territorial health agencies to identify populations and communities at increased risk, align partners across public health, health care, and public safety, and pursue sustainable funding for suicide prevention and crisis system improvements. ASTHO’s Suicide Prevention Offices and Committees Legal Map highlights the varied policy approaches states have taken to establish this infrastructure and identifies which states had statutory suicide prevention structures in place as of January 1, 2025. During the 2025 legislative session, states considered at least 30 bills related to establishing suicide prevention offices, coordinators, advisory bodies, and suicide fatality reviews. Five of these bills were enacted, including Delaware’s HB 54 which establishes the state’s Office of Suicide Prevention. Delaware also enacted HB 87, expanding membership in the state’s Suicide Prevention Coalition to include someone who has experienced suicidal ideation or survived a suicide attempt and someone who has lost a loved one to suicide. Conversely, Oklahoma enacted SB 676, repealing the section of the state’s Suicide Prevention Act that established the Oklahoma Suicide Prevention Council, which was slated to sunset in 2020. The council was originally tasked with identifying issues and promoting strategies to prevent suicide, and providing technical assistance on best practices for identifying people at risk of suicide. The Department of Mental Health and Substance Abuse Services still serves as the leading agency for implementing the remainder of tasks outlined in the Act. Illinois and Texas enacted legislation establishing advisory bodies focused on suicide prevention among first responders. In Texas, HB 1593 creates a committee to study suicide prevention and peer support programs within fire departments and requires a report with recommendations by September 2026. In Illinois, HB 2551 reconstitutes the First Responders Suicide Prevention Task Force, and increases membership in the task force to include a member from an organization that provides mental health training and support to first responders and two members who represent organizations that advocate on behalf of public safety telecommunicators, such as 911 operators and dispatchers. The bill also charges the task force with developing a final report by December 2026. Both bodies are scheduled to sunset in January 2027. Currently, Wisconsin has several types of fatality review teams operating through voluntary efforts with no law formally establishing or governing these teams. Wisconsin is considering SB 192, which would formally establish processes for reviewing fatalities, including deaths by suicide. It would also direct the Department of Health Services to establish a fatality review program comprised of established local teams and authorize the department to establish state fatality review teams. AI Chatbots While states continue to strengthen suicide prevention infrastructure, policymakers are beginning to turn their attention to emerging mental health considerations related to AI. Since emerging in the 1950s, AI has evolved from rule-based systems to today's machine learning and natural language processing applications, powering everything from data analysis to interactive chatbots. Recent AI advances enable chatbots to simulate human conversation so convincingly that users may forget they are interacting with a machine. However, these systems lack genuine empathy and cannot substitute for professional mental health treatment. Their tendency to be excessively agreeable creates particular dangers for people experiencing suicidal ideation, leading some states to explore regulations governing AI chatbot use in mental health and suicide prevention contexts. At least 19 states considered legislation regulating the use of AI for mental health related reasons to promote user safety. At least five bills were enacted, including California SB 243, which requires chatbot platform operators to disclose that users are interacting with AI if confusion could occur, develop protocols to prevent and respond to suicidal ideation or self-harm, and report annually on safety measures to the state Office of Suicide Prevention. The California legislature also passed AB 1064, which the Governor subsequently vetoed due to concerns that its broad restrictions on AI companion chatbots for minors could limit access to potentially beneficial tools. Illinois and Nevada passed legislation that largely prohibits AI from providing behavioral health services. Illinois HB 1806 restricts the use of AI for therapy or psychotherapy unless delivered by a licensed professional who is required to inform the patient, or their legal representative, in writing and receive consent. The law also prohibits licensed professionals from allowing AI to make independent therapeutic decisions or interact directly with clients and allows the use of AI only for administrative or supplemental tasks under professional oversight. Nevada AB 406 similarly prohibits AI systems from providing or representing themselves as offering professional mental or behavioral health care, prohibits AI from performing the functions of a school counselor, psychologist, or social worker in public schools, and allows licensed professionals to use AI only for administrative or supportive purposes, with oversight to ensure accuracy and safety. New York and Utah passed laws requiring mental health chatbots to clearly disclose that they are not human. As part of their annual budget, New York S 3008 mandates that AI companion systems capable of simulating human-like interactions detect suicidal ideation or self-harm, provide crisis referrals, and regularly disclose that users are interacting with AI rather than a person. Utah HB 452 requires AI-driven mental health chatbots to provide clear disclosures and limits advertising and data practices. At the federal level, on December 11, 2025, the White House issued an executive order seeking to establish a national policy framework for artificial intelligence and create a “minimally burdensome” federal approach. The order also directs the Department of Justice to form an AI Litigation Task Force to identify and challenge state AI laws deemed in conflict with this federal policy, and the Department of Commerce to limit eligibility for certain federal funds for states that take a non-preferred approach. The scope and criteria of these federal actions, including their impact on state laws aimed at suicide prevention, have not been clearly defined. Advancing suicide prevention will require states and territories to take comprehensive approaches that address both systemic gaps within state infrastructure and emerging technologies. ASTHO will continue to monitor these policy developments and provide relevant updates. Reviewed by - Baker-White, Maffey article yes

Good news and bad news on tobacco use: smoking rates are down but e-cigarette use continuing rapid rise among youth. Read how states are combating the problem.

Learn how state and territorial legislatures can bolster or restrict public health legal authority, with examples from early COVID-19 as well as 2024.

Strengthening Public Health Communication: Oklahoma’s Strategy and Lessons Learned ASTHO Staff Communications is a foundational capability for all health departments, essential for supporting public health protections, programs, and activities that ensure community well-being and promote equitable outcomes. To educate their communities and encourage healthy behaviors, health departments must communicate clearly and effectively. After COVID-19, the Oklahoma State Department of Health revisited and modernized its communication strategies. This video shares their journey, including the process they followed, best practices they adopted, outcomes achieved, and lessons learned—offering valuable insights for other Public Health Infrastructure Grant (PHIG) recipients aiming to enhance their communications capabilities. OE22-2203 PHIG article yes

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

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.

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

Following disruptions to daily life caused by the COVID-19 pandemic, emergency departments saw an increase of mental health-related visits. A June 2021 study showed a significant increase of mental health-related visits among 12–17-year-olds compared to the previous year. States and territories that implement a comprehensive public health approach to suicide prevention across all domains of life—an approach known as the socio-ecological model—can reduce contributing risk factors.