by Matt Shafer, Keith Buckhout and Adam Diersing
As a dentist and military spouse, Dr. Christine Hammer says moving has never been simple. Beyond the ordinary logistical challenges of moving, she regularly faces an additional burden — navigating the regulatory system.
“The most frustrating part of getting multiple licenses over time is the process of having to obtain a number of verifications and documents from all states in which you were licensed previously,” she said. “It’s an incredible amount of time, money and coordination that often requires repeated steps as documents are lost in travel from state to state.”
Hammer’s story is all too familiar for many military spouses. Approximately 1 in 3 military spouses work in a licensed profession. Military families are also one of the most mobile populations in the United States — they are more than 10 times more likely to move to another state each year, and on average, they move to a new state every two years. Because of these high mobility rates, barriers to occupational licensing mobility put an extra burden on military spouses who work in licensed professions.
License mobility is an increasingly pertinent issue for the civilian workforce, too. Since 1950, the share of jobs that require a state license has grown from 1 in 20 to 1 in 4. This dramatic rise in occupational licensing, and the traditional role states have played as regulators of professions, has created a patchwork of differing regulatory structures, licensing requirements and scopes of practice.
This regulatory framework can create barriers to work, including complicated, expensive application processes and duplicative licensing requirements. In turn, barriers to work can discourage licensees from moving to a new state or practicing in multiple states, leading to unemployment or underemployment in critical licensed sectors such as health care.
In response, state policymakers have sought tools to reduce or remove barriers to mobility for licensed practitioners. Interstate compacts are one powerful option states increasingly use to solve mobility issues, addressing barriers to work that impact military and civilian families alike.
Interstate compacts are legally binding, legislatively enacted contracts involving two or more states. States have used interstate compacts for hundreds of years to resolve boundary disputes, manage shared natural resources and recognize one another’s legal decisions (for example, the issuance of driver’s licenses). By joining an interstate compact, states agree to the stated provisions and bind themselves together in a legal relationship.
Over the past decade, states have turned to interstate compacts to solve the mobility issues caused by the variance in state licensing requirements. These compacts create reciprocal pathways to professional licensure between states, while continuing to ensure the quality and safety of services and protecting state sovereignty. Interstate compacts also allow states to work collaboratively to solve common licensing challenges and open new channels of communication and joint decision-making.
The benefits of interstate licensing compacts for practitioners include streamlined paths toward re-licensing in a new state, reduced time to employment, the elimination of duplicative requirements and the provision of new opportunities for multi-state practice. These individual benefits reduce workforce shortages and support state economies. Interstate compacts also increase retention in licensed professions and facilitate malpractice investigations and discipline across states, further safeguarding public health.
States have worked to develop individual solutions, with almost every state passing legislation to support the relicensing of military spouses in recent years. States have passed bills that grant temporary or expedited licenses, waive fees or create pathways for out-of-state military spouses to have their licenses recognized in a new state.
Partnering with the Department of Defense
The Department of Defense has found that aiding military spouse employment is an important facet of supporting active-duty military service members and their families.
For that reason, the department has sought to support the development of interstate compacts as a mechanism for ensuring the professional licenses of military spouses are easily portable. In September 2020, the Department of Defense entered into a cooperative agreement with The Council of State Governments to fund the creation of new interstate compacts designed to strengthen occupational licensing portability. Through an appropriation of federal funds initiated by the Senate Armed Services Committee, the Department of Defense and the CSG National Center for Interstate Compacts are developing compacts for up to 10 professions.
In collaboration with the Department of Defense, CSG developed and administered a competitive application process to select the professions for initial compact development in late 2020 and early 2021. Eligible applicants included associations of professionals, associations or federations of state licensing boards, coalitions of state licensing boards and national credentialing bodies for professions licensed in at least 30 states. In March 2021, the Department of Defense and CSG announced the selection of:
Cosmetology and barbering
Dentistry and dental hygiene
Collectively, these professions represent 5.7 million licensed professionals across the U.S. They were selected based on a variety of factors, including number of licensees, number of military spouses licensed, uniformity of licensure requirements across states and the capacity of the profession to sustain the effort into the future.
This opportunity represents the first round of assistance CSG is making available to professions for interstate compact development. The CSG National Center for Interstate Compacts convened working groups involving professionals, professional organizations, state regulators and other stakeholders to identify obstacles to efficient re-licensing and effective solutions to them. Out of these discussions will emerge draft compact language to be crafted into legislative proposals in advance of the 2023 sessions of state legislatures. This process includes a robust review process for interested stakeholders to provide public comment and feedback on the draft language.
Developing a viable interstate compact is essential to meeting the challenges these professions face. With a focus on innovation and collaboration, CSG will continue to provide staff support, research and data to these professions in order to facilitate efficient and effective conversations.
Assisting Their New Communities
Oklahoma state Sen. Adam Pugh, an Air Force veteran, says it’s stressful enough for military families to move frequently, often to places they’ve never been. Worries about lost income can create an unnecessary burden. Additionally, communities often face a shortage of licensed workers, such as teachers, so it’s in everyone’s interest to help licensed professionals get back to work.
“I’ve talked to people in different careers, and it’s taken them sometimes two years to reenter the workforce,” Pugh said. “I want them to be able to move to Oklahoma and thrive…I want to be able to get you into a classroom because we really need you.”
Karen Weiss, a licensed teacher and military spouse, echoed Pugh’s assessment, pointing out that improved licensing processes through a teaching compact would offer benefits for the community as well. She says reducing the time military spouse teachers have to wait for their license might make them less likely to take other jobs in the interim.
“The beauty of the ability to obtain a license in a new state immediately is that the military spouse can immediately impact the community surrounding each base by providing a much-needed teacher for that community,” she said.
The CSG National Center for Interstate Compacts has aided in the development and operation of interstate compacts for decades and has a long history of expertise in occupational licensing, making CSG an ideal partner to assist professions from initial discussions about an interstate compact to enactment among the states. Interested professions are encouraged to remain in contact with CSG as more opportunities for assistance become available.
“These compacts will allow mobile professionals to bring the licenses they earned and the essential services they provide to communities in different states,” said CSG Chief Public Policy Officer Elizabeth Whitehouse. “We are grateful the Department of Defense recognized the proven ability of the National Center for Interstate Compacts to develop viable occupational licensure compacts and look forward to providing states with opportunities to expand employment opportunities in licensed professions.”
The Defense State Liaison Office in the Department of Defense has worked has worked on professional licensure issues among military spouses for almost a decade. The department recognizes that interstate compacts are the best long-term solution to this problem. Marcus Beauregard, director of the Defense State Liaison Office, said compacts “solve an interstate problem with an interstate solution.”
“Oftentimes, the main limiting factor for a profession to engage in the process of developing an interstate compact are the technical and financial resources required to do so,” Beauregard said. “The Senate Armed Services Committee was more than willing to support this opportunity to support military spouses through this compact development process. Congress recognized that these compacts have great potential for all practitioners within a profession, not only military spouses.”
The Impact of Compacts on Health Care
in health care professions. Many governors and state legislatures temporarily suspended licensing regulations to allow health care providers to fill these shortages as quickly as possible. By creating a regulatory framework that allows practitioners to work seamlessly across state lines, compacts make permanent what states did temporarily during the height of the pandemic.
Compacts also bring professional licensure into the 21st century by facilitating cross-state telehealth practice. The pandemic accelerated the momentum toward greater use of remote technology to deliver physical and mental health diagnoses and treatment. States responded to the pandemic by further streamlining licensing regulations, at least temporarily, and in some cases waiving re-licensing requirements as practitioners delivered remote health care across state lines.
However, states have not approached the challenges and opportunities of the surge in remote health care delivery in a uniform way. States have different requirements for out-of-state clinicians, with many still requiring the out-of-state clinician to be licensed in the state where the prospective patient resides — a process of re-licensing that may be costly or arduous for the provider. Regulations are amended frequently in response to changing conditions and are consequently confusing to practitioners and patients. Compacts eliminate ambiguity and provide a consistent streamlined pathway for tele-practice.
Throughout 2021, CSG worked with national partner organizations from each of the selected professions to begin developing each compact. CSG staff regularly convened representatives from selected professions, state regulators, subject-matter experts and other industry stakeholders to develop the interstate compacts. CSG and regulatory experts worked to identify obstacles the professions face and collaboratively develop and recommend solutions that will inform the drafting of model compact legislation.
Executive Director of the Texas Behavioral Health Council Darrel Spinks, who worked with CSG on the development of the Social Work Compact, said he appreciated the expertise of CSG in navigating the complex process and that he expects great results.
“I hope to see a significant increase in the number of providers eligible to serve Texans,” Spinks said. “I expect the number of providers to increase much faster than what could be accomplished through traditional licensure, and at a much lower cost to the state without any increase in my agency’s workload.”
Hammer, the dentist and military spouse, said she hopes the Dentistry and Dental Hygiene Compact allows military spouses “the freedom to live and work in any state, for any period of time, at any point in his or her career, without the burdens and anxieties of being forced to choose between family and profession.”
“I continue to be impressed with how unbiased CSG is and how the wide variety of opinions are taken into account equally,” Hammer said. “They are convening a diverse group of stakeholders that each bring a critical and unique perspective.”