Bipartisan Support Drives Interstate Compact Growth, Success

Fifty-seven pieces of licensure compact legislation enacted in 2023; 290 enacted since 2016.

By Jessica Thomas and Kaitlyn Bison

A recent uptick in the number of newly enacted licensure compacts has come as result of support from both sides of the aisle. The rise in these compacts, which establish mutual agreement between member states for professional licensure, offer state legislatures an opportunity to safeguard state sovereignty while also ensuring the quality and safety of services. 

Since 2016, 290 pieces of licensure compact legislation have been enacted and, to date, 46 states, Washington, D.C., and three territories have enacted licensure compact legislation. A total of 15 professions currently have a compact available to states for enactment. In 2023, 57 pieces of compact legislation were enacted, with six new compacts becoming available for states to enact. 

The National Center for Interstate Compacts, housed within The Council of State Governments, played a role in the development of all active licensure compacts. Through the work of NCIC, as well as policymakers sponsoring compact-related legislation, licensees in compact member states can more quickly obtain authorization to practice and get to work in other member states. 

BIPARTISAN SUPPORT FOR WORKFORCE ADVANCEMENT

Compact legislation has experienced success in states with majorities from both sides of the aisle, while also having been sponsored by legislators from both parties. Support for state workforces proved to be a unifying theme among sponsors of 2023 compact legislation. 

Rep. Michelle Caldier, a Washington Republican elected into the House in 2014, was grateful for the bipartisan support she received when sponsoring the Dentist and Dental Hygienist Compact, which is recognized in Washington as HB 1576. Resolving workforce issues in the state, especially within health care, has been a priority. 

“I think trying to resolve Washington’s workforce issues is one of those things — across the board — that we acknowledge as one of the state’s goals,” Caldier said. “Breaking down the borders and allowing people from other states to come in and practice easily was one we could get a win on, so that was one of my focuses.” 

Bipartisan support led to the enactment of the Cosmetology Compact bill in Arizona, where the successful HB 2049 was sponsored by Republican Rep. Tim Dunn.

“This is a bipartisan bill that promotes the flexibility for stylists to move between states,” Dunn said. “Arizona has a lot of winter visitors, and this could provide work for them when they visit.” 

In Indiana, Democratic Sen. J.D. Ford coauthored both SB 251 ‚ the Interstate Medical Licensure Compact, and SB 160, the Counseling Compact. In addition to highlighting the bipartisan sponsorship of these bills, he explained ways in which he collaborated with his counterparts in the Indiana General Assembly to learn about and address community health needs. 

“Access to care isn’t a partisan issue, it impacts all communities,” Ford said. “I think we were able to really come together well in that common goal with these compact bills.”

MILITARY FAMILY BENEFITS

Legislators often mention how compacts break down barriers for military families who move frequently and face challenges working in a licensed profession. Without a licensure compact, both military members and their spouses must navigate each state’s process for licensure. 

Nebraska Sen. Carol Blood, a Democrat motivated to sponsor several compacts, believes they offer many benefits and opportunities to military families. 

“Interstate compacts benefit others in specific licensure areas, but the reason I started working with these compacts is because of our military families,” Blood said. “Military families tend to move every two to three years, which means new schools, new doctors, new homes and more. This is one less headache for these families to deal with.”

Due to the increased military support, the Department of Defense facilitated the development of interstate compacts as a mechanism for ensuring the portability of professional licenses for military spouses. In September 2020, the Department of Defense entered into a cooperative agreement with CSG to fund the creation of new interstate compacts designed to strengthen licensure portability. 

“[Compacts] are very positive for military partners who move to our state and people who are moving out of active service but want to continue working in a field where they are already licensed in another compact state,” said Colorado Rep. Mary Young. 

PROFESSIONAL PERSPECTIVES

Many sponsors of compact legislation were licensed professionals themselves. The sponsors of Colorado HB 23-1064, the Interstate Teacher Mobility Compact, worked in the field of education and understand the barriers teachers face. 

Young, a Democrat and former special education teacher and school psychologist, noted having her own experience with barriers to licensure as a teacher upon moving to Colorado. She admired efficiency and ease that compacts brought to licensure and wanted teachers moving to Colorado to remain in the profession. 

“With the Interstate Teacher Mobility Compact, we can ensure that teachers who want to come to Colorado can do so,” said Colorado Rep. Meghan Lukens, a Democrat and former social studies teacher. “Giving teachers 

the flexibility to live and work in any state in the compact benefits everyone. This compact will help incentivize teachers to stay teachers because of the flexibility that is provided to move to other states.” 

As a former dentist, Caldier, like Lukens and Young, was also familiar with the compact profession she sponsored. She also recognized the need for license mobility and the need to address the shortage of dental hygienists in Washington. Although she continues to support the field of dentistry, Caldier’s support of compacts extends to other professions as a cosponsor on the Counseling Compact, the Nurse Licensure Compact and the Occupational Therapy Compact.

Licensure Compact Enactments by State and Territory 
TELEHEALTH

Licensure compacts for health care professions can bring an added benefit to states: access to telehealth services. Ford said that compacts can “provide us with the opportunity to have more providers move to Indiana, but also greatly expand telehealth opportunities when you can meet with specialists in other states.” 

Much of the general population can benefit from the increase in telehealth that compacts present. Communities that do not have access to health care providers, as well as people with low mobility due to a lack of public transportation or low accessibility, can all benefit from a rise in telehealth. 

Of the 15 available licensure compacts, Audiology and Speech-Language Pathology, Psychology Interjurisdictional Compact, Counseling, Occupational Therapy and Social Work include provisions specific to telehealth. 

Blood offered the example of Nebraska LB 1034, the Psychology Compact, as psychology is a licensed profession. If a patient moves or travels to a different state than where their psychologist is licensed, their care can be stalled or halted. 

“Prior to that compact, Nebraska psychologists could not legally counsel someone over the phone if they were to have a mental health crisis in another state because that psychologist would not be licensed in that state,” Blood said. “With the compact, if the psychologist belongs [to the compact] as well as the state the patient is calling from, that psychologist can provide care for their patient.” 

With the rise of telehealth and telemedicine, compacts are an important tool to meet the needs of patients. As more states join compacts, the pool of providers grows, and patients access to care expands. 

OPPORTUNITIES FOR INCREASED STATE INVOLVEMENT

Legislators developed key takeaways throughout the process of introducing and enacting compact legislation. Attending informative events, involving key stakeholders, and working with colleagues from all parties enabled success. 

Several legislators noted how collaborative convenings, such as the CSG National Conference, are useful for learning from other leaders who have sponsored compact legislation. At the 2022 CSG National Conference, Caldier learned about the Dentist and Dental Hygienist Compact while Kansas Sen. Pat Pettey was impressed by discussion on the Teacher Compact. 

Pettey, a Democrat, and Washington Republican Sen. Ron Muzzall both suggest involving others, including other legislators and members of boards and professional associations. 

“Engage stakeholders on an individual basis and engage with Department of Defense and organizations dedicated to supporting military spouses,” said Muzzall, who introduced Washington SB 5219, the Counseling Compact. 

As the sponsor for Kansas SB 66, the Interstate Teacher Mobility Compact, Pettey recommended looking at compacts with an open mind. 

“Take note of compacts your state may already be involved in,” Pettey said. “Make sure that you talk to other legislators on either side of the aisle about the legislation that you are considering introducing, as well as talking to your state board of education and your teachers’ associations. Doing early work to make contact with other parties will be helpful for when they actually introduce [legislation].” 

More information on compacts can be found at the following website: compacts.csg.org. Policymakers interested in sponsoring a licensure compact can reach the National Center for Interstate Compacts via email at [email protected]. 

Educators to Executives: Education ‘at the core’ of Executive Officials’ Public Service

By Maggie Mixer and Abeer Sikder

Across the country, from Kentucky to Wisconsin to New Mexico, educators have been elected to the highest executive offices in their states. While their careers as teachers, coaches and administrators have taken different paths, they have all been driven by a commitment to serving their communities and future generations. Education, for them, is the cornerstone and catalyst of their public service.

Serving the State by Serving Youth
Wisconsin Gov. Tony Evers started as a teacher before climbing the educational administration ladder, advancing positions that ranged from principal to state superintendent. After his three terms at the helm of the Department of Public Instruction, which manages all of Wisconsin’s public education systems, he was elected as governor on a platform that put education front and center.

“What’s best for our kids is best for our state.”

— Wisconsin Gov. Tony Evers

Throughout Evers’ career in education administration and elected office, he has been driven by his goal to ensure that the education system “had the resources they needed” to set Wisconsin’s students on the path to success. His favorite adage — “what’s best for our kids is best for our state” — is a slogan he joked his longtime supporters are tired of hearing, yet he said it still rings true and has served as a guide stone during his career.

“Public education is still at the core of my being and it continues to be. I get in front of schools as much as possible,” Evers said. “What I learn on a daily basis is the most important thing is to get out and talk to people, ask them what they need, what they’re irritated about, how we can help.”

Regardless of who he is talking to around Wisconsin, Evers always asks them about the kids in their life and what the state can do to improve the education system. Despite all possible differences in policy discussions, he still sees the unifying power of education. This approach has served Evers well as he coordinates with his state agencies, the state Legislature, community organizations and constituent groups across the state to create a better future for Wisconsin.

“Whether you’re in front of a classroom of kids that come from any kind of background you can imagine, to working with parents and school boards, the ability to bring people together and accomplish things is critically important,” Evers said.

This year, concerned about the crises he was “seeing in every part of the state,” Evers declared 2023 the “Year of Mental Health in Wisconsin” and directed his administration’s resources towards strengthening the mental health support systems available throughout the state. Through negotiations with the Wisconsin Legislature, he secured $30 million in the most recent budget for school mental health programs.

The Accidental Advocate
Kentucky Lt. Gov. Jacqueline Coleman has also prioritized student mental health during her term. An educator for more than a decade, she first served as a teacher before later becoming an assistant principal. During that time, according to Coleman, she became an “accidental advocate,” choosing to teach social studies and civics because “there were so many young people that didn’t understand how government should work and their role in ensuring that it does work.”

Although Coleman loved her time as an educator, “the lack of resources, the lack of funding, the attacks on teachers … were all things that really drew [her] to more of the advocacy arena.”

“With every challenge that we face in Kentucky, the solution — or at least part of the solution — is education. I see [every challenge] through the eyes of the kids in our classrooms and the families that I got to work with every single day as a teacher.”

— Kentucky Lt. Gov. Jacqueline Coleman

In 2021, Coleman launched the Team Kentucky Student Mental Health Initiative. She said schools are “microcosms” of the communities that make up Kentucky, which is why it is so crucial to include the perspectives of teachers and students in the legislative process.

As part of the initiative, Coleman’s office held 10 regional summits where students facilitated conversations with their peers and used that information to create policy recommendations. These recommendations became the “North Star” of the administration’s efforts after they were presented to the Legislature, state agencies and community partners. Coleman credited the initiative with helping her secure $40 million in federal funding to support Kentucky’s mental health care workforce and strengthen mental health services in schools.

An educator and “lifelong learner,” Coleman’s recent work pushed her to also extend her own education on student mental health. She is currently pursuing her doctorate in educational leadership from the University of Kentucky and plans to focus her dissertation on the topic.

Special Education and Service
Educators’ focus on building a better future has been crucial for pushing policy forward, especially in the face of serious setbacks. After teaching special education for 10 years, New Mexico Lt. Gov. Howie Morales served in the state Senate for 11 years before taking office as lieutenant governor.

In the Senate, Morales proposed the creation of an Early Childhood Education and Care Department to organize New Mexico’s support structures for early childhood development. The bill failed to pass, but he continued working and was able to oversee the department’s creation during the beginning of his term as lieutenant governor.

Morales’ effort was part of his long-term goal to improve not only K-12 and higher education opportunities, but also New Mexico’s programs and services around early childhood, extracurricular and adult education, so that all New Mexicans can receive a quality education.

“Being a special educator, I think it has really shown that it’s about the personalization of the educational process. I believe that we’ve focused all too often across the country on student proficiency or student achievement when, in reality, we should be focusing on student engagement.”

— New Mexico Lt. Gov. Howie Morales

Through Morales’ work, “a historic $20 million appropriation” was directed toward after-school programs that engage students “beyond the walls of a classroom.” Known as the General Appropriate Act of 2023, New Mexico HB 2 was signed into law in April.

Morales’ goal for more personalized education comes from both personal and professional experiences as the first member of his family to attend college and graduate school. From a young age, as a member of student council, he was committed to his “responsibility” to ensure that the students after him had access to the educational path that transformed his life. His experiences and family also instilled in him the idea that “leadership is about service … it’s not about a position, it’s about action.”

“I left the classroom to make a difference in policy,” Morales said. “Above all, what I love more than anything is to interact with people … to be there shaking hands, to be accessible, be respectful and always have the opportunity to create those relationships.”

A House Divided

By Lexington Souers

Pennsylvania and Virginia, much like Congress, have split chambers with the House and Senate led by each respective party. Five other states — Alaska, Arizona, Michigan, Minnesota and New Hampshire — have a near or total party split within either one or both chambers. 

With split chambers, legislators face unique challenges when compromising and collaborating on legislation. 

The 49th state, with thriving waterways, sweeping mountain views and distinct detachment from the contiguous U.S., has a history of coalition building, according to Alaska House Minority Leader Calvin Schrage. Because parties lack a definite voting majority or minority, Alaskan legislators join across party lines, creating coalitions made up of likeminded individuals, with more emphasis placed on values and fiscal policy. 

“It’s not trying to necessarily achieve a party agenda but trying to meet your unique needs in unique districts. When you then try and form a majority or minority around the party issues, it just doesn’t work,” Rep. Schrage said. “So you see a lot of work going into trying to find what values and what issues can we find a majority support around. That’s where in the last Legislature, and in this Legislature, we have coalition governments that are formed much more around values and fiscal policy than you do around party identity.” 

Rep. Cathy Tilton, Alaska’s House speaker, noted a bipartisan partnership allowed the Legislature to serve Alaskans effectively, especially because of Juneau’s geographical location, which may keep citizens from participating in traditional government activities. 

“Over the last several years, it’s taken a long time for the House, specifically, to organize because it’s so split,” Tilton said. “One of the goals was to organize in a timely manner because Alaskans are really frustrated with sending their representatives to Juneau. … Fortunately, we found alignment with the [Alaska House] Bush caucus, or the more rural partners, to organize. We’re able to do that on the second day of session.” 

The minority party is also comprised of Democrats, Republicans and independents, which Schrage credits as being “vital” to the legislative process. By uniting around shared values, rather than strict party identity, Schrage said the coalition can work together. However, he recognizes that each member has legislation they are passionate about, which may not align with the coalition as a whole. 

House Speaker Cathy Tilton briefs policymakers during a legislative session earlier this year in the Alaska House of Representatives. The Wasilla native was elected to her current role as speaker by the House on Jan. 18. Tilton previously served as House minority leader from 2021-22, which is a role now occupied by Rep. Calvin Schrage. Photo credit: Forrest Musselman 

“If it’s something that support isn’t there, individual members need to do the work of finding a way to meet those diverse members where they are,” Schrage said. “For those issues, individual members have to do a lot of work and kind of figure out how they can tailor their legislation to meet that very unique political identity of the Alaskan Legislature. There’s a much greater appetite in Alaska to pass bills out across party lines, or across caucus lines. That’s just something that I think is inherent in a close Legislature like this. You don’t have votes to spare within your own caucus, and sometimes you’re going to have to work across those lines to find a path forward.” 

To do this, both Schrage and Tilton emphasize communication. 

“You do that with just respectful communication and bringing back respect to this institution, which means that we need to communicate with each other,” Tilton said. “We can agree to disagree. I may not support your bill and you may not support my bill. That’s okay. We can still work together.” 

— Rep. Cathy Tilton, Alaska House Speaker

Schrage noted how communication can assist with better understanding what values members align on and how those with differences can comfortably work together and make incremental progress. He added that communication also helps address potential roadblocks in legislation, which can be more easily achieved by straying from “typical political messaging” and clearly explaining bills to fellow legislators to find common ground. 

“See where there’s some alignment on those values and recognize that because the chamber is so split, you don’t have that kind of party strength that you might have in other states,” Schrage said. “We all really have to moderate our expectations and be willing to make incremental progress. Accept that and do not let perfect be the enemy of good.” 

— Rep. Calvin Schrage, alaska House Minority Leaders

From this communication, members build strong relationships, regardless of party identity. Tilton said the relationships she built led to some of her favorite memories from her time in the Legislature. Among them was her past work as House minority leader with Alaska Sen. Tom Begich, who was then Senate minority leader. Despite standing on opposite sides of the aisle, Tilton and Begich established a close relationship that helped meet the needs of the minority parties. 

“I don’t know that if you were out in the real world that you would have that opportunity to build a relationship, and what I would call it true friendship, with somebody who was on the other side of the aisle from you,” Tilton said. 

House Minority Leader Calvin Schrage is a third generation Alaskan with a history in aviation and nonprofit leadership. He was elected to the Alaska House in 2020, and has sponsored legislation focusing on the environment, civil rights and support for parents.
Photo credit: Graham Judson 

“Member-to-member communication” and relationships build trust and familiarity, according to Schrage. The role of legislator also allows him to meet and engage with individuals who are “experts in their fields.” The result of those relationships can lead to effective policy work and coalition building — both now and in the future. 

As speaker, Tilton said she recognizes her role as a “leader of leaders,” regardless of party identity. 

“I realize that my responsibility is to be the speaker of the entire House. I have to take in and listen to the needs of all of the members here,” Tilton said. “Because they were all elected in their districts to be a leader, just like I am that leader. Being a leader of leaders is a fine balance.” 

This balance often leads to compromise, which Tilton said can be difficult when “everyone has a different idea” of what major legislation like the annual budget will look like. These types of decisions can have a lasting impact on Alaska, which is why Tilton believes she — and those in similar positions — must make every effort to acknowledge the needs and wants of every member. 

Both Schrage and Tilton highlighted the importance of passing a budget that addresses the distinct financial challenges found in Alaska, like the reliance on natural resource revenue and the question of implementing broad taxes. 

“A lot of the discussion surrounding organization of the majority and minority caucuses are around what you view as the right fiscal solution for the state, so you don’t see a lot of compromise,” Schrage said. “As you face challenges, or as you see the need to negotiate on fiscal issues, the focus is really on consensus building, education and discussion. We have a large amount of time and energy focused around really making sure that members are communicated with and that everyone has an opportunity to speak to their districts’ needs, to be heard and to have a say in that process.” 

While the budget remains a complicated compromise, other legislation illustrated the benefits of bipartisan support. Schrage said Senate Bill 58, which extends postpartum Medicaid coverage to 12 months, is a key piece of bipartisan legislation. The relationship between respect and bipartisan success remains vital in this session and beyond, the speaker added. 

“I think we’ve done great things with the bills that we’ve had,” Tilton said. “But more than looking at creating laws, I think that it’s just important that you’re building good relationships. I think it goes back to how you have to be true to yourself and respect yourself, but you also need to respect the other person that you’re working with.” 

CSG Celebrates 90 Years

By Trey Delida

For 90 years, The Council of State Governments has pursued the advancement of common good in state government. CSG is among some of public policy’s most influential nonpartisan, nonprofit organizations that represent state and local government. 

It all began in 1925 when Henry Wolcott Toll, who was then a Colorado state senator, envisioned an organization that would convene state leaders and improve legislative standards — together. The result of that vision was the American Legislators Association, the first iteration of what would soon become The Council of State Governments.

As the organization gained traction, interstate issues became more prevalent. Toll knew to achieve his original vision, the scope of his organization had to include the federal government and state administrative officials. In a letter to ALA board members, Toll wrote that the ALA’s role was evolving and that it was no longer a service organization solely for legislators. Simultaneously, ALA engaged in undertaking “an attempt for harmony in state activities between state and state, and between state and nation.” 

It wasn’t until Oct. 22, 1933, when a group of state legislators gathered at the Penn Harris Hotel in Harrisburg, Pennsylvania, that CSG was born. Though there is no official record of the meeting, Henry Toll recalled it nearly 25 years later as the conception of CSG. 

“Probably 12 or 15 of us sat around a table in a small room,” Toll said. “The Council of State Governments had never been heard of before that day.” 

That same meeting brought forth the Articles of Organization for this newfound, nonpartisan organization. One sentence from those articles stated, “In thousands of instances the laws of the states are in conflict, their practices are discordant, their regulations are antagonistic, and their policies are either competitive or repugnant to one another. Such disharmony cannot continue.” 

By 1939, the organization had reached national acclaim for its collaborative nature and efficiency. On Jan. 20, 1939, The New York Times published an editorial noting how CSG successfully facilitated an interstate compact between New Jersey and New York, which established joint authority over the Palisades Interstate Park. 

“Notice the fitness of the machinery for the job. The commission members of state legislatures will look after the necessary laws. The administrative members will execute them. CSG is a practical machine of information and action, highly useful in a day of complex problems,” the editorial read. 

The piece also noted the assistance of CSG in ending a 55-year-old question between eight states on the regulation of fishing in the Great Lakes. 

Throughout the organization’s history, CSG has consistently played an integral role in uniting state legislatures, notably during the dawn of World War II. In 1940, CSG members met with federal officials at the request of President Franklin D. Roosevelt’s administration to craft plans to aid states in developing legislation that helped fuel federal government defense efforts near the onset of World War II. As a result, the CSG Suggested State Legislation Committee, now referred to as Shared State Legislation, was developed. Throughout the war, CSG united state defense councils, administered the Selective Service System, and established state guards to offset the shortage of National Guard members who were called into federal services.

It was around this time that CSG had become a notable force in the policy world. Toll and his 15-member staff established a headquarters in Chicago, with an additional office space in New York City. 

After the war, CSG continued to broaden its service area through the expansion of its regional presence. While the Eastern Regional Conference had already been developed in 1935, by the mid-1940s, organizational leaders across the nation had established regional conferences in the Midwest, South and West. As the regions began to take root, the scope of CSG services expanded. In 1969, under Executive Director Frank Bane, CSG relocated its headquarters to its current location in Lexington, Kentucky. 

In 1983, Carl W. Stenberg III came on as executive director of the organization. Prior to his role at CSG, Stenberg directed the Weldon Cooper Center for Public Service at the University of Virginia. He has also authored several books and publications relating to policy, including “Managing Local Government Services: A Practical Guide,” “Pulling the Lever: The States’ Role in Catalyzing Local Change,” and “America’s Future Work Force: A Health and Education Policy Issues Handbook.” He went on to serve as director of the Master of Public Administration program at the University of North Carolina School of Government from 2006-11. 

Before Stenberg was named executive director, he recognized the unique perspective CSG had in the policy space. 

“It is an organization that represents all three branches of government, not just one of them. No other organization has that reach.”

— CARL STENBERG, CSG EXECUTIVE DIRECTOR (1983-89)

He added, “CSG is a regionally based, national organization. It is unique in that it has a national office and Washington presence, but it also has four regional offices that enable it to, in a more focused way, identify and help policymakers deal with issues that are not national in nature, but may be regional or Interstate. The capability to have a broad national view, but also the more focused regional perspective sets CSG apart from the other organizations that serve state officials.”

One of Stenberg’s first big projects was the 50th anniversary of CSG, a pivotal moment in the organization’s history as it was the first national convening of all regions and affiliated organizations. 

“I believe it was Dec. 5, 1983,” he said. “Until that time, CSG National had not held annual conferences in a very long time, but the 50th anniversary was kind of a pilot. It was well attended with representatives from all three branches, and it was a terrific substantive program.”

As a newcomer to the organization, Stenberg wondered if bringing everyone together at the end of each year added value to CSG for members and affiliates.

The event proved to be so well-received that it morphed from an anniversary celebration to the annual convening now known as the CSG National Conference.

“When I look back and think of some of the ways I left CSG as a better organization, having an annual conference served a number of important purposes. Not being in Washington, D.C., it was hard to maintain the national visibility for the CSG headquarters office. Having an annual meeting that was moved around the country was one way to do that.”

For the past 40 years, CSG has convened state leaders, policymakers, representatives and affiliates in cities across the nation in a homecoming-style reunion where participants can share ideas, collaborate and learn from one another. 

This December, the CSG National Conference will be held in Raleigh, North Carolina, the home state of Rep. Julia Howard, who is serving as the 2023 CSG National Chair. 

Howard is the longest-serving member of the North Carolina House. She also has an extensive history with CSG, serving as the organization’s national vice chair in 2020 before advancing to chair-elect. She is a 2008 CSG Henry Toll Fellow and previously served as the 2007 chair of the CSG Southern Legislative Conference. 

“It is so exciting to have the opportunity to champion this organization into its 90th year and to host members from across the nation in my home state. I have been involved with CSG in many roles over many years. It is an honor to serve as national chair during such a monumental time for the organization.” 

— REP. JULIA HOWARD, NORTH CAROLINA, 2023 CSG NATIONAL CHAIR 

Over the past nine decades of serving the states, CSG has had nine executive directors lead the organization through times of triumph and national hardships. David Adkins, a former Kansas State Legislator who is at the helm of CSG in its 90th year, has seen the organization through some of the most testing times in our nation. Joining as executive director/CEO in 2008, he has led CSG through the Great Recession and the COVID-19 pandemic. With every new challenge, Adkins has held the core values and principles that founded the institution at the forefront of his guidance. 

With each generation, CSG has grown and adapted alongside our members to address the ever-evolving, uniquely complex landscape of public policy. In doing so, the organization has settled into a distinctive niche that sets it apart from any other establishment. 

“Our four strong regions, our three-branch participation, and one-of-a-kind Justice Center, all help set us apart. But, when one asks state officials what they value most about CSG, we consistently hear one response: ‘It’s a family,’” Adkins said. “We create spaces where state officials from 

both parties and from many ideological perspectives can come together, see the humanity in each other, learn together and support each other, commiserate about successes and failures, support each other and share many memorable moments.” 

The Council of State Governments has undoubtedly grown, advanced and changed over the course of 90 years. Some of the problems faced in the nation’s statehouses today are resonant of the issues CSG aided leaders with in its early years, while others were unheard of even a decade ago. However, much of the organization’s origins in state stewardship, advancing democracy and the common good remain. 

So, what’s next? 

“When someone asks me what the future holds for CSG, my answer is simple: We will continue to do what we have always done,” Adkins said. “We will focus on the priorities state officials tell us are important to them; we will provide objective, nonpartisan analysis of public policy issues; we will be a source of trusted data and information; we will provide state officials with meaningful ways to learn from each other; and we will fiercely defend the role of the states in our federal system. Like always, we will adapt to changing conditions, find new ways to accomplish our mission and be responsive to the states we serve.”

Housing’s Hurdles

States turn to new legislation to remedy affordable housing issues

By Cody Porter and Jennifer Horton

Lingering fallout from the COVID-19 pandemic placed an immense economic burden on countless Americans. Since 2020, the housing market is one area experiencing the brunt of its weight, remaining in a volatile state due to significant reductions in jobs and wages.

Deemed at an “inflection point” by the Joint Center for Housing Studies of Harvard University, the homebuying market’s record 2021 was followed by increased interest rates in 2022 that helped slow purchases in a market lacking inventory. Due to limited supply, costs for homes and rentals alike continued to soar in unison with rising rates.

Those most directly impacted by the active shortage of affordable and available rental homes are extremely low-income households, which includes those with incomes at or below the poverty guideline, or 30% of their area median income, whichever is higher. There are just 36 affordable and available rental homes for every 100 low-income households — a deficit of 7 million homes nationwide. For extremely low-income renter households, 71% are severely cost burdened, meaning they spend more than half of their income on housing, making it more difficult to afford healthy food and health care.

ATTAINING AFFORDABILITY
In its February policy brief on housing prices and affordability, the Kem C. Gardner Policy Institute at the University of Utah noted that housing affordability comes in two forms that are not mutually exclusive: affordable housing and housing affordability.

Affordable housing refers to a specific type of housing, generally government-assisted rental housing targeted for very low to extremely low-income households. Housing affordability is a much broader term and refers to the general level of housing prices relative to the general level of household incomes. The term does not refer to any particular type of housing. The two concepts are not mutually exclusive or in conflict but are complementary with affordable housing being a subset of housing affordability. 

— James A. Wood, Kem C. Gardner Policy Institute at the University of Utah 

In 2022, a person working full-time in the U.S. needed to earn $25.82 an hour on average just to rent — not purchase — a modest, two-bedroom home. That hourly wage is $18.57 higher than the $7.25 federal minimum wage. In some states, the two-bedroom housing wage is even higher— up to more than $40 an hour. The average worker earning minimum wage would need to work almost 96 hours per week to afford a two-bedroom rental at the national average fair market rent of $1,324.

With the rapid increase in home and rent prices over the last several years, millions of low-income renters struggled to afford their rent even before the pandemic. The economic impacts of COVID-19 exacerbated the problem even further as low-wage workers lost income. While temporary eviction moratoriums and Treasury Emergency Rental Assistance programs kept millions of disadvantaged renters housed during the pandemic, as these programs end, the need for affordable housing for the lowest-income renters will not.

Homes suited for low- or middle-income earners to rent or purchase have been quickly consumed by investors in recent years for rental income or for quickly upgraded resells. During 2022’s first quarter, investors accounted for 28% of single-family home purchases, which is 9% higher than the year prior, according to CoreLogic data cited by The Joint Center for Housing Studies in its 2022 housing report.

More densely populated areas, such as Atlanta, Los Angeles, Phoenix and San Jose, and were favored by investors in recent years due to higher home values compared to those in smaller cities. This factor, combined with the workforce’s ability to work remotely, promoted substantial population growth from 2020-22 in the likes of Idaho, Montana and Utah. Axios reported Idaho’s population increase of nearly 4.9% as the most for any state during the two-year span, while Utah came in just under 3%.

Utah, ranking fourth overall in growth from 2020-22, experienced similar increases from 2020-21 by adding 56,000 new residents, or 1.7%. Much of the state’s continued growth can be attributed to its lure as an employment hub, including in the tech space. The Milken Institute’s 2023 “Best-Performing Cities” featured many impacted by Utah’s employment boom, including Provo-Orem — its best-performing city for a third consecutive year — in addition to Logan and St. George as viable options among smaller cities.

A common theme for the states without dense populations has been determining how to best offer sufficient housing. Plagued by challenges stemming from the pandemic, funding for new projects has been difficult to obtain. When available, new housing projects are marred by issues associated with zoning mandates.

Former Utah Sen. Wayne Niederhauser, a real estate broker by trade, was involved in many affordable housing efforts prior to assuming his current role as Utah homeless coordinator in the Office of Homeless Services. While proud of his state’s ability to attract new employment opportunities, he said it doesn’t come without “a little caveat.”

“With all of these new, high-paying jobs there’s more money chasing a limited supply of housing,” Niederhauser said. “Our population could not have sustained such employment growth, so we’ve had huge in-migration from places like California where real estate values are higher. You’ve got all this equity coming in from a state with higher property values chasing after a limited housing supply, and it only multiplies our problem.”

In October 2021, The University of Utah Kem C. Gardner Policy Institute revealed in its “State of the State’s Housing Market” report that more than half of the state households could not afford median-priced homes. In the time since, prices have only increased.

“Our children and grandchildren are priced out at this point unless you’re making a lot of money — almost six figures at this point,” Niederhauser said. “We’ve had unprecedented home appreciation, and we have got great economy, but that does price out social workers, case managers, firefighters, police officers and teachers. Compared to the national level, [Utah] ranks near the top in appreciation and that’s why it’s different here.”

AVENUES FOR RESOLUTION
In Maine, where the population grew quicker from 2020-21 than its previous 10-year average, state leaders have remained active in identifying avenues for additional housing.

It’s quite possible the state has even underproduced housing for quite some time, according to Ryan Fecteau, senior advisor of community development and strategic initiatives for the Maine Governor’s Office of Policy Innovation and the Future. However, as Fecteau noted, the issue of affordability and availability has only emerged in the past few years due to in-migration.

“We’ve had net migration of around 37,000 people. For most states, that might not sound like a lot, but for a state of 1.3 million people that is a pretty significant number of individuals moving here,” Fecteau said. “The vast majority of the people moving here as part of the in-migration have been under age 45. So, we’re not talking about retirees calling Maine home; we’re talking about working-age folks. We now have this real gridlock, this stalemate, in our housing sector, where older adults might [be prepared to] downsize but [unsure if ] they’re going to be able to find another housing opportunity.”

Maine Gov. Janet Mills appointed Fecteau to his current role in January as part of a string of efforts to address the state’s pressing need for housing. Maine’s House Speaker from 2020-22, Fecteau sponsored many bills on housing and community development. Among them was LD 1645, which created the Maine Affordable Housing Tax Credit that — to date — remains the state’s largest investment in affordable housing. 

Maine’s Affordable Housing Tax Credit is an eight-year program granted $10 million per year, including shares for senior and rural housing. As a result, the state’s investment is matched with federal low-income housing tax credit dollars. To qualify for the program, individuals must earn below 60% of the area’s median income and monthly rent cannot exceed 30% of an individual’s monthly income.

“We’re very lucky that here in our state, we have the leadership of the governor, legislature and lawmakers on both sides of the aisle,” Fecteau said. “This is probably one of those rare issues in today’s politics where you have members on both sides of the aisle resoundingly in favor of tackling this problem.”

— Ryan Fecteau, senior advisor of community development and strategic initiatives for the Maine Governor’s Office of Policy Innovation and the Future

Fecteau reported the completion of 192 housing units since LD 1645 was enacted, with an additional 701 units in the works. The governor’s budget includes an additional $35 million for the tax credit that could lead to the development of 350 more units. 

Additional housing initiatives in Maine include the Rural Affordable Rental Program and protecting United States Department of Agriculture Section 515 properties — the latter of which employs the use of the state’s tax credit. Mills has also proposed $10 million for a new Innovation Fund for Attainable Housing, expediting the production of affordable housing for qualified renters and homebuyers.

EQUITY FOR THE “MISSING MIDDLE”
Fecteau’s other prominent work came with 2022’s enactment of LD 2003, advancing affordable housing and housing-friendly zoning and land use regulations. The legislation resulted in the creation of a local zoning and land use commission that delivered recommendations to the governor’s office in December 2021 allowing, “Maine property owners to build accessory dwelling units in residential areas and up to two units on a lot zoned for single-family housing.”

Although it could possibly aid growing housing issues, the topic of zoning is a highly debated one. In February, NPR reported on the discussion to end single-family zoning mandates in Arlington, Virginia, thus paving the way for new housing opportunities. As part of Arlington’s “missing middle” housing reform plan, developers could construct multiple units on a single-family lot, including duplexes up to six-unit buildings.

Arlington, much like Minneapolis and the states of Maine, California, Oregon and Washington before it, looked to capitalize on an opportunity to do more than increase affordable housing — it looked to re-establish racial equity in areas previously segregated by single-family zoning laws, as well as limit the need for commuting.

The “missing middle” plan, which was ultimately passed in March, included opposition who believed that not even increased community density would improve pricing. Other local Arlington homeowners were also concerned about potential parking issues, high taxes and flooding.

Public outcry led to city commissioners in Gainesville, Florida, reversing course on their decision to end single-family zoning just months after adopting the plan. Gainesville was originally the first city to adopt the plan after Florida Statute 163.31771 passed in 2021. 

The following examples of state adopted affordable housing legislation include that plan and more:
California Assembly Bill 2162 (2018) encourages the production of supportive housing statewide by mandating streamlined and expedited approval for such projects and the elimination of minimum parking requirements for developments located within half a mile of public transit. 

Florida Statute 163.31771 allows localities with a shortage of affordable rental housing to adopt an ordinance permitting accessory dwelling units in single-family residential areas to increase the availability of affordable housing for low and moderate-income individuals.

Massachusetts State Statute 40B enables local zoning boards of appeals to approve affordable housing developments under flexible rules if at least 20-25% of the units have long-term affordability restrictions. 

Oregon HB 2001 (2019) implemented state-level legalization of “missing middle” housing. It expands the areas across the state available for duplex construction.

Utah SB 153 (2023) establishes the Redevelopment Matching Grant Program under which local governments can qualify if they have an approved development application that allows for “the creation of new or additional affordable housing units.”

“People achieve economic prosperity through homeownership. In some cases, being a homeowner is going to be what sets someone up for economic security in their later years,” Fecteau said. “Obviously, we want folks to take every initiative they can to save and plan for retirement, but homeownership is a very critical means to economic security and prosperity.”

Following Legislation Trends

State policymakers offer unique, viable solutions to common issues in 2023

By Lexington Souers

Legislatures in 2023 have introduced or pre-filed more than 97,000 bills, resolutions and memorials. Of those, at least 14,000 were enacted into law by June, ranging from workforce development to pass-through entity taxes. 

WORKFORCE DEVELOPMENT
Once COVID-19’s societal impact subsided, states attempted to remedy workforce concerns by passing legislation on sector specific programs, regional development plans and interstate compacts. In 2023, more than 30 bills on interstate compacts have been enacted in more than 15 states. 

The Kansas Legislature enacted HB 2288, enabling mental health professionals to join the multistate Counseling Compact. Rep. Susan Ruiz, who helped pass the bill, said its success is a win-win for providers, patients and Kansans. Ruiz is the ranking member of the Health and Human Services Committee and a licensed clinical social worker.

“This is a very bipartisan effort to enhance our workforce,” Ruiz said. “We have put a lot of funding into enhancing our mental health services across the board, but we need the practitioners involved to bring all that to fruition. So, anything that we could do to enhance our workforce, we did it.”

Ruiz said HB 2288 allows practitioners licensed in another state to practice in states that are members of the compact. Practitioners must maintain their licensure, undergo a background check and complete other requirements. Due to these safety measures, patients can feel confident in a provider and protect their continuity of care, which Ruiz said could be “devastating” if interrupted. 

Almost every bill on workforce training was passed, leading 24 states to pass more than 85 bills. Minimum wage bills were enacted in five states and 15 unemployment bills passed in four separate states. 

ELECTIONS 
By June, legislators filed more than 1,700 bills relating to elections. Of those, 119 were enacted across 28 states. While the focus of legislation varied, many bills enhanced protections for election officials. It’s those workers who help “operationalize democracy,” according to former election official Veronica Degraffenreid, senior manager of strategic partnerships, elections and government at the Brennan Center for Justice.

Degraffenreid said the Brennan Center completed three surveys, the most recent of which notes that one in three election officials have been abused, harassed or threatened, with three in four seeing an increase in threats.

“What I believe policymakers and lawmakers are doing is a pragmatic approach. They’re like ‘let’s do something and address it,’ but understand that along with the pragmatism is a passion that these are people in our communities. They are our friends. They are our neighbors. We go to school with them and to religious services with them or ballgames. It’s their job to carry out the work and carry out their responsibilities. It’s absolutely something that we need to do, but we should want to do it, and want to make sure that we protect the lives and the livelihood of these American citizens.” 

— Veronica Degraffenreid, senior manager of strategic partnerships, elections and government at the Brennan Center for Justice.

Legislation protecting election officials generally follows three paths that potentially result in increased funding, mounting criminal penalties for perpetrators, and/or additional information protection. Funding adds to the physical safety of election offices and polling places. Legislation surrounding doxing prevention and implementing address protection programs allows for increased physical safety and prevents malicious action against an election administrator or poll worker. 

“If we want voters, however they participate, to have faith and confidence in the process and the people who are performing those duties, we want election administrators to be focused on conducting fair, accurate and safe elections; we want them to do their duty, their job that is dictated by federal and state law.” 

TELEHEALTH 
Originally designed to provide health care access to rural and underserved areas, telehealth is now in widespread use. However, the popularity of telehealth, especially following its use in 2020, highlighted a need for increased regulation. Legislation in 2023 expanded existing framework to allow out-of-state providers to work with a certain state’s patients, increases prescribing ability for certain drugs and payment parity for services. Multistate legislation could be helpful in allowing providers to uphold state specific licensure requirements, meaning patients have a wider range of care. 

Across 22 states, 44 telehealth bills were enacted this year entering June. These bills expanded funding and access to telehealth. Virginia SB 1418, which passed on March 21, permits telehealth entities with state licensed health care providers do not need to maintain an instate address to enroll as a vendor or provider group under Medicaid. The bill also allows health care providers to not maintain a physical presence in the Commonwealth to enroll as a Medicare provider. 

“This is a bill with a significant impact on access to quality health care for Virginians, especially those in rural areas like southwest Virginia, which I represent,” said Virginia Sen. Todd Pillion. “In short, it fixes a systemic problem in Medicaid enrollment for Virginia-licensed providers. Prior to this bill, a Virginia licensed provider or provider group must have a physical address in Virginia in order to enroll in the Medicaid program.”

This allows licensed providers who do not have a physical Virginia address to aid patients. At the same time, patients can know the care they are receiving meets state licensing standards and other Medicaid qualifications. Pillion said the legislation reduces regulatory burdens and allows Medicaid to “leverage telemedicine” to better serve both providers and patients. 

“The more we can do to reduce regulatory burdens and enhance quality of life, while increasing health care options, is a win for patients, providers and rural communities.”

— Sen. Todd Pillion, Virginia

INSULIN 
More than 29 bills filed in 23 states were aimed at capping the cost of insulin and other diabetes care-related supplies. Despite recent federal caps, many Americans with diabetes still face high annual insulin costs. In response, states and private companies are capping costs in specific circumstances.

Insulin is relatively easy to produce, given its chemical makeup, but patients are often paying at least four times the amount those in other countries do. Additionally, the cost of pumps and other supplies are often not covered under a cap.

In North Dakota, Sen. Tim Mathern introduced SB 2140 to cap monthly copays at $25 for insulin drugs and supplies for health insurance programs. Mathern said the bill went through several iterations in both house and senate committees.

“The challenge is never-ending — to create a world where each and every person has the right to affordable, accessible and quality health care,” Mathern said. “SB 2140 is one small step toward that goal which I have been working on in the senate since 1986.”

Mathern suggested connecting with families experiencing diabetes and federal advocates to explain the importance of capping insulin costs. As well, he suggested increased education on the issue, especially because of an existing federal cap. 

“A challenge in the drafting was identifying what specific items were to be covered by the $25 cap,” Mathern said. “I also found, as a democrat in a red state, it was a great boost to have republican cosponsors.”

CAREER AND TECHNICAL EDUCATION 
Career and technical education, or CTE, is defined in the Strengthening Career and Technical Education for the 21st Century Act of 2018 as a series of courses that prepares students for futures in technical skills or industries, works to solve the skills gap. Studies show that involvement in CTE leads to higher wages, especially after the completion of advanced coursework. Spreading awareness of these programs and knowledge of the typical CTE student helps increase program success. In addition, integrating CTE courses into high school curriculum provides a benefit for students who may have chosen other classes to meet strict graduation requirements.

High school career and technical education courses prepare students for entry into the workforce by offering hard and soft skills specific to an industry. Students can use these skills immediately after graduation or in postsecondary training. States report that high school students taking at least two CTE courses have a 95% graduation rate. CTE programs provide skilled employees in professions facing labor shortages.

In 2023, 23 bills concerning career and technical education were enacted. At least eight states passed legislation allowing CTE courses to count as high school credit or meet a graduation requirement. Six states — Colorado, Georgia, Hawaii, Idaho, Kansas and Washington — passed general legislation concerning career and technical education, including pilot programs for nurses and joint studies on high school program enrollment.

PASS-THROUGH ENTITY 
This year, seven states joined 28 others with pass-through entity taxes, according to the American Institute of Certified Public Accountants. An additional two states have also proposed legislation. A partnership, such as an LLC, can elect to pay state and local taxes at the entity level, rather than having those costs “pass through” to the owners. This offers the owner a federal income tax credit to reduce their personal federal income tax. Due to disparities in state taxes, some state residents paid more than others in federal income taxes despite similar incomes. By passing legislation allowing pass through taxes, states can balance the cost of taxes on some citizens.

“We think this will help our West Virginia small businesses that are organized as pass-through entities decrease the amount that owners would have to pay in federal income tax,” said West Virginia Sen. Mike Oliverio, who sponsored SB 151. “In turn, we’re hopeful that will enable them to invest more money into their business, pay more money to their staff, or simply enjoy more the dollars that they’ve earned from their business.”

Oliverio said states have taken various approaches to legislating pass-through taxes, and given that the federal government was not preventing states from passing legislation, he and other West Virginia legislators wanted businesses to have the same benefits as other states. 

“At some point, there has to be a balancing of what each of you respectively pay to the federal government in taxes as well,” Oliverio said. “The citizen in West Virginia versus the citizen in [a high tax state] is enjoying the same benefits of the CDC, the United States Army, the Postal Service and all those federal agencies that they’re funding with their taxes.” 

Presiding Over Party Lines

Relationships, respect integral to Rep. Tilton as Alaska’s House speaker 

By Lexington Souers

Alaska Rep. Cathy Tilton served as House minority leader from 2021-22 before being elected as speaker of the House in 2023. As speaker, she directs the chamber’s legislative process, upholds bipartisanship and appoints committee membership. Tilton’s focus in that capacity is on building respect within the chamber and improving Alaska’s financial stability. 

Prior to joining the Alaska State Legislature, Tilton enjoyed a long history in public service. Her 33-year career features work with both the Legislature and mayor’s office in Wasilla, Alaska. First elected in 2014, Tilton chaired the House Community & Regional Affairs Committee as a freshman legislator. She has since served on the House Finance and Rules Committees, among others. 

What sets Alaska’s coalition apart from other state legislatures? 
Tilton: In the past several elections, this electorate has elected people into office where it’s been really divided — for the House, especially. It could be even on a 20/20 divide if you’re looking at partisan membership. That’s been a hard thing to overcome. One of the key things, I think, to keeping this chamber a working chamber is to show that respect for yourself while also having respect for others. I want to bring respect back to the institution overall. Alaskans want us to get our jobs done. We have this partisan divide that, over the years, has become wider and wider. I recognize that we really need to stay true to our beliefs, our morals, our values, our constituency, but we can do that in a respectful manner where we can agree to disagree. 

As speaker of the House, how do you approach bipartisan issues? 
Tilton: Way back when I was in my first session as a legislator, I chaired the House Community and Regional Affairs Committee, which is really about all of Alaska. Let’s face it, I was raised on the Railbelt, in south central Alaska. I hadn’t really traveled my own state very much. It was a really good experience for me to be on that committee to learn to balance the needs of my area with the needs of rural Alaska, and to take bills and bring those together in a collaboration so that that they were acceptable to both areas. That’s the way I’m approaching this as a speaker. We have to be conscientious of the needs of our entire caucus.

What unique challenges does Alaska face? 
Tilton: The big issues that we’re dealing with are the volatility of our income and revenues. We are an oil revenue state, and, of course, we all know what the volatility of oil. Then there’s the tension between the permanent fund dividend, which is different than a lot of states have. There’s a little bit of tension between the dividend going to the people and public and government services. Where does that all fit in in our budget? We have a lot of tension in our own caucus, in this entire building and for the entire Legislature. 

What experiences outside of the Legislature helped you become the leader that you are? 
Tilton: I started out working at a law firm as a legal secretary, which I think gave me a little bit of background in some law. Then, for 10 years, I worked in local government. I worked for five mayors of Wasilla. That’s a lot of different types of leadership that I adjusted to. Before I ran for office, I was running my own business and taking care of my family. When you’re paying your own payroll and taking care of others, it’s a different perspective. 

I stick to my values of who I am and what my constituency believes in. I’m from a really red part of Alaska. I’m very conservative. That being said, I do believe in fair treatment for everybody. I look at the fact that I am a leader of leaders. My role as the leader of leaders is to lift other leaders up and help them to become a leader. I won’t be here forever. I don’t expect to be. I feel like my role is to help them move into leadership spots. 

What do you see for the future of Alaska? 
Tilton: I would love to see us be able to come together on some sort of a fiscal plan. It’s going to be difficult. Obviously, the Legislature has been working on it for 20 years and haven’t gotten there yet. But I think that we’re at that point in Alaska where we don’t have a choice. We really have to do something here to stabilize Alaska. 

The second thing I think I would like to see really worked on is high crime issues. There are a series of crime bill dealing with fentanyl, sex trafficking and those kinds of things. I think it’s important to Alaskans that we do something about those things, and I’m hoping that we can all work together to get those over the line. 

Do you have any favorite memories from serving in the Alaska State Legislature? 
Tilton: I was a private business owner and stayed home with my kids before I went to work at the Legislature. I really didn’t plan to run for office. Some of my favorite memories are from some of the relationships that I have built here that are uncommon. I was a minority leader last session and the minority leader for the Senate was Sen. Tom Begich. I feel like he and I — although on total opposite sides of the aisle — built a relationship and were able to work together to meet the needs of the minorities. I think that’s one memory. I don’t know that if you were out in the real world that you would have that opportunity to build a relationship, and what I would call a true friendship, with somebody who was on the other side of the aisle from you. I think I look at that as being one of the accomplishments from being here that I hold very dear. Relationships are really important to me. 

Emerging State Responses to Homelessness

Increased funding, innovative strategies intend to offer resolve

By Cody Porter and Jennifer Horton

Homelessness in the United States trended upward ahead of the COVID-19 pandemic. An already dire situation neared critical levels as the economic downturn forced countless businesses to close and unemployment rates to surge.

The nationwide poverty rate in 2020 climbed by 3.3 million, increasing the total number of individuals living in poverty to 37.2 million people, or 11.4% of the population. With necessities like housing being less affordable due to soaring home prices, homeless numbers also grew.

As of January 2022, an estimated 582,462 individuals experienced homelessness in the U.S., according to the National Alliance to End Homelessness. Rates of homelessness vary widely across the states. Per capita, Washington, D.C., California, Vermont, Oregon and Hawaii have the highest rates of homelessness.

State legislators take a range of approaches to address the nuances linked to homelessness, including efforts focused around affordable housing, transitional housing, and programs like Housing First that reduce prerequisites involved in the buying or renting processes.

— Wayne Niederhauser, Utah homeless coordinator

Utah Gov. Spencer Cox appointed former Senate President Wayne Niederhauser to the role of state homeless coordinator in April 2021. His appointment came on the heels of the Utah Legislature establishing the role in its pursuit of a strategic plan to reduce homelessness.

That strategic plan — the Statewide Collaboration for Change: Utah’s Plan to Address Homelessness — arrived in March, a year after the Utah Department of Workforce Services revealed a 14% increase in the number of Utahns experiencing first-time homelessness. Response efforts included within the plan include a five-goal strategy centered around increasing opportunities for accessible and affordable permanent housing, support services and case management, homeless prevention strategies, and housing resources and services for the unsheltered.

In September 2022, Salt Lake County, Utah, received $30.2 million from the state for new affordable housing. The funds were part of a broader $55 million statewide investment via American Rescue Plan Act funding for the construction of 1,078 affordable to deeply affordable housing units. Access to deeply affordable housing is for those who annually earn less than $25,000.

“We now have the opportunity to increase deeply affordable housing, which is the hardest housing to provide,” Niederhauser said. “That’s focused on homelessness and workers who really are [earning] $15-20 per hour and got to have deeply affordable housing.”

Salt Lake City’s 40-acre Other Side Village is among the first developments to come from the ARPA funding in 2022. Ground broke in March for the tiny home village, which is expected to house 60 individuals experiencing homelessness. The plan is to further develop the lot to offer sufficient housing for as many as 400 individuals.

“Deeply affordable housing requires additional help — [more than just] low-income housing tax credits,” Niederauer said. “The project needs to be sustainable and it’s not sustainable if it doesn’t have enough cash flow.”

In total, more than $200 million was appropriated by the Utah Legislature for affordable housing and homelessness initiatives prior to concluding the 2023 session. According to Niederhauser, legislative successes include $50 million in deeply affordable housing funding; a low-income housing tax credit worth nearly $60 million; housing stabilization grants, including project based rent support, accompanied by $5 million in funding; a statewide code blue system; a request for a response plan for larger counties; and $12 million for homeless services.

Between 2005-15, Utah was a prime example of how to curb homelessness through its use of the Housing First model. The state reported reducing its homeless population by 91% throughout the decade, although that number has decreased since 2015.

Housing First is an evidence-based approach to ending homelessness that provides people with immediate access to housing and support services without preconditions. Based on the belief that people need to have their basic needs met before addressing other issues like employment or substance abuse, the Housing First model emphasizes client self-determination within a trauma-informed, harm-reduction framework. The model has been successful when applied to a range of circumstances, including both families who became homeless due to a temporary crisis and chronically homeless individuals.

There are two common models that utilize the Housing First approach depending on a person’s needs and whether they need long or short-term assistance. The permanent supportive housing model provides long-term rental assistance and supportive services to individuals with chronic illnesses, disabilities, mental health issues or substance use disorder who have experienced long-term or repeated homelessness. A second model, known as rapid re-housing, provides short-term rental assistance and services to help people obtain housing quickly and increase self-sufficiency so they can remain housed.

The Maine Legislature’s Committee on Housing hosted Niederhauser in March to learn more about Utah’s successes and failures with the Housing First model.

“I testified in their committee because they wanted to know what happened in Utah. The fact is we didn’t keep up. That’s the bottom line,” Niederhauser said. “You need to provide housing, but you also need to provide more as your population grows … and you have got to have deeply affordable housing to address homelessness. You can’t be satisfied with what you’ve done in the past. It has to be an ongoing effort.”

Maine ranked eighth per capita for homelessness in 2022, according to data compiled by the National Alliance to End Homelessness. And from 2021-22, Maine’s homeless population increased by 113.8%, according to U.S. Department of Housing and Urban Development.

“[Housing First] is an initiative that really is transformational,” said Ryan Fecteau, senior advisor of community development and strategic initiatives for the Maine Governor’s Office of Policy Innovation and the Future. “It’s probably the most transformational policy around homelessness in Maine history and will be a huge step forward in addressing that.”

Housing First was included in by the recently proposed budget of by Maine Gov. Janet Mills. If adopted, the program, contained in Speaker Talbot Ross’ proposed LD 2, would be established within the Maine Department of Health and Human Service.

An estimated 450 chronically homeless Mainers currently live throughout three Housing First model properties in Portland. Ninety efficiency apartments were constructed by nonprofits Avesta Housing and Preble Street in 2005, 2010 and 2017.

“Our service center communities, particularly Bangor and Portland — our two largest cities — are shouldering this challenge in a big way because a lot of people seek services in the city,” Fecteau said. “[While those seeking shelter] might not necessarily be from Portland or from Bangor, they end up there as a means of seeking services from the cities. Getting people stabilized affordable housing is a challenge across the spectrum. Whether it be folks who are experiencing homelessness or folks who are currently housed, they are having to pay way more than they should have to with their annual incomes.”

Fecteau added that Gov. Mills’ proposed budget also offers $12 million in one-time funds for the Emergency Housing Relief Fund. Those funds could continue supporting efforts to assist individuals and families experiencing homelessness. In addition, the Legislature included a $21 million emergency spending package in January supporting emergency housing and shelter.

Research indicates people assisted through the Housing First model access housing faster and are more likely to remain housed, with studies showing a one-year housing retention rate ranging from 75-98%. The approach tends to be cost-efficient, generating savings through reduced usage of emergency services, hospitals, jails and emergency shelters.

Shifting Skills: Labor Shortages Drive State Changes to Education, Employment Requirements 

By Grace Harrison

For government leaders at the state and national levels, some of the most important metrics of their success in office are economic conditions, such as unemployment levels or job growth. Market conditions and workforce characteristics are often determined by macro-level circumstances, though, and are beyond the control of a single U.S. representative or governor. Despite trends toward an increasingly educated workforce, states still face labor shortages. Governors in Alaska, Colorado, Maryland, New Jersey, North Carolina, Pennsylvania and Utah are advocating for changes in education and skill requirements to bridge this gap.

EDUCATIONAL ATTAINMENT OVER TIME
Since the mid-20th century, the number of workers with a postsecondary degree has increased significantly. For workers aged 25 and older, the proportion of those with a higher education degree increased by around 30 percentage points from 1960 to 2021. As the education level of the U.S. population has increased, researchers have begun to question how educational attainment, income and unemployment are interrelated.

In 2014, Pew Research Center published a report detailing the “rising costs of not going to college” for millennials. Combining Pew and U.S. Census Bureau data, the report highlights three areas of disparity based on levels of educational attainment — annual earnings, unemployment rates and the share of individuals living in poverty. Though there have been differences in the earnings and general economic outcomes of college and high school graduates across generations, the annual income gap has increased from $7,449 in 1965 to $17,500 in 2013.

Underlying this trend is the general divergence of earnings, indicating rising median earnings of college graduates coupled with falling median earnings of high school graduates.

THE CURRENT STATE OF THE LABOR MARKET
Despite fluctuations throughout COVID-19, the economy stabilized to a point where analysts can determine the current state of employment for various demographics. There was a 13.6% decrease in employment during the first month of the pandemic, which is the largest one-month decrease since 1939. Since then, employment fluctuated across sectors as overall economic growth remained volatile. Now, three years later, in the context of interest rate hikes and contractionary spending, the labor market faces the opposite problem: rapid growth in job postings, with not enough applicants to fill open roles.

In January 2023, employers created 517,000 jobs. Economists want to know why, despite low unemployment levels and the increasing population of highly educated workers, labor force participation is around one percentage point lower than pre-pandemic rates. A working paper from the National Bureau of Economic Research found this trend is due to “less hours worked” rather than “less workers.” Males aged 25-55 with bachelor’s degrees experienced the greatest decrease in work hours. Exactly why this voluntary decline in hours worked took place is undetermined, but authors suggest a desire to create a better work-life balance could explain this trend, which, if true, will have further implications for societal roles and future efforts to curb unemployment.

Similar research offers an alternative explanation as to why open roles continue to go unfilled. The relationship between higher education and higher wages is a primary factor, particularly in fields like retail and health care.

“As long as the benefits of obtaining a college degree exceed the cost for an increasing number of Americans, we should expect to see the number of Americans with a college degree continue to steadily climb."

— Kory Kantenga, LinkedIn senior economist, to S&P Global

People who would traditionally fill low-wage positions are pursuing higher education and increased wages or otherwise seeking more competitive employment. This trend could shift if employers modify their hiring practices and requirements. For instance, skill-based assessments, rather than degree requirements, might slow the growth of individuals pursuing higher education. Governors across the U.S. supported replacing degree requirements with skills and experience assessments.

EXECUTIVE ACTIONS TO ADDRESS LABOR SHORTAGES
Public sector employment, responsible for government and public services such as education and transportation, faced some of the largest labor shortages in the last few years. Despite the increased demand for public services due to growth and infrastructure investment, state and local governments struggle to attract college graduates to fill these crucial positions. Competitive employment, as well as job and social mobility, are not typically characteristics of state and local government employment, despite the offerings of stable income and benefits.

The need to fill these public sector positions, combined with efforts of workforce development across states, has recently led governors to remove degree requirements — typically a bachelor’s degree — for government jobs.

Maryland Gov. Larry Hogan announced in March 2022 a “first in the nation” program to strengthen the state’s workforce. It was determined that more than half of the nearly 40,000 state jobs did not require four-year degrees, but rather relevant skills, work experience or community college education.

In April 2022, Colorado Gov. Jared Polis signed an executive order “directing state agencies to consider job applicants skills and experiences as substitutions for educational degrees.” On Pennsylvania Gov. Josh Shapiro’s first day in office, a similar executive order was passed.

Other governors implementing similar skills-based hiring practices within the past year include Alaska Gov. Mike Dunleavy, New Jersey Gov. Phil Murphy, North Carolina Gov. Roy Cooper and Utah Gov. Spencer Cox.

Implications of these Practices
This advancement in employment accessibility and development has now extended past executive actions. In the first few months of 2023, the Georgia Senate proposed and passed SB 3, the Reducing Barriers to State Employment Act of 2023. To date, eight states reduced the requirements of public sector employment, serving as examples for other states looking to do the same.

Because it is still early on in this transition, concrete impacts are yet to be determined. However, predictions for the future of educational attainment and state workforces are becoming clear. Employment expansion to skilled individuals without a degree provides economic stability and growth to not only the state and its constituents, but those individuals now receiving salaries and benefits that were previously unattainable.

Skills-based hiring practices and newly-created state programs also benefit individuals with disabilities, who often face higher barriers to education and employment. Though the steady increase in individuals obtaining postsecondary degrees likely will not disappear, state governments are making strides in promoting employment accessibility and combatting labor shortages.

Mental Health Among Top Policy Priorities for the States

By Jennifer Horton and Sean Slone

The Council of State Governments works to help state officials solve problems and share information with other policymakers across the U.S. As a nonpartisan association of all state officials, elected and appointed, the work of CSG is research informed in order to help states identify solutions that help their communities. We recognize that no single solution works for everyone, but we can learn from the successes — and failures — of other states. 

Through extensive survey work conducted by the CSG Center of Innovation research team, the CSG national office identified five top priority public policy issues that — in addition to work in other areas — CSG policy staff will expand on and provide resources for during 2023: 

  1. INFRASTRUCTURE AND TRANSPORTATION. 
  2. FISCAL AND ECONOMIC POLICY. 
  3. HOUSING. 
  4. MENTAL HEALTH INCLUDING SUBSTANCE USE DISORDER. 
  5. EDUCATION AND WORKFORCE. 

Each issue of CSG Capitol Ideas magazine in 2023 will focus on the work states are doing in each of these policy areas. This issue kicks off with a deeper dive into mental health and the different ways states are working to address this growing issue. 

STATE ACTIONS TO ADDRESS MENTAL HEALTH 
Nine out of 10 adults in the U.S. believe the country is experiencing a mental health crisis. With that consideration, which resulted from a poll conducted by CNN and the Kaiser Family Foundation, and the topic of mental health gaining more attention in the conversations surrounding health care and wellness, many states are directing efforts at some of the most pressing concerns.

Recently, these have included suicide prevention (a leading cause of death in the U.S.), children’s mental health (1 in 6 children between the ages of 2 and 8 has a diagnosed mental, behavioral or developmental disorder), and expanding access to care. Mental Health America’s 2022 report provided a state-by-state look at access to mental health services, ranking states overall and in a number of categories including adult mental health, youth mental health, prevalence of mental illness and access to care.

SUICIDE PREVENTION 
In 2020, there were 45,979 deaths attributed to suicide, or one death every 11 minutes. Even more people thought about or attempted suicide with more than 16 million adults seriously thinking about, planning or attempting suicide.

Suicide is now ranked as the 12th leading cause of death in the U.S. overall and is the second leading cause of death for children between the ages of 15 and 19 years old. As cases of mental health conditions rise and the search for solutions continues, specialists around the nation are calling it a national mental health crisis.

A number of states passed legislation to fund and implement the new National Suicide Prevention Lifeline, 988, in 2021. Experts hope that the inclusion of 988, dubbed by some as the mental health equivalent of 911, will successfully prevent more people from dying due to mental health concerns. Colorado (Senate Bill 21-154; 2021) and Washington (House Bill 1477; 2021) established telecommunications charges and appropriated funds to support the help line’s implementation and working groups to provide recommendations and/or oversee and administer the hotline. 

Individuals who identify as LGBTQ+ experience disproportionate levels of poor mental health and suicidality. According to a survey conducted in 2021 by the Centers for Disease Control and Prevention looking at high school students, 25% of lesbian, gay or bisexual students attempted suicide during the past year compared to 5% of heterosexual students. States have passed legislation to support this population, both by protecting them from practices that have been linked to substantial harm as well as by enacting bills that increase access to LGBTQ+ affirmative care.

In 2021, North Dakota enacted new ethics standards in alignment with the American Psychiatric Association’s Guidelines for Psychological Practice with Sexual Minority Persons and the APA’s Position Statement on Conversion Therapy and LGBTQ Patients that prohibit licensed social workers from subjecting LGBTQ+ youth to conversion therapy and require practitioners to use therapies that affirm individuals’ sexual orientations and gender identities. During the 2021 and 2022 legislative sessions, Illinois (SB 4028) and Vermont (HB 210) enacted bills creating task forces that will provide recommendations for increasing access to LGBTQ+ supportive care.

CHILDHOOD MENTAL HEALTH 
In recognition of the role of schools as a crucial access point to youth mental health care, states have enacted at least 100 laws since early 2020 aimed at supporting schools in the delivery of school-based mental health services. Some examples of this recent legislation include:

  • Connecticut: HB 6621 (Public Act No. 21-95, enacted June 2021) established requirements for the School Emotional Learning and School Climate Advisory Collaborative, which will develop a strategy to initiate collaborations with community-based mental health providers and support school staff in mental health and social-emotional learning. Connecticut SB 2 (Public Act No. 21-46, also enacted in June 2021) requires local boards of education to allow students to take up to four mental health days per school year.
  • Illinois: SB 818 (Public Act 102-0522, enacted August 2021) requires that health education courses for students include information on mental health.
  • Massachusetts: H 4002 (Chapter 24, enacted July 2021) appropriated funding for a pilot program for telebehavioral health services through schools.
  • North Carolina: SB 105 (SL 2021-180, enacted November 2021) allocated funding from the American Rescue Plan Act to establish a grant program for schools to hire psychologists in response to COVID-19.
  • Rhode Island: SB 31/HB 5353 (Chapter 131, enacted April 2021) requires that school staff and students receive education on suicide awareness and prevention.
  • Texas: SB 279 (enacted June 2021) requires schools to include crisis line contact information on all identification cards for students in grades six through twelve.
  • Virginia: SB 1288/HB 2299 (Chapter 452, enacted March 2021) requires that school counselors receive mental health training in order to obtain and renew their license.
  • Wisconsin: Assembly Bill 528 (enacted February 2020) established a competitive grant program to support peer-to-peer suicide prevention programs in high schools.

Mental Health Stigma and Employability

Attitudes and stigma around mental health were one of the topics addressed in a 2021 study on mental health at work published by the organization Mind Share Partners. According to the study, the country may be witnessing a subtle shift in those attitudes in the wake of the impacts of COVID-19. 

58% of respondents were willing to hire or work with someone with a mental health condition, up from 46% in 2019. 

55% of respondents believe that an employee with a mental health condition could be just as productive as one without, up from 52% in 2019. 

55% said they knew someone personally with a mental health condition, up from 50% in 2019. 

READ MORE about states addressing stigma and employability on the State Talk blog.

ACCESS TO CARE
Many states have expanded behavioral health care in Medicaid to address mental health and substance use outcomes. Many of these initiatives extend beyond Medicaid enrollees and funding. Research indicates that Medicaid expansion, and the resulting increase in mental health coverage, is associated with a decrease in suicide mortality.

Montana’s Healing and Ending Addiction through Recovery and Treatment 1115 demonstration waiver expands access to treatment and recovery services, improves transitions of care across treatment levels, and seeks Medicaid coverage for evidence-based substance use disorder treatment models and pre-release care management for individuals involved in the justice system. In another state example, North Dakota’s Medicaid 1915(i) state plan amendment, authorized by SB 2012, allows North Dakota Medicaid to pay for 12 additional home and community based services to support individuals with behavioral health conditions. The program includes policies that address rural challenges.

MENTAL HEALTH PARITY
Disparities in mental health coverage persist despite Congress passing the Mental Health Parity and Addiction Equity Act in 2008. The bill, requiring equitable coverage of mental health and substance use disorder treatment, was further bolstered by the 2010 Affordable Care Act’s requirement that most health plans cover mental health and substance use disorder care. Some forms of insurance, such as Medicare, the Veterans Administration and short-term limited duration health plans, are able to place limitations on mental health coverage and the laws don’t require parity in reimbursement rates, making it difficult or impossible to find in-network mental health care providers.

Although states must meet the minimum standards established by the MHPAEA, some have taken steps to make their laws more rigorous, to have a broader scope, or to oversee enforcement. During the 2021 and 2022 legislative sessions, at least 14 states passed parity laws: Maryland, Wyoming, Oklahoma, Montana, Oregon, Ohio, Kentucky, Missouri, Colorado, Florida, Georgia, Illinois, Nevada and Washington.

In 2021, both Ohio SB 284 and Missouri HB 604 enacted legislation requiring their state insurance directors to issue regulations and enforce the MHPAEA. And Illinois SB 0471 expanded and clarified requirements for insurers to provide timely access to treatment.

Some state’s bills expand telehealth options while others focus on oversight and reporting requirements. In Maryland, SB 3 amended the state’s telehealth law to promote coverage for mental health and substance use disorder services. Additionally, Nevada AB 181 requires providers and insurers to report suicide attempts to the chief medical officer for parity compliance.

ADDITIONAL RESOURCES
50-State Medicaid Budget Survey for Fiscal Years 2021 and 2022, Kaiser Family Foundation (VIEW)

National Alliance on Mental Illness State Legislation Report: Trends in State Mental Health Policy (2019), National Alliance on Mental Illness (VIEW)

Mental Health America State Policy Recommendations: Youth Mental Health, Mental Health America (VIEW)