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

This blog explains ASTHO’s Islands Health Equity Framework, which outlines a culturally resonant approach to health equity in the island areas.

Social determinants of healthcare are the conditions in which people are born, live, work, play, worship, and age. Read how these issues affect population health.

This report shares results and key takeaways from interviews on topics including the overall structure of Legionnaires’ disease programs, diagnosis and clinical testing protocols, and risk communication.

How New Laws Support Telehealth and Access to Health Care How New Laws Support Telehealth and Access to Health Care Ashley Cram Learn how federal and state policies are improving access to health care by supporting telehealth. Telehealth strengthens the health system by reducing barriers to access to health care and extending services to underserved communities. Federal and state policies — many born out of the COVID-19 pandemic — have increased the use of telehealth by patients and providers. This includes expanded reimbursement to allow more providers to deliver telehealth services in more locations and through more modalities. This Health Policy Update summarizes recent federal and state laws and policies that impact telehealth delivery and access to care. Federal Laws and Policies Rural Health Transformation Program Enacted as part of the One Big Beautiful Bill Act in July 2025, the Rural Health Transformation Program appropriates $10 billion per fiscal year for the Centers for Medicare & Medicaid Services (CMS) to award to eligible states looking to improve rural health care. CMS encouraged state applicants to focus on select strategies, including investment in technology platforms that enhance care delivery. This includes tools and resources that support telehealth overall and remote patient monitoring (RPM), which is a way for providers to monitor and support patients through the use of devices that support data collection and transmission. Applicants that participate in interstate licensure compacts are also incentivized throughout the five-year program period by being awarded additional points for participation, which may lead to states pursuing compact legislation in the coming years. Medicare Telehealth Flexibilities Set to Expire During the COVID-19 pandemic, CMS issued numerous flexibilities that authorized broader telehealth use to expand access to care. Flexibilities included expansion of certain audio-only services, geographic areas and patient locations, and additional provider types eligible to deliver telehealth services. Current policy authorizes these pandemic-related telehealth flexibilities through January 30, 2026. Without permanent extension of these flexibilities, Medicare coverage for telehealth services beyond January 30, 2026, telehealth will again be limited to patients living in rural areas and to certain services, providers, and facilities. Physician Fee Schedule Changes CMS establishes the annual Medicare Physician Fee Schedule (PFS), which sets payment policy for health care services provided by physicians and other professionals to Medicare beneficiaries. The 2026 PFS includes new codes for RPM that allow providers to tailor monitoring frequency and engagement levels to meet patient needs. These codes, and the expansion of RPM, allow providers to effectively monitor health indicators such as weight, blood pressure, blood glucose, and respiratory flow rates, to manage health issues. By regularly monitoring a patient’s health status, a provider can reduce the risk of adverse health outcomes and emergency department visits. Additionally, the PFS streamlined the process for adding eligible telehealth services for reimbursement by removing distinction between permanent and provisional services and focusing review on whether services can be delivered via telehealth. State Legislation Impacting Telehealth Delivery States are also developing policy solutions to enable broader access to telehealth services, including expansion of audio-only and RPM services. Audio-only telehealth services are the use of communications technology, without a visual component, to deliver synchronous health care services. This modality can ensure continuity of and access to care for patients who live in areas with limited broadband and/or those who lack access to a video-enabled device. In 2025, at least four states enacted laws related to audio-only telehealth services. This includes at least three states that extended coverage that would have otherwise expired. In Hawaii, SB 1281 extended the expiration of the state’s coverage of certain audio-only behavioral health services through 2027, while Minnesota (HF 2) took a similar approach to audio-only telehealth services, including certain behavioral health and substance use disorder services, through July 1, 2027. Similarly, Maryland (SB 372/HB 869) removed the sunset date for coverage of audio-only telehealth services. And more broadly, Missouri (SB 79) clarified the state’s telehealth definition to include audio-only technologies. RPM uses digital devices to monitor a patient’s health by collecting and sharing health information with providers. RPM is particularly effective for management of chronic conditions, allowing providers to engage in shared decision making with patients and prevent adverse health outcomes through more regular monitoring. In recent years, several states enacted legislation to expand access to RPM including two bills in Louisiana. Enacted in 2024, HB 896 established the Louisiana RPM program for Medicaid patients with chronic conditions and a history of high-cost services, with the goal of improved care coordination and reduced costs. Then in 2025, SB 70 expanded these criteria to include pregnant and postpartum women and infants following discharge from the NICU. In Maryland, HB 553 specifies that the Medicaid program must cover the equipment and provider oversight of blood pressure monitoring for eligible recipients, including pregnant and postpartum individuals and those with chronic health conditions. Lastly, Virginia enacted SB 843 which directs the state Medicaid agency to develop a plan and cost estimate for expanding Medicaid eligibility for RPM for patients with chronic conditions. State and territorial health agencies can encourage public health programs to incorporate telehealth and propose policy solutions that enable broader utilization of telehealth modalities across the entire jurisdiction. States that are interested in expanding access to telehealth can visit ASTHO’s Telehealth Project Initiation and Scoping Assessment to conduct a review and identify opportunities to expand access to telehealth, particularly related to policy, infrastructure, and funding. UD3OA22890-13-00 article yes

Leveraging Medicaid to Support Community Health Workers and Address Health-Related Social Needs This conversation dives into the role community health workers play in improving public health and how Medicaid funding can support them. 20:13 PH Conversations Series - Leveraging Medicaid to Support Community Health workers and Address Health-Related Social Needs Across the nation, states are exploring opportunities to improve population health by integrating community health workers (CHWs) into the health care workforce. CHWs are public health workers who typically have lived experience and personal connections with the communities they serve. Through these connections, CHWs build trust with community members and serve as crucial links between health systems and marginalized communities. CHWs are vital to addressing health-related social needs (HRSN) and play critical roles in achieving more equitable care across the nation. CHWs may work in clinical and community-based settings under a range of titles, including promotores. CHWs provide many different services and assist clients in navigating resources to support their needs. For example, CHWs can conduct outreach and education, and link people to state and federal benefit programs. State Medicaid agencies and state/territorial health agencies can support the provision of CHW services through collaboration and cross agency-partnerships between public health and Medicaid agencies. These partnerships are particularly salient as state Medicaid agencies begin covering more HRSN services, related HRSN case management, and CHW-provided services through Section 1115 demonstrations and state plan amendments (SPAs). Section 1115 demonstrations, which allow states to test new policies to support Medicaid members and their needs, can fund state pilots for Medicaid-funded CHW programs. Approximately 20 of 64 approved 1115 demonstrations related to HRSN and five states have used 1115 demonstrations to support CHWs. The Centers for Medicare and Medicaid Services’ new 1115 demonstration opportunity on HRSN allows states to invest in CHW certification programs, among other workforce development infrastructure investments. SPAs are another pathway to create sustainable funding for CHW programs. To date, Centers for Medicare and Medicaid Services has approved SPAs to cover CHW services as formal Medicaid benefits in nine states, including Louisiana and California. To learn more about the financing mechanisms states can use to integrate CHW services into the health care system—and how state/territorial health agencies can support Medicaid in these efforts—ASTHO spoke with Diana Crumley, JD, MPAff, Former Associate Director of Delivery System Reform at the Center for Health Care Strategies. Listen to an abbreviated version of the discussion below. Show Notes Article Authors Jahira Sterling, Center for Health Care Strategies Madison Hluchan, ASTHO Interviewer Jennifer Jean-Pierre, Director, Content Development and Communications, ASTHO Guest Diana Crumley, JD, MPAff, Former Associate Director of Delivery System Reform, Center for Health Care Strategies Resource ASTHOBrief: Leveraging Medicaid to Support Community Health Workers PHC Podcast Transcript - Leveraging Medicaid to Support Community Health Workers and Address Health-Related Social Needs website yes

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

This podcast explores innovative practices for leveraging non-traditional partnerships to support and sustain health equity expansion efforts.

Community Action Plan Templates for Children’s Environmental Health Environmental Health Community Action Plan Templates Health agencies can use these community action plan templates to bolster their children’s environmental health programs. ASTHO, through support from EPA, developed a set of four Community Action Plan Templates for use by state and territorial health agencies. These templates are intended to be adapted and customized by jurisdictions according to their specific needs and goals for children’s environmental health. Jurisdictions can prioritize the most pressing actions based on the areas of highest importance, needs, strategic plans, and timelines. The templates focus on air quality, climate, environmental justice, and lead poisoning. They provide a roadmap for creating community change by specifying what will be done, who will do it, and how it will be done. Health agencies can utilize the templates when helping communities develop new (or refine existing) action plans. Learn more about the templates by exploring the primer, or dive right in with one of the four templates below. website yes

This resource provides strategies to incorporate health equity in overdose prevention programs.

The Keys to Driving Generational Health, Well-Being, and Justice 30:13 Tune in to this podcast episode to hear a discussion about the vital conditions for health and well-being framework to reach full potential. PH Conversations Series - The Keys to Driving Generational Health, Well-Being, and Justice Somava Saha and Andrew Martin from Well-Being and Equity in the World (WE in the World) discuss the vital conditions for health and well-being framework or what we all need to collectively thrive and reach our full health and wellness potential. Through their conversation, they offer reflections and stories around how public health and community collaborations across the country organize around the vital conditions, prioritizing belonging and building civic muscle, to drive health, well-being, and justice across generations. Show Notes Guests Somava Saha, MD, MS, President and CEO, WE in the World Andrew Martin, MS, MHCDS, Director of Networks and Partnerships, WE in the World Resources Organizing Around Vital Conditions Moves The Social Determinants Agenda Into Wider Action | Health Affairs Thriving Together Springboard Vital Conditions | WIN NETWORK Pathways to Population Health Equity PHC Podcast Transcript - The Keys to Driving Generational Health, Well-Being, and Justice website yes

Looking to the future, states are improving access to care, providing subsidies for tuition costs, expanding hours of licensed facilities, increasing access, and meeting the needs of both parents and children.

Explore the transformative power of community engagement and community power building in public health research, and learn how these initiatives can enhance racial and health equity. Discover strategies for addressing structural determinants of health and empowering communities to drive positive change.

ASTHO spoke with Palina Louangketh about her history as a refugee to the United States, her extensive work in expanding health equity in Idaho, and how her past has influenced her present.

An in-depth look at how Wisconsin state agencies are partnering across sectors and systems to strengthen supports for children and youth to stop the cycle of incarceration.

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

In this episode, three experts discuss the Federal Advisory Committee on Infant and Maternal Mortality’s most recent report on American Indian and Alaska Native health outcomes and the data-focused recommendations for states and territories.

People with chronic diseases have suffered the most during the pandemic both in rates of COVID-19 mortality and morbidity, and the health disparities that exist in those with chronic disease and poor social determinants of health are stark. On today’s episode, we speak to chronic disease and health equity experts on how to address this growing divide.

Healthy People 2030 charts the course for public health over the next decade. In this episode, public health leaders share their perspectives about where state and territorial health agencies intersect with Healthy People 2030 and why it should be treated as a "North Star" in public health.

This episode emphasizes the importance of addressing heart disease and stroke prevention through approaches that center on health equity, including systems-level changes, quality improvement, and community development. CDC’s Division for Heart Disease and Stroke Prevention is partnering with ASTHO to support jurisdictions in successfully integrating efforts with healthcare and community partners and implementing best practices and evidence-based policies to identify, control, and improve blood pressure.