The Latest Trends in Health Workforce Legislation

The Latest Trends in Health Workforce Legislation

In a rapidly changing federal landscape, states are stepping up to recruit and support professionals across the health care workforce.

To support the well-being of health workers, nearly every state now has a program that provides confidential resources to professionals suffering from addiction and/or psychiatric, medical, behavioral or other potentially impairing conditions. (AJ_Watt/Getty Images)

The Health Resources and Services Administration projects health workforce shortages across the fields of allied health, behavioral health, long-term care, nursing, oral health and medicine. In response, at least 49 states and Puerto Rico this year enacted more than 730 bills addressing the health workforce, according to NCSL's legislation tracking database.

NCSL's Health Workforce Peer Learning Group met in August to discuss these priorities:

• Navigating federalism in health workforce policy.
• Ensuring access to care at health facilities.
• Retaining the health workforce.

Navigating Federalism in Health Workforce Policy

In a rapidly changing federal landscape, what is the role of states in ensuring high-quality care for residents? Erin Fraher, deputy director for policy at the University of North Carolina's Cecil G. Sheps Center for Health Services Research, highlighted several points throughout the career lifecycle of a health professional, and the unique state policy levers available to address them. For example, states might encourage new entrants to the workforce, leverage foreign-trained health professionals or enhance workplace safety for existing workers.

Graduate medical education has historically been funded through Medicare, but some states are bolstering graduate programs through Medicaid payments (Iowa and New Hampshire) and state appropriations (Florida and Minnesota). States are also creating new oversight mechanisms (Nevada) to ensure dollars invested in graduate programs result in additional physicians practicing in rural and underserved areas.

State legislation addressing international medical graduates has become more frequent in the last several years as legislatures look to establish provisional licenses or remove barriers to practice (Hawaii, Oklahoma and Washington). States may use the Conrad 30 Waiver Program or other J-1 visa waiver programs, or address barriers to practice in their licensure processes.

Nearly every state has legislation addressing workplace violence for health care professionals, but states may differ in their approach, with measures often addressing penalties, prevention and remediation. Legislation enacted this year mandated workplace violence prevention programs (Texas and Washington) and reporting requirements regarding violence against health care workers (Montana and New Hampshire).

Ensuring Access to Care at Health Facilities

The health workforce and care facilities have a mutually dependent relationship: Health care professionals are employed by health systems, and facilities require a stable workforce to deliver care. Since January 2005, more than 196 rural hospitals have closed or converted their services, erasing a critical access point for inpatient care and affecting patients and providers alike.

States have a variety of strategies to support health care facilities to ensure safe, quality care for residents. Policymakers may provide technical assistance and resources to rural hospitals (Mississippi), grants for capital improvements (California) or notice of closure requirements (Nevada). States may also bolster alternative access points, such as rural health clinics (Kentucky), community health centers (Texas) or certified behavioral health clinics (Maryland).

Retaining the Health Workforce

Recruitment alone will not solve states' health workforce challenges. Keeping health professionals in the workforce also is important. States are establishing financial incentives, supporting mental and physical well-being and leveraging technology advances to retain health workers.

Financial Incentives: Research on financial incentives such as student loan repayment and forgiveness, scholarships and tax credits generally suggests that they have a positive impact on recruiting and retaining health care workers. States enacting legislation this year on financial incentives include Alabama (loan repayment), Georgia (tax incentives), Minnesota (rural physician training ) and North Dakota (scholarships).

Mental and Physical Well-Being: A 2023 study by the Columbia Mailman School of Public Health found health care workers are at increased risk of suicide compared with workers in other fields. Several states, including Alabama, Connecticut and Texas, have established or ensured confidentiality of peer support networks for first responders to process traumatic experiences. Arizona, Indiana and Rhode Island have limited the ability of regulatory boards to ask about applicants' previous mental health assistance, treatment or diagnoses, or to disqualify them on those grounds.

In addition, nearly every state has a physician health program that provides confidential resources to professionals suffering from addiction and/or psychiatric, medical, behavioral or other potentially impairing conditions. Many states have expanded the health professions eligible to receive nonpunitive assistance for mental health or substance use. Hawaii established the State of Well-Being Project to increase mental health training.

Technology Advances: Administrative burden often is cited as a source of burnout for health care professionals, including compliance with administrative rules, learning and navigating new systems and psychological stressors. Artificial intelligence presents an opportunity to address some of these challenges in the health workforce, but AI comes with potential challenges as states look to safeguard consumers. New Mexico directed its nursing board to create rules and standards on the use of AI in nursing. Viriginia required hospitals and certain long-term care facilities to implement policies on the use of patients' intelligent personal assistants that use natural language processing and artificial intelligence.

Looking Ahead

As state policymakers wrap up this year's legislative sessions and look ahead to 2026, they noted several emerging health workforce priorities: nursing, health technology interoperability, preventive care, applied behavior analysis, family caregiving and K-12 career pathways.

NCSL continues to track enacted legislation in its Health Workforce Legislation Database and maintains a multitude of resources on allied health professions, scope of practice policy, graduate medical education, career pathways and other health workforce topics.

This resource is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of an award totaling $747,800 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS or the U.S. government.

Kelsie George is a senior policy specialist in NCSL's Health Program.