Which States Participate in Multi-State Licensing Models?

Healthcare licensing has traditionally been a state-by-state affair, creating barriers for providers who want to practice across state lines and patients seeking care from specialists located in different states. Multi-state licensing models have emerged as a solution to streamline this process, allowing qualified healthcare professionals to obtain licenses in multiple states through coordinated agreements and mutual recognition systems.

The Foundation of Multi-State Licensing

Multi-state licensing compacts represent interstate agreements that allow healthcare professionals licensed in one participating state to practice in other member states without obtaining separate licenses in each jurisdiction. These agreements maintain state sovereignty over licensing while creating pathways for practitioners to provide care across state boundaries more efficiently.

The concept gained significant momentum following natural disasters and public health emergencies, where the need for rapid deployment of healthcare resources across state lines became apparent. The COVID-19 pandemic particularly highlighted the importance of these agreements, as states needed to quickly access healthcare professionals from neighboring jurisdictions to address staffing shortages and capacity issues.

Nursing: Leading the Multi-State Movement

The Nursing Licensure Compact (NLC) stands as the most established and widely adopted multi-state licensing model. Currently, 41 states participate in the NLC, making it the largest healthcare licensing compact in the United States.

The NLC operates on a mutual recognition model where nurses hold one multistate license in their primary state of residence, which grants them practice privileges in all other compact states. This eliminates the need for multiple licenses while maintaining each state’s authority to take disciplinary action when necessary.

Medical Licensure Compacts

The Interstate Medical Licensure Compact (IMLC) launched in 2017 to address physician licensing across state lines. While not as extensive as the nursing compact, the IMLC has gained steady participation from states seeking to facilitate physician mobility.

The medical compact differs from the nursing model by maintaining individual state licenses while creating an expedited pathway for physicians to obtain additional licenses in participating states. Qualified physicians can apply through the IMLC portal and receive expedited processing of their applications in other compact states.

Psychology and Mental Health Licensing

The Psychology Interjurisdictional Compact (PSYPACT) addresses the growing need for mental health services across state lines, particularly important given the shortage of mental health providers in many regions. This compact allows psychologists to practice telepsychology and provide temporary in-person services in other participating states.

The psychology compact recognizes that mental health services often require ongoing therapeutic relationships that shouldn’t be interrupted by state boundaries, particularly for patients who relocate or prefer providers in neighboring states.

Emerging Compacts and Specialized Fields

Several other healthcare professions have developed or are developing multi-state licensing agreements.

Benefits and Challenges of Multi-State Models

Multi-state licensing models offer numerous advantages for healthcare delivery. Patients gain access to a broader pool of healthcare providers, particularly important in rural or underserved areas where local specialists may be limited. Providers benefit from increased practice opportunities and the ability to serve patients across state lines without administrative burdens.

Healthcare organizations can more easily staff facilities in multiple states and respond to surge capacity needs during emergencies. Telehealth services become more viable when providers can legally serve patients in multiple states through compact agreements.

However, these models also present challenges. States must balance their regulatory authority with the benefits of interstate cooperation. Different states have varying continuing education requirements, scope of practice regulations, and disciplinary procedures that must be reconciled within compact frameworks.

Revenue considerations also play a role, as states generate income from licensing fees that may be affected by compact participation. Some states worry about maintaining oversight of practitioners who primarily practice in other jurisdictions.

The Role of Technology and Telehealth

The rapid expansion of telehealth services has increased the importance of multi-state licensing models. Patients receiving care via telecommunications often cross state lines virtually, creating jurisdictional questions about where practice occurs and which state’s regulations apply.

Multi-state compacts help resolve these ambiguities by providing clear frameworks for telehealth practice across state boundaries. The COVID-19 pandemic accelerated telehealth adoption and demonstrated the value of having established interstate licensing agreements in place.

Many states that were previously hesitant about multi-state models reconsidered their positions after experiencing the benefits of temporary licensing reciprocity during the pandemic emergency declarations.

Implementation Considerations

States considering participation in multi-state licensing models must evaluate several factors. Legislative action is typically required to join interstate compacts, which can be a lengthy process requiring stakeholder input and political consensus.

Administrative systems need modification to accommodate compact requirements, including background check processes, license verification systems, and disciplinary action coordination with other states. States must also consider how compact participation aligns with their existing regulatory frameworks and professional practice acts.

Financial implications include both the costs of implementation and potential changes in licensing revenue. States must weigh these costs against the benefits of increased provider mobility and improved healthcare access for their residents.

Future Outlook and Trends

The trend toward multi-state licensing models appears likely to continue, driven by healthcare workforce shortages, technological advances in care delivery, and lessons learned from pandemic response efforts. Additional healthcare professions are exploring compact development, including dentistry, pharmacy, and various therapy specializations.

Interstate cooperation in healthcare regulation reflects broader trends toward regional approaches to healthcare delivery and recognition that health systems often operate across state boundaries. As healthcare becomes increasingly interconnected, regulatory frameworks are adapting to support this reality.

The success of existing compacts provides models for future development, though each profession faces unique regulatory considerations that affect compact design and implementation strategies.

Implications for Healthcare Organizations

For healthcare organizations operating across multiple states, multi-state licensing models can significantly reduce administrative complication and costs associated with maintaining provider credentials in multiple jurisdictions. Organizations can more easily deploy staff where needed and respond to capacity demands across their service areas.

Medwave, specializing in payer contracting, recognizes that multi-state licensing models can influence network adequacy requirements and provider availability for health plans operating in multiple states. These compacts affect how health plans structure their provider networks and ensure adequate coverage across their service territories.

Healthcare systems must stay informed about compact developments in states where they operate, as participation can affect staffing strategies, recruitment efforts, and service delivery models. The ability to utilize providers across state lines through compact agreements can be a significant competitive advantage in markets facing provider shortages.

Multi-state licensing models represent a significant shift in healthcare regulation, balancing state authority with the practical needs of modern healthcare delivery. As more states join existing compacts and new professions develop interstate agreements, healthcare continues to develop to support improved access and provider mobility across state boundaries.