Occupational Licensing Trends
Summary of Legislative Trends
NCSL tracked and analyzed all legislation introduced in state legislatures across the country from 2017 to 2019 that addressed occupational licensing. Over the three years, at least 2,018 pieces of legislation relating to occupational licensing were considered by state legislatures in all 50 states. NCSL categorized bills based on 12 topics and four population groups. Legislative activity was also broken down based on the project’s original 11 consortium states compared to non-consortium states.
Of the 12 topics tracked, the most common topic addressed in state legislatures were related to fees or requirements, with 122 bills enacted from 2017 to 2019. Licensing for ex-offenders received the most attention among the populations tracked. While non-consortium states introduced more bills in total than consortium states, the rate at which those bills were enacted was substantially higher among the consortium states.
Analysis by Year
Many factors can affect legislative activity, including elections, changes in partisan majorities, evolving political priorities, and the fact that four states only hold session in odd years. When looking at legislative activity over each of the project’s three years, 2018 saw the fewest bills introduced. In 2019, there was a significant increase in the number of bills introduced. Further analysis would be required to explain the reason for this increase. Despite the spike in introduced bills, the number of bills signed into law was less than in 2017—the year most bills became law.
Increasing or decreasing licensing fees or requirements, and reciprocity, were the top issues addressed in state legislatures in 2017. Requirement clarification, increasing fees or requirements, and reciprocity were the top issues in 2018. And requirement clarification, modifying the scope or exemptions of licenses, and both increasing and decreasing licensing fees and requirements topped the list in 2019.
Bill Topics
Increasing licensing fees and requirements were the most addressed topics in state legislatures from 2017 to 2019, with 122 enactments out of 218 introduced bills. States also considered high numbers of bills that clarified requirements, addressed reciprocity across states, and reduced fees or requirements.
Populations
Of the four population groups tracked, states gave the most attention to licensing for ex-offenders, with 73 enactments out of 176 bills introduced. States were also active on licensing for veterans and military spouses. States spent less time addressing immigrants with work authorization and low-income workers.
Interstate Compacts
One of the major legislative trends over the past few years has been the creation and adoption of interstate compacts to facilitate licensure portability. Since 2014, seven licensure compacts have been established through the associated compact legislation. Over the course of the project (2017-2020), 106 individual pieces of compact legislation have been passed by states.
Governors’ Role in Occupational Licensing
Governors can play a significant role in advancing a state’s occupational licensing efforts by elevating the issue as a statewide policy priority and taking direct action through the use of executive order. Occupational licensing has been a priority for many governors over the past several years, as evidenced by significant gubernatorial interest and action on the topic across the country.
Elevating Occupational Licensing as Statewide Policy Priority
Governors can use their state of the state address to establish a sense of priority for taking action to improve occupational licensing policies. Eight governors mentioned occupational licensing in their state of the state addresses in 2019. During legislative sessions that year, relevant legislation was introduced in every state in which the governor mentioned occupational licensing in his or her state of the state address, and relevant legislation was passed in six of the eight states. This indicates a strong influence of a governor’s priority setting on legislative action.
State of State Mentions & Relevant Legislation Introduced/Passed
|
2019
|
2020
|
State of State Mentions
|
8
|
13
|
Relevant Legislation Introduced
|
8
|
|
Relevant Legislation Passed
|
6
|
|
Governors’ 2020 state of the state addresses have demonstrated that the emphasis on occupational licensing as a policy priority for governors is an enduring trend. As of March 1, 2020, 13 governors mentioned occupational licensing in their 2020 address. Many of these governors used their address to celebrate accomplishments in licensing policy over the past year. Governors also used their remarks to urge policy action in the coming year. Improving license reciprocity and recognizing and alleviating burdens for special populations, like those with a criminal record and military families and veterans, emerged as key themes in these addresses.
Executive Order
In addition to setting priorities for the legislature to act on, governors can use their executive order authority to address occupational licensing policy reforms in a variety of ways. From 2016 to 2019, 10 governors issued 15 executive orders taking action on issues related to occupational licensing.
The most common way governors have used their executive authority in the 2016-2019 time period has been to mandate a statewide review of their occupational licensing system, often by establishing a dedicated task force. During this time, four governors—Arizona Governor Doug Ducey, New Mexico Governor Susana Martinez, Oklahoma Governor Mary Fallin and Pennsylvania Governor Tom Wolf—have used their executive power to call for such a review. These reviews are used to identify challenges within the state’s licensing systems and processes and can be used to inform subsequent policy action. Mandating this type of review may be a politically palatable way for governors to initiate the process of improving occupational licensing rather than changing policies directly without engaging the legislative process.
Other governors have used executive orders to make more systemic changes to licensing policy and procedures. For example, Governor Brad Little of Idaho and Governor Charlie Baker of Massachusetts both used their executive order power to establish sunrise and sunset processes in the state. Governor Mary Fallin of Oklahoma signed an executive order in 2018 requiring the creation of a database to serve as a central source of statewide information related to occupational licensing. These executive orders demonstrate how governors can make more systematic and permanent changes to occupational licensing policies and procedures in accordance with their priorities. All these examples demonstrate how executive action can be a powerful tool that governors can use to make timely policy changes.
Year
|
Number of Executive Orders
|
2016
|
4
|
2017
|
3
|
2018
|
5
|
2019
|
4
|
Topic
|
Number of Executive Orders
|
States
|
Statewide Review/Task Force
|
4
|
Arizona, New Mexico, Oklahoma, Pennsylvania
|
Emergency/Temporary
|
3
|
North Carolina, Massachusetts, New Hampshire
|
Sunrise/Sunset
|
2
|
Idaho, Massachusetts
|
Gubernatorial Engagement by the Consortium
All states participating in the consortium had a representative from their governor’s office on their team in order to align the group’s work with executive priorities and garner support from the executive branch. Through this liaison, participating states leveraged their governors’ offices in their work in a variety of ways. For example, in Indiana, the consortium core team worked closely with Governor Eric Holcomb’s Health Workforce Council to improve licensing policies and processes to address a labor shortage in the health sector. The alignment of the consortium team’s priorities with this initiative led by the governor was a catalyst for Indiana joining the Nurse Licensure Compact. The Indiana core team has identified its collaboration with the working group as a key strategy for keeping momentum in this work moving forward beyond the end of the grant.
In Arkansas, Governor Asa Hutchison established the Governor’s Red Tape Reduction Working Group (RTRWG) in 2019. Arkansas’ consortium home team was appointed by Hutchison to form the Occupational Licensing Advisory Group, which was tasked with advising the RTRWG. This collaboration led to The Red Tape Reduction Sunrise and Sunset Act of 2019 being passed and enacted. This legislation reflected Hutchison’s and the consortium home team’s priorities and was informed by the information-sharing the home team engaged in through the consortium.
States maintained executive support through gubernatorial transitions by actively engaging top executive officials early on in the new administration. For example, in Nevada, the director of the Governor’s Office of Workforce Innovation (OWINN) under the Sandoval administration was an active participant in the Nevada core team. When a new director was appointed under the Sisolak administration, the core team immediately reached out to engage him in its work. This led to consistent participation from the executive branch amid a gubernatorial transition, allowing the team to maintain momentum in its work, even with an executive branch party change.
Population Trends
Population Highlights Deep Dive
As mentioned earlier in the Trends section on page 37, the project examined the ways different population groups were disproportionately affected by licensing regulations. During the application process, consortium states were asked to identify which population groups they aimed to focus on. Although certain population groups did receive more attention than others, all were addressed by at least one state. Many consortium states also realized that policy solutions to address one population often benefited multiple population groups. This finding will be addressed further in the Lessons Learned section, beginning on page 55. Below is a deep dive into a few specific actions taken by consortium states. The examples draw from both legislative actions and executive/regulatory actions.
People With Criminal Records: Delaware
Addressing barriers for people with criminal records was a topic that saw a significant amount of attention both nationally and among the consortium states. Generally, state action on this issue falls into a few broad categories. These categories include, but are not limited to, limiting the length of time criminal convictions can prevent licensing, specifying the types of disqualifying criminal convictions, and allowing for predetermination (or early ruling) if an applicant’s criminal history will disqualify them for licensure. Seven consortium states paid special attention to this population, devoting significant time and resources to reviewing potential barriers to licensure and areas for improvement.
In 2016, Delaware Governor Jack Markell signed Executive Order 60. This order created a committee to review the state’s current licensing requirements. One of the committee’s recommendations was to reduce barriers for justice-involved individuals by creating a list of crimes that are substantially related to the profession.
In 2018, the Delaware legislature passed HB 97 (now Act 214). This bill states that a person can only be denied a license based on a criminal record if the conviction happened in the last 10 years and is “substantially related” to the practice of cosmetology or barbering. The board could also provide a waiver for a felony conviction for a crime against a person if the conviction happened over three years prior to licensing, and for all other felony convictions if they happened more than two years ago. The applicant also cannot be actively completing a sentence parole, or any other court- required actions like community service before applying.
After Act 214 was signed into law, Carney signed an executive order creating the Delaware Correctional Reentry Commission. This commission is responsible for creating and implementing efficient and effective reentry initiatives that are rooted in evidence. In 2019, following the passage of Act 214, four more pieces of similar legislation were introduced for massage therapists; electricians; heating, ventilation and air conditioning (HVAC) operators;, plumbers; and real estate agents
Delaware’s work to improve access to licensure for workers with a criminal record was achieved through a combined effort by the legislature and the governor’s office. The research and coordination from the governor’s committees and commissions helped inform the legislation championed and passed by the legislature. Act 214 passed with no opposition. Though the other four pieces of legislation encountered some opposition, it was minimal. HB 124 and HB 43 each passed with only one “no “vote in the House. HB 7 passed with only one “no” vote in the Senate.
Veterans and Military Families: Utah
Addressing barriers for veterans and military families was another topic that saw significant interest among both consortium and non-consortium states. Nine consortium states focused specifically on this population group, as outlined in their action plans. National legislative trends focused on expediting licensure processes, creating temporary licensure or exempting veterans and military spouses from state licensure requirements if they were previously licensed in another state.
In 2018, the Utah Legislature passed SB 227, one of the first pieces of legislation of its kind. The bill provides exemptions from licensure for a variety of professions for both individuals serving in the military and spouses of those serving in the military if the applicant has a valid existing licensing in another jurisdiction. The bill also exempts certain military spouses and those actively serving in the military from paying licensing fees in Utah.
To qualify for this exemption, applicants must:
- Either be actively serving in the military or be the spouse of someone actively serving.
- Hold a valid and active license to practice in another state.
- Be in good standing in the state or jurisdiction where they hold the license.
SB 227 passed with no opposition. The bill was intended to build off similar legislation from 2011: HB 384. This bill created exemptions for veterans and active-duty military for professions that fell under Utah’s Division of Occupational and Professional Licensure. SB 227 expanded the occupations covered under the exemption. In Utah, the legislative-dominant approach worked exceedingly well.
Immigrants With Work Authorization: Colorado
Addressing barriers for immigrants received less attention than people with criminal records or veterans and military families. Four consortium states, however, ultimately focused closely on this population. One of the most significant pieces of legislation on this issue came from Colorado.
Similar to Delaware’s efforts, Colorado’s work on reducing burdens for immigrants was a joint effort between executive branch officials and legislators. The work started in Colorado’s Immigrant Gap Analysis Committee, a committee the consortium team formed to better understand licensing barriers for this population and to help drive policy. The committee found that barbers and cosmetologists in Colorado have some of the highest numbers of immigrant applicants. The committee convened stakeholders and led focus groups on the topic. From its research and convenings, the committee helped create and advocate for the passage of HB 1290.
HB 1290, which was considered during the 2019 legislative session, allows an applicant to substitute the required hours of training for licensure as a barber or cosmetologist with work experience gained in a foreign country. The applicant must submit documentation of their foreign work experience to qualify. The experience conversion allowed three months of documented experience to substitute for every 100 required hours of training. However, required hours related to health, safety and disinfection cannot be substituted. This bill does not reduce requirements for passing the exam for licensure.
Low-Income, Dislocated and Unemployed Workers: Wisconsin
Addressing barriers for low-income, dislocated and unemployed workers saw the smallest amount of attention both nationally and from consortium states. Legislation for this population generally looked at addressing fees and the initial cost of licensure. This population group did not receive as much attention, overall, from consortium states, mainly because it is a harder population group to define and these individuals often fall into one of the other population groups. Additionally, this project largely took place from 2017 to 2019, years featuring nationwide economic growth.
Wisconsin passed AB 733 (now Act 319) in 2017. This act allowed license applicants making less than 180% of the federal poverty level to pay only 10% of licensure fees. The bill only applies to certain licensed professions. Act 319 initially waived all fees for applicants making less than 180% of the federal poverty level. However, this version of the bill received pushback in the Legislature. By changing the amount of fees paid to 10%, the bill received bipartisan support and was enacted. Act 319 was also part of Wisconsin’s larger consortium participation goal of reducing licensing barriers for populations disproportionately affected by licensure requirements.
Trends: Licensing Boards and Portability Options
Licensing Boards
The inclusion of state licensing boards during the project proved to be an integral part of the design and success of consortium state action plans. Licensing boards and their staff can act as the primary purveyors of licensure regulations and often serve as the direct points of interaction between license holders and applicants. Though licensing regime structures vary by state, licensing boards are commonly tasked with issuing and renewing licenses, overseeing licensure examinations and continuing education, hiring and managing staff, promulgating rules, and communicating and conducting outreach to the legislature and other stakeholders.
These regulating entities therefore serve as key stakeholders for states that are seeking to enact licensure reforms. For example, licensing boards can provide legislative input and support during the policymaking process or they can enact regulatory changes themselves through rulemaking. Recognizing their importance, consortium states have cited licensing board education and involvement as a key contributor to the success of licensure reforms.
Board Inclusion in State Teams
During the project, consortium states were given the opportunity to include licensing board members in their state core and home teams. Some states, such as Arkansas and Nevada, had substantial participation from their licensing boards. Arkansas’ home team, named the Occupational Licensing Advisory Group, consisted of members from the nursing, medical, real estate, barbering, cosmetology, contractors and veterinary boards.
Nevada engaged the state’s cosmetology, physical therapy, contractors and nursing boards regularly in its core team’s work. This partnership proved particularly beneficial in supporting legislative attempts to pass the Enhanced Nurse Licensure Compact and Physical Therapy Compact and simplify and modernize the licensing process for the contractor’s board.
Other states added board members with the assistance of the project’s second phase of funding. The 2018 Consortium Meeting in Clearwater, Fla., brought together newly invited state board members to existing state teams. A preconference half-day session and the facilitated state team sessions during the conference aided the incorporation of board members into the work of the consortium states.
Board Organization and State Supervision
States employ varying designs in the structure and level of autonomy provided for their licensing boards. At one end of the spectrum, boards can be largely autonomous and assume most of the functions necessary to implement licensure laws and maintain a state agency. At the other end, boards may exist only in an advisory capacity and the entirety of their functions may be assumed by the state’s umbrella agency itself.
States commonly use a mix of these two polarities for their licensing boards with the understanding that there are benefits and trade-offs associated with how boards are organized. Where more autonomous boards may benefit from efficiency gains and greater professional expertise, centralized boards may enjoy lower administrative costs, higher levels of coordination and the liability protection that is associated with state oversight. However, the benefits and trade-offs of each structure are not necessarily exclusive and can vary based on the profession, specific design of the board and other considerations.
States have recently taken a renewed interest in ensuring that licensing boards are properly prepared against the prevailing criticisms of industry “protectionism” and antitrust liability concerns. In 2015, the United States Supreme Court decided in the landmark case, North Carolina State Board of Dental Examiners v. Federal Trade Commission, that licensing boards could only claim immunity from federal antitrust actions if the board was subject to active supervision by the state. The Federal Trade Commission has also released subsequent guidance for states to further review potential liability for licensing boards and the preventive measures states may implement.
In response to these concerns, the partners hosted several technical assistance opportunities throughout the project regarding board liability, including a general session at the 2019 Consortium Meeting and a 2019 webinar on antitrust liability.
State teams have also been proactive in considering the organization of their licensing boards. Kentucky’s project team established a goal in its action plan to “Reorganize all occupational licensing boards under the appropriate functional model to effectively and efficiently provide administrative support, enhanced communication between regulators and policymakers, and consistency of regulations and administrative procedures.” The idea for this goal stemmed from both the North Carolina dental examiners case as well as a gubernatorial priority to establish efficient, coordinated and ethical regulatory structures.
The project goal resulted in a multi-year effort by the state team to assist in the legislative efforts to organize boards under the state’s Department of Professional Licensing to establish active state supervision. Though the effort ultimately was unsuccessful in both the 2018 and 2019 legislative sessions, the state did reorganize its four real estate licensing boards under the Kentucky Real Estate Authority.
Board Engagement During Policy Reform Efforts
Board member education and involvement in the policy process was seen by consortium state teams as both a crucial step and challenge to building support for the proposed regulations. The team from Delaware said engaging the state’s 34 boards and securing buy-in for policy efforts was a prominent challenge. Kentucky’s state team reflected on the importance of engaging licensing boards early in the policy process to garner better input and participation. Early and frequent engagement can help foster support for legislative and/or rule changes and ensure that the proposed changes account for the specific needs and situations of professions and their licensing boards.
The Kentucky team hosted a training event in 2019 for the state’s licensing board members on regulatory best practices and strategies to mitigate antitrust liability. The event, attended by over 100 board members, was a key opportunity to build better relationships and minimize any potential misunderstandings with boards, especially in relation to the state’s reorganization efforts.
Arkansas’ home team deployed a survey to every state licensing agency and board to assist its policy efforts. The survey included a self-assessment tool to account for the practices, processes and requirements that the agencies and boards employ for credentialing. The state team found the survey to be valuable tool in its overall efforts, as boards were asked to suggest potential policy changes.
Maryland’s state team pursued policy reforms at the board level in the hope of quicker results than the legislative process typically allows. Specifically, the established goal of the state team was to “educate boards on best practices for the least restrictive licensing processes.” To accomplish this, state team members developed and implemented a board outreach strategy that included the presentation of reform ideas specific to their profession.
Licensure Portability
A priority of several consortium states, including Delaware, Indiana and Kentucky, was to enhance licensure portability, broadly defined as the ability of a licensed individual to align and transfer their qualifications to meet the licensing requirements of another state.
Where barriers to portability do exist, there can be significant financial costs to the licensed individual, such as those incurred by meeting additional exam or training requirements. Further, states have an interest in ensuring licensing standards do not unnecessarily conflict with interstate migration and broader workforce strategies that seek to address labor shortages.
States possess a number of policy options to improve licensure portability. These can range from individual state-by-state reciprocity agreements to formal interstate compacts. In instances where an individual’s circumstances might warrant further assistance, states are employing measures such as expedited and temporary licensure to ensure workers are able to mitigate delays and more quickly acclimate to the state’s workforce.
Each portability policy, however, is based on the understanding that workers who are otherwise qualified to practice in one state should have options that facilitate their mobility and reduce the time it takes to obtain licensure in another state.
Licensure by Endorsement
A licensure by endorsement model allows states to consider the qualifications of an individual licensed in another jurisdiction in respect to their own requirements. At what level these qualifications are recognized can vary by state and the discretion of a licensing board or agency. For example, some states prescribe that the licensing qualifications of an individual applying for endorsement must be substantially “equal to or greater” than their state’s standards. Licensing requirements, including training and educational requirements, however, can vary widely from state to state.
Consequently, the transferability of a licensed individual’s qualifications can likewise vary when considered by quantitative or other specific standards. For example, states may consider and accept different exams that qualify an individual for licensure. To address these differences and improve the mobility of out-of-state workers, a state may use tools such as the project’s occupational licensing database to look at outliers in its licensing standards that may make this process particularly onerous. Should a state affirm that public health and safety will still be protected, reducing licensure requirements to better align with the averages of other states can improve the portability of licenses.
For example, in the cosmetology profession, eight states have recently reduced the required hours for initial licensure. This included the consortium state of Kentucky, which in 2017 reduced its training requirements from 1,800 hours to 1,500 hours, 50 hours fewer than the national average.
Other states, like Utah, have recently streamlined their licensure by endorsement process. Utah SB 23 (2020) directs the state’s Division of Occupational and Professional Licensing to grant licensure without examination to applicants who have at least one year of experience, with their license maintained in good standing, in another state. In addition, the division must determine that the scope of practice is similar to the license being sought in Utah. Previously, the licensure by endorsement model specified the division had to determine that requirements substantially equal to Utah’s were met by applicants in their home state.
Reciprocity Agreements
Reciprocity agreements between states serve as another way to formalize portability standards. Typically, these may be used by neighboring states where mobility between licensed workers is more likely to occur. However, states can formulate these agreements regardless of geography. A reciprocity agreement does not necessarily mean the licenses granted by the participating states are interchangeably recognized, like a driver’s license. Rather, it sets up a formal process and understanding between the states of how recognition is to occur. This can reduce the time it takes for licensed individuals to be granted authorization to work in a participating state. It is common for states to statutorily allow licensing boards to enter into these agreements at their discretion.
Expedited and Temporary Licensure
To reduce the time to it takes to be granted a license, most states have adopted some use of expedited and temporary licenses. Expedited licensing policies instruct the appropriate licensing entity to prioritize the processing of an out-of-state license holder’s application. Some state policies allow the board discretion on what constitutes an expedited process, while others have established a certain maximum threshold of days. States may also employ temporary licensure provisions, such as meeting additional licensing requirements, to grant individuals the authority to work under certain conditions.
These policy options may be used separately or in conjunction with each other. For example, some states specifically mandate an expedited process for those holding temporary licenses. These provisions are also typically afforded to certain population groups, such as military spouses, who face specific challenges to licensure mobility and reciprocity because of the frequency of their relocations.
Interstate Compacts
States and professions have increasingly turned to occupational licensure interstate compacts to mitigate challenges faced by workers as they navigate various state licensing requirements, rules, regulations and fee structures. Since January of 2017, 40 states have enacted 106 separate occupational licensure compact bills. In total, 42 states have enacted at least one occupational licensure compact and 28 states have enacted three occupational licensure compacts. These compacts create reciprocal professional licensing practices between states while still ensuring the quality and safety of services and safeguarding state sovereignty.
While other reciprocity mechanisms, such as bilateral agreements and universal recognition models, are also used by states to improve licensure mobility, interstate occupational licensure compacts are an attractive and trending policy option for states. This is because of their ability to establish formal, binding coordination among state licensing boards and require investigative information-sharing, which enhances public protection.
It is important to note that interstate compacts leave the state licensure process in place, are not mandatory for licensees to participate and that state practice acts are not affected. The Nurse Licensure Compact, established in 1999, served as the first occupational licensing interstate compact and has since been adopted by 34 states under its revised iteration, the Enhanced Nurse Licensure Compact. Seven additional occupational licensing compacts have been formed in recent years, including for medical doctors, physical therapists, emergency management service personnel, advanced practice registered nurses, audiologists, language pathologists, occupational therapists and occupational therapy assistants, and psychologists.
As an example of the trending nature of interstate compacts, other professions are currently in various stages of developing their own compact, including dietitians, physician assistants, counselors and teachers.
One of the primary goals of the project was to provide educational and policy support for the consortium states interested in prioritizing interstate compacts as a part of their state’s licensing reform strategies. Interstate compacts, therefore, were commonly included as session topics during the project’s various convenings, including individual state team meetings. The partners also authored written and web-based resources to aid the consortium states’ understanding of the mechanics and differences between existing interstate compacts.
- Several consortium states, including Delaware, Indiana, Maryland, Nevada and Wisconsin, chose to specifically prioritize and receive project support on interstate compacts.
- Other consortium states, while not specifically adding interstate compacts to their action plan, were provided assistance on interstate compacts through project outputs and the subject-matter expertise of The Council of State Governments’ National Center for Interstate Compacts.
Consortium States Compact Participation
Every consortium state* is a member of a least one occupational licensing interstate compact and, compared with non-consortium states on a proportional basis, have adopted more occupational licensing compacts:
Enhanced Nurse Licensure Compact (34 states)
Original Consortium States (8): Arkansas, Colorado, Delaware, Indiana, Kentucky, Maryland, Utah, and Wisconsin
Added Consortium States (4): Idaho, New Hampshire, North Dakota, Oklahoma
Non-consortium States (22): Alabama, Arizona, Florida, Georgia, Iowa, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, New Mexico, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Virginia, West Virginia, and Wyoming
Comparison:
- Original Consortium States (72%)
- All Consortium States (75%)
- Non-consortium States (62%)
Interstate Medical Licensure Compact (30 states)
Original Consortium States (7): Colorado, Illinois, Kentucky, Maryland, Nevada, Utah, and Wisconsin
Added Consortium States (5): Idaho, New Hampshire, North Dakota, Oklahoma, Vermont
Non-consortium States (17): Alabama, Arizona, Georgia, Iowa, Kansas, Maine, Michigan, Minnesota, Mississippi, Montana, Nebraska, Pennsylvania, South Dakota, Tennessee, Washington, West Virginia, and Wyoming
Comparison:
- Original Consortium States (64%)
- All Consortium States (75%)
- Non-consortium States (52%)
Physical Therapy Compact (28 states)
Original Consortium States (7): Arkansas, Colorado, Delaware, Kentucky, Maryland, Utah, Wisconsin
Added Consortium States (3): New Hampshire, North Dakota, Oklahoma
Non-consortium States (18): Arizona, Georgia, Iowa, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, Oregon, South Carolina, South Dakota, Tennessee, Texas, Virginia, West Virginia
Comparison:
- Original Consortium States (63%)
- All Consortium States (63%)
- Non-consortium States (53%)
EMS Compact (20 states)
Original Consortium States (4): Colorado, Delaware, Indiana, Utah
Added Consortium States (3): Idaho, New Hampshire, North Dakota
Non-consortium States (13): Alabama, Georgia, Kansas, Mississippi, Missouri, Nebraska, South Carolina, South Dakota, Tennessee, Texas, Virginia, West Virginia, Wyoming
Comparison:
- Original Consortium States (36%)
- All Consortium States (43%)
- Non-consortium States (41%)
Advanced Practice Registered Nurse Compact (3 states)
Original Consortium States: None
Added Consortium States (2): Idaho, North Dakota
Non-consortium States (1): Wyoming
Comparison:
- Original Consortium States (0%)
- All Consortium States (13%)
- Non-consortium States (3%)
Psychology Interjurisdictional Compact (12 states)
Original Consortium States (5): Colorado, Delaware, Illinois, Nevada, Utah
Added Consortium States (2): New Hampshire, Oklahoma
Non-consortium States (5): Arizona, Georgia, Missouri, Nebraska, Texas
Comparison:
- Original Consortium States (46%)
- All Consortium States (44%)
- Non-consortium States (24%)
Interstate compact adoption information current as of April 2, 2020.
* A second round of funding from the Department of Labor allowed additional states to join the project consortium in 2018. These states are included in this analysis as they have received technical assistance on interstate compacts by the partners.
* Six states, including two consortium states (Oklahoma and Utah), adopted audiology and speech-language pathology in 2020.