Update on State Legislative Sessions 2025

May 23, 2025 | Beth Giambrone

In December 2024, ASTHO announced the top five public health state policy issues to watch for the state and territorial legislative sessions in 2025. With approximately 30 states scheduled to conclude their legislative sessions by the end of May, here’s an update on where things stand.

Modernizing Public Health Data and Protecting Privacy

ASTHO anticipated that expanding access to Health Information Exchanges (HIEs) while protecting consumer health data would be a focus of the state legislative sessions in 2025. So far, at least seven states have introduced legislation that would establish or improve HIEs, including Massachusetts (H 1404), Michigan (HB 4037), and North Carolina (SB 509).

States are also looking at ways to ensure the privacy of health and other personal data. So far, at least 20 states have introduced legislation to protect data privacy. Legislators considered provisions including requiring entities that process or use health data to have a comprehensive and public-facing data privacy policy (Illinois HB 3494/SB 2273) and providing patients the right to restrict the disclosure of their health information (New York A 2613/S 1633).

Strengthening the Public Health Workforce

With projected national shortages in health care, states are exploring programs, policies, and incentives to recruit and retain this workforce. So far in 2025, at least six states have introduced legislation to financially support health care professionals by establishing, expanding, or revising grant programs — Georgia (HB 541) and Oregon (SB 142) — or loan repayment programs — Connecticut (SB 1450), Iowa (HF 972), Indiana (HB 1274), and Maryland (HB 19).

In addition, at least four states are considering legislation to support certification or advancement in health care professions such as nurse midwifery (California SB 520) and nursing (Hawaii HB 714/SB 294, Mississippi HB 1127, and Massachusetts H 2544). Two bills in Maine would remove barriers to certifying and licensing health care professionals by eliminating the supervision requirement for certified nurse practitioners to practice independently (LD 961) and allowing community-based agencies and hospitals to train and certify mental health rehabilitation technicians and behavioral health professionals in house (LD 1084).

Finally, the Hawaii legislature recently passed SB 447 which addresses the state’s public health workforce shortage by establishing a pilot program within the Department of Health to streamline the hiring process. The bill is currently with the governor for consideration.

Comprehensive Care for Pregnant and Postpartum Women

Maternal health and well-being significantly affect both fetal and infant health outcomes, highlighting the importance of comprehensive support systems. Additional research reveals the impact maternal mental health has on early brain development and pediatric mental health.

States are continuing to explore access to supportive services like doulas during pregnancy, childbirth, and postpartum. So far in 2025, at least 10 states have introduced legislation expanding Medicaid coverage to doulas, with Utah enacting SB 284, directing the Department of Health and Human Services to take steps to provide Medicaid coverage of doula services. In addition, Montana enacted SB 319, which establishes certification requirements for doulas and authorizes using state-certified doulas under Medicaid. New York also introduced companion bills A 5140 and S 6494, which would require all health insurance companies to cover doula services.

Furthermore, at least 12 states have introduced legislation in 2025 requiring health insurance and/or Medicaid to provide support for maternal mental health services. Recently, Tennessee enacted SB 849, which includes development of optional continuing education courses for health care professionals in maternal mental health. New Hampshire is considering SB 246, which would require insurers to provide benefits for periodic prenatal and postpartum maternal depression screenings, and require maternal depression screenings during well-child visits up to the six-month well-child visit. Alabama (SB 191) and Oklahoma (SB 1058) have considered policies expanding access to maternal mental health services including coverage of required screening for postpartum depression and Indiana (HB 1244) considered providing grants to community-based programs with the goal of addressing maternal mortality.

Containing and Preventing the Spread of Infectious Disease

The core of public health is comprised of preventing, identifying, and containing disease. Common public health strategies include exercising legal authority for prevention measures, issuing standing orders, supporting vaccination programs, and advancing programs and policies to monitor, prevent, screen, and treat sexually transmitted infections as well as infectious and communicable diseases.

The estimated number of HIV infections decreased 12% between 2018 and 2022. To further decrease HIV infections, jurisdictions are considering legislation that would give individuals at risk of contracting HIV increased access to pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). At least four states introduced legislation in 2025 — Iowa (HF 183), Kansas (HB 2100), Missouri (HB 1057), and New York (A 358) — that would allow pharmacists to order, administer, and/or dispense PEP/PrEP to individuals. Another four states — Illinois (HB 2584), Indiana (HB 1298), Nebraska (LB 715), and Pennsylvania (HB 1301) — introduced bills mandating health insurance cover the costs of PEP/PrEP, including testing and patient visits. And two proposals in Washington, D.C. (B 26-0159 and B 26-0101) would prohibit health insurers from using an individual’s use of PrEP or PEP to determine premiums and prohibit insurance companies from considering an individual’s use of PrEP when reviewing applications for life, disability, or long-term care insurance policies.

Jurisdictions also use immunization registries and HIEs to support providing recommended vaccines and to monitor vaccine coverage rates. In 2025, at least six states considered legislation related to operating these registries, including New Hampshire’s SB 75 that would have allowed health insurance companies to access the state’s immunization registry to help support individuals with notice of recommended or overdue immunizations. Legislation in two states would expand registry data, including Arizona’s SB 1663, which would expand the immunization registry to include adults, and New York’s A 765/S 453, which would change the state’s immunization registry from an opt-in to an opt-out process and require reporting adult vaccinations. Conversely, companion bills in Texas (HB 772/SB 46) would allow individuals to request exclusion from the immunization registry at any time. Finally, New York’s A 1336/S 4536 would help to ensure compliance with the state’s vaccine exemption law by requiring that exemptions to school vaccinations be recorded in the immunization registry.

Substance Misuse and Overdose Prevention

Preventing substance misuse and the resulting negative health outcomes and injuries continues to be a top priority for public health officials. After years of steadily rising overdose fatalities, rates of fatal overdose have dramatically declined in the United States since September 2023. State and territorial legislatures have considered measures to reduce fatal overdose rates in 2025, with at least seven states exploring expanded access to and use of opioid antagonists (e.g., naloxone).

Bills in four states would provide for greater access to opioid antagonists in public and community spaces. Maine’s LD 710 would broaden existing state law that allows public health agencies and local governments to distribute naloxone through community programs and in publicly accessible spaces, such as in vending machines. As part of a larger bill focused on overdose prevention, Illinois HB 4039 would require that naloxone be available to individuals who are incarcerated upon their release. Companion bills introduced in Massachusetts (H 2535 and S 1551) would establish a trust fund to cover the cost of purchasing, storing, and distributing opioid antagonists to certain health care facilities.

Finally, New York introduced legislation that would (1) allow individuals to leave opioid antagonists at locations with a known or suspected overdose (A 6481), (2) include all FDA-approved forms and doses of naloxone in the state’s definition of opioid antagonists and require the Department of Health to make them available for purchase or use (A 7409), and (3) require public venues such as theaters, amusement parks, and concert venues to maintain a supply of opioid antagonists and have staff on site who are trained to provide overdose response services (S 4640).

Legislatures also expanded who may administer opioid antagonists and provided liability from criminal or civil legal action. Nebraska recently enacted LB 195 to cover opioid antagonists other than naloxone in criminal and civil liability. Meanwhile California is considering AB 1037, which would expand peoples’ ability to obtain opioid antagonists and receive liability protections for possessing and/or using them. Colorado recently enacted SB 164, which permits school employees to administer opioid antagonists if they believe doing so will assist in an overdose event, even if they have not received training. The law also gives the state’s Board of Health the authority to determine eligible entities to receive standing orders and request naloxone from the bulk fund.

ASTHO continues to monitor these important public health issues and state legislative sessions of 2025 and will provide relevant updates.