State legislators enacted more than 3,000 of the nearly 27,000 health policy bills introduced in 2024. Health policy will continue to be a focus in the legislative sessions ahead, as states continue to grapple with health workforce shortages, youth mental health challenges, and Medicaid flexibilities and rule changes.
Here’s a look at what might be in store for 2025.
NCSL Forecast ’25
This special report from State Legislatures News covers the topics NCSL’s policy experts anticipate will occupy state lawmakers’ time in 2025 legislative sessions. Read the full report here.
Hot Topic: Health Workforce
The health workforce remains a top priority across state legislatures. States are addressing the shortage of health care professionals, particularly in rural and underserved communities, in a variety of ways and focusing on a variety of specialties.
ACTION: At least 44 states, Washington, D.C., and Puerto Rico enacted some 567 bills relating to the health workforce in 2024. Nearly one-third of the enacted measures addressed access to behavioral health professionals. About 37% of the U.S. population lives in areas with shortages of psychologists, counselors and social workers, and nearly two-thirds of shortage areas are rural. At least 38 states and Washington, D.C., enacted 149 bills relating to the behavioral health workforce. Enactments included establishing licensure processes for emerging occupations (Illinois and Alaska), creating financial incentives to recruit and retain professionals (Georgia and Washington) and increasing licensure portability for certain occupations (Iowa and Maryland).
Many states are focused on recruiting and retaining a strong, skilled maternal health workforce to improve patient access and quality of care while reducing maternal mortality and morbidity. At least 20 states enacted 27 maternal workforce bills. States addressed certification processes for lactation consultants and doulas (New Hampshire and Rhode Island), increased access to maternal mental health resources to better equip providers (Kentucky and Illinois), and promoted access to midwives (Massachusetts and Idaho).
As many long-term care facilities and community-based care settings face shortages of nursing and direct care staff, states are looking to bolster this workforce. At least 29 states and the district enacted 56 bills related to the long-term and direct care workforce this year, with many bills addressing scope of practice for certified medication aides (South Carolina), licensure for nursing home administrators (Wyoming), supports for family caregivers (Illinois) and facility staffing requirements (Hawaii).
Hot Topic: Medicaid
A perennial issue, Medicaid accounts for 18% of state spending and covered 81 million people nationwide as of May 2024—13 million more people than before the pandemic began. As enhanced federal funding has eased following the end of the public health emergency, states are facing uncertain budget conditions, ongoing health workforce shortages, and growing needs for behavioral health, maternal health care, and long-term services that all put pressure on the Medicaid program.
ACTION: At least 233 bills were enacted in 45 states in 2024. Lawmakers continue to increase and study provider payment rates for behavioral health and long-term services and supports (Illinois and Idaho); expand benefits for a wide range of services (Delaware and Indiana); and take steps to finance the state share to maintain state budget stability and support the Medicaid program and its providers (California and South Carolina). A bipartisan bevy of states are also pursuing Medicaid Section 1115 waivers to address social drivers of health and services for people who are incarcerated prior to their release. Learn more about state action on Section 1115 waivers for prerelease services here.
Looking ahead, new federal rules finalized this year provide opportunities—and challenges—as state agencies begin to modernize Medicaid information systems, improve rate transparency, increase and monitor access to care, and increase oversight over managed care agencies.
Hot Topic: Youth Mental Health
The rates of poor mental health remain high among young people. Suicide is the second-leading cause of death for youths ages 10-14. According to the most recent (2023) Youth Risk Behavior Survey, which surveys a subset of U.S. high school students, there were increases in students’ experiences of violence, poor mental health, and suicidal thoughts and behaviors compared with 2013. Of the students surveyed:
- 40% experienced persistent feelings of sadness or hopelessness.
- 29% experienced poor mental health during the past 30 days.
- 20% seriously considered suicide.
- 16% made a suicide plan.
- 9% attempted suicide.
The survey presented some early signs that adolescent mental health improved from 2021 to 2023, for example, a decrease in the percentage of students who experienced persistent feelings of sadness or hopelessness. Still, the rate remained 33% higher than the percentage reported in 2013.
ACTION: States explored a variety of policy strategies in 2024 to address youth mental health, including incentivizing early intervention (Arkansas and Rhode Island), providing mental health education and training (New Jersey and Utah), supporting school-based health services (Alabama and Colorado), improving crisis response (Hawaii and Louisiana), and establishing commissions and task forces (Connecticut and Mississippi).
Learn more about these state efforts in the NCSL brief Youth Mental Health: States Pursue Prevention, Treatment and Crisis Response.
Trending: AI, Prescription Drugs
Policymakers are increasingly turning their attention to the use of artificial intelligence in the health care sector. Specifically, lawmakers are considering bills that would put guardrails on the use of AI to protect privacy, data integrity and transparency, and to ensure the systems are used safely. At least 13 bills were enacted in 2024 to address the use of AI in the health care sector.
A recent KFF poll showed that health care affordability is a top issue among voters, with over half worrying that they would not be able to pay for their medications. With constituents voicing these concerns, lawmakers responded this session with policy approaches designed to increase access to affordable prescription drugs. More than 545 bills in 46 states, the district and the territories are being tracked in NCSL’s Prescription Drug State Bill Tracking Database. As of November, 34 states had enacted at least 87 measures.
NCSL Resources: