The Role of State Legislative Leaders in Policymaking

By Ishara Nanayakkara

State legislative leadership roles directly impact the agendas and actions of legislatures. Although voters are responsible for electing officials, they have little direct say in who holds leadership positions within each chamber as the legislatures usually select their own leaders.

These leadership roles, such as creating the calendar or presiding over debates, allow elected officials to play a more significant role in policymaking than the typical legislator. For instance, presiding officers, such as the House speaker and Senate president, have the power to exert decisive control over legislative proceedings. They oversee the process through which legislation is referred to a committee and are responsible for setting and executing agendas.

Those holding leadership positions play explicit and implicit roles in elections by making appearances at campaign events or developing strategies to hold a majority in or change control of a chamber. Other institutional management duties consist of making committee assignments, appointing committee chairs and legislators to task forces, enforcing disciplinary measures, and overseeing staff. This means leaders have the power to advance or even stall the careers of individual legislators.

Quick Facts About Legislative Leaders

  • The late Sen. Thomas Vincent Miller Jr. served as Maryland’s president of the Senate from 1987 to 2019 and is the longest serving state senate president in the U.S.
  • The Nebraska Legislature has only one chamber, called the Unicameral, meaning there are fewer legislative leadership roles. Instead of having a speaker of the House and a president of the Senate, Nebraska has a speaker of the legislature.
  • In 26 states, the lieutenant governor serves as the president of the Senate. In other states, members of the chamber choose the president of the Senate. 
  • Lieutenant governors are usually elected, but the title in Tennessee and West Virginia is given to the member-selected Senate leader.

Overview of Legislative Leadership Roles

The president of the Senate is the primary leader of the Senate and the speaker of the House is the primary leader of the House or Assembly. Their duties for each respective body include:

  • Presiding over daily sessions.
  • Preserving order in the chamber.
  • Stating parliamentary motions.
  • Ruling on parliamentary questions.
  • Appointing committee chairs and members.
  • Referring bills to committee.
  • Signing legislation.
  • Acting as the official Senate spokesperson

President pro tempore and speaker pro tempore preside over the Senate or House and exercise all powers and duties in the absence of the Senate president or House speaker. They also carry out other duties as assigned by the Senate president or House speaker, which can vary by state. These positions may be honorary ones, but in states where the lieutenant governor presides over the Senate, the president pro tem serves as a de facto president.

The majority leader is the lead speaker for the majority party during debates. They also develop the calendar and assist the president or speaker with program development, policy formation and policy decisions.

The majority caucus chair is responsible for developing the majority caucus agenda with the president and speaker, presiding over majority caucus meetings and assisting with policy development.

The majority whip’s duties include assisting the floor leader, ensuring attendance, counting votes and communicating the position of the majority.

The minority leader serves as the principal leader of the minority caucus. They are responsible for developing the minority position, negotiating with the majority party, directing activities on the chamber floor and leading debate for the minority.

The minority caucus chair’s duties include presiding over caucus meetings and assisting the minority leader with policy development. The minority whip is responsible for assisting the minority leader on the floor, counting votes and ensuring attendance of members of the minority party.

2023 State Legislative Leaders

(as of Feb. 13, 2023)
Speaker: Nathaniel Ledbetter
Speaker Pro Tem: Chris Pringle
Majority Leader: Scott Stadthagen
Minority Leader: Anthony Daniels
Lt. Governor/President: Will Ainsworth
President Pro Tem: Greg Reed
Majority Leader: Clay Scofield
Minority Leader: Bobby Singleton
Speaker: Cathy Tilton
Majority Leader: Dan Saddler
Minority Leader: Calvin Schrage
President: Gary Stevens
Majority Leader: Cathy Giessel
Speaker: Ben Toma
Speaker Pro Tem: Travis Grantham
Majority Leader: Leo Biasiucci
Minority Leader: Andrés Cano
President: Warren Petersen
President Pro Tem: T.J. Shope
Majority Leader: Sonny Borrelli
Minority Leader: Raquel Terán
Speaker: Matthew Shepherd
Speaker Pro Tem: Jon Eubanks
Majority Leader: Marcus Richmond
Minority Leader: Tippi McCullough
President Pro Tem: Bart Hester
Majority Leader: Blake Johnson
Minority Leader: Gred Leding
Speaker: Anthony Rendon
Speaker Pro Tem: Christopher Ward Majority Leader: Eloise Reyes
Minority Leader: James Gallagher
President Pro Tem: Toni Atkins
Minority Leader: Brian Jones
Speaker: Julie McCluskie
Speaker Pro Tem: Chris deGruy
Majority Leader: Monica Duran
Minority Leader: Mike Lynch
President: Steve Fenberg
President Pro Tem: James Coleman
Majority Leader: Dominick Moreno
Minority Leader: Paul Lundeen
Speaker: Matt Ritter
Majority Leader: Jason Rojas
Minority Leader: Vincent Candelora
President Pro Tem: Martin Looney
Majority Leader: Bob Duff
Republican Leader: Kevin Kelly
DelawareSpeaker: Peter Schwartzkopf
Majority Leader: Valerie Longhurst
Minority Leader: Michael Ramone 
President Pro Tem: David Sokola
Majority Leader: Bryan Townsend
Minority Leader: Gerald Hocker
District of Columbia Chairman: Phil Mendelson
Chairman Pro Tem: Kenyan McDuffie
Speaker: Paul Renner
Speaker Pro Tem: Chuck Clemons
Majority Leader: Michael Grant
Minority Leader: Fentrice Driskill
President: Kathleen Passidomo
President Pro Tem: Dennis Baxley
Majority Leader: Ben Albritton
Minority Leader: Lauren Book
Speaker: Jon Burns
Speaker Pro Tem: Jan Jones
Majority Leader: Chuck Efstration
Minority Leader: James Beverly
Lt. Governor: Burt Jones
President Pro Tem: John Kennedy
Majority Leader: Steve Gooch
Minority Leader: Gloria Butler
Speaker: Scott Saiki
Vice Speaker: Greggor Ilagan
Majority Leader: Nadine Nakamura Minority Leader: Lauren Cheape
President: Ron Kouchi
Vice President: Michelle Kidani
Majority Leader: Dru Mamo Kanuha
Speaker: Mike Moyle
Majority Leader: Megan Blanksma
Minority Leader: Ilana Rubel
President Pro Tem: Chuck Winder
Majority Leader: Kelly Arthur Anthon
Minority Leader: Melissa Wintrow
Speaker: Chris Welch
Majority Leader: Robyn Gabel
Minority Leader: Tony McCombie
President: Don Harmon 
President Pro Tem: Bill Cunningham
Majority Leader: Kimberly Lightford
Minority Leader: John Curran
Speaker: Todd Huston
Speaker Pro Tem: Mike Karickhoff
Majority Floor Leader: Matt Lehman
Minority Leader: Phil GiaQuinta
President Pro Tempore: Rodric Bray
Majority Floor Leader: Chris Garten
Minority Floor Leader: Greg Taylor
Speaker: Pat Grassley
Speaker Pro Tem: John Wills
Majority Leader: Matt Windschitl
Minority Leader: Jennifer Konfrst
President: Amy Sinclair
President Pro Tem: Brad Zaun
Majority Leader: Jack Whitver
Minority Leader: Zach Wahls
Speaker: Dan Hawkins
Speaker Pro Tem: Blake Carpenter
Majority Leader: Chris Croft
Minority Leader: Vic Miller
President: Ty Masterson
Vice President: Rick Wilborn
Majority Leader: Larry Alley
Minority Leader: Dinah Sykes
Speaker: David Osborne
Speaker Pro Tem: David Meade
Majority Floor Leader: Steven Rudy
Minority Floor Leader: Derrick Graham
President: Robert Stivers
President Pro Tem: David Givens
Majority Floor Leader: Damon Thayer
Minority Floor Leader: Gerald Neal
Speaker: Clay Schexnayder
Speaker Pro Tem: Tanner Magee
President: Page Cortez
President Pro Tem: Beth Mizell
Speaker: Rachel Talbot Ross
Majority Leader: Maureen Terry
Minority Leader: Billy Bob Faulkingham
President: Troy Jackson
Majority Leader: Eloise Vitelli
Minority Leader: Trey Stewart
Speaker: Adrienne Jones
Speaker Pro Tem: Sheree Sample-
Majority Leader: Marc Korman
Minority Leader: Jason Buckel
President: Bill Ferguson
President Pro Tem: Malcolm Augustine
Majority Leader: Nancy King
Minority Leader: Vacant
Speaker: Ron Mariano
Minority Leader: Brad Jones
President: Karen Spilka
Minority Leader: Bruce Tarr
Speaker: Joe Tate
Speaker Pro Tem: Laurie Pohutsky
Majority Floor Leader: Abraham Aiyash
Minority Leader: Matt Hall
President Pro Tem: Jeremy Moss
Majority Leader: Winnie Brinks
Minority Leader: Aric Nesbitt
Speaker: Melissa Hortman Speaker Pro Tem: Dan Wolgamott
Majority Leader: Jamie Long
Minority Leader: Lisa Demuth
President: Bobby Joe Champion
President Pro Tempore: Ann Rest
Majority Leader: Kari Dziedzic
Minority Leader: Mark Johnson
Speaker: Philip Gunn
Speaker Pro Tem: Jason White
Lt. Governor/President: Delbert
President Pro Tem: Dean Kirby
Speaker: Dean Plocher
Speaker Pro Tem: Mike Henderson
Majority Floor Leader: Jon Patterson
Minority Floor Leader: Crystal Quade
President Pro Tem: Caleb Rowden
Majority Floor Leader: Cindy O’Laughlin
Minority Floor Leader: John Rizzo
Speaker: Matt Regier
Speaker Pro Tem: Rhonda Knudsen
Majority Leader: Sue Vinton
Minority Leader: Kim Abbott
President: Jason Ellsworth
President Pro Tem: Kenneth Bogner
Majority Leader: Steve Fitzpatrick
Minority Leader: Pat Flowers
NebraskaUnicameralSpeaker: John Arch
Speaker: Steve Yeager
Speaker Pro Tem: Daniele Monroe-
Majority Floor Leader: Sandra Jaurgui Minority Floor Leader: P.K. O’Neill
President: Stavros Anthony
President Pro Tem: Pat Spearman
Majority Leader: Nicole Cannizzaro
Minority Leader: Heidi Seevers Gansert
New Hampshire
Speaker: Sherman Packard 
Speaker Pro Tem: Laurie Sanborn
Majority Leader: Jason Osborne
Minority Leader: Matthew Wilhelm
President: Jeb Bradley
President Pro Tem: James Gray
Majority Leader: Sharon Carson
Minority Leader: Donna Soucy
New Jersey
Speaker: Craig Coughlin
Speaker Pro Tem: Benjie Wimberly
Majority Leader: Louis Greenwald
Republican Leader: John DiMaio
President: Nicholas Scutari
President Pro Tem: Sandra Cunningham
Majority Leader: M. Teresa Ruiz
Minority Leader: Steve Oroho
New Mexico
Speaker: Javier Martinez
Majority Floor Leader: Gail Chasey
Minority Floor Leader: Ryan Lane
President Pro Tem: Mimi Stewart
Majority Floor Leader: Peter Wirth
Minority Floor Leader: Gregory Baca
New York
Speaker: Carl Heastie
Speaker Pro Tem: Jeffrion Aubry
Majority Leader: Crystal Peoples-Stokes
Minority Leader: William Barclay
President Pro Tempore/Majority Leader:
Andrea Stewart-Cousins
Minority Leader: Rob Ortt 
North Carolina
Speaker: Tim Moore
Speaker Pro Tem: Sarah Stevens
Majority Leader: John Bell
Minority Leader: Robert Reives
President Pro Tem: Phil Berger
Majority Leader: Paul Newton
Minority Leader: Dan Blue
North Dakota
Speaker: Dennis Johnson
Majority Leader: Mike Lefor
Minority Leader: Josh Boschee
President Pro Tem: Donald Schaible
Majority Leader: David Hogue
Minority Leader: Kathy Hogan
Speaker: Jason Stephens
Speaker Pro Tem: Scott Oelslager
Majority Floor Leader: Bill Seitz
Minority Leader: Allison Russo
President: Matt Huffman
President Pro Tem: Kirk Schuring
Majority Floor Leader: Rob McColley
Minority Leader: Nickie J. Antonio
Speaker: Charles McCall
Speaker Pro Tem: Kyle Hilbert
Majority Floor Leader: Jon Echols
Minority Leader: Cyndi Munson
President Pro Tem: Greg Treat
Majority Floor Leader: Greg McCortney
Minority Floor Leader: Kay Floyd
Speaker: Dan Rayfield
Speaker Pro Tem: Paul Holvey
Majority Leader: Julie Fahey
Minority Leader: Vikki Breese-Iverson
President: Rob Wagner
President Pro Tem: James Manning Jr.
Majority Leader: Kate Lieber
Minority Leader: Tim Knopp
Speaker: Mark Rozzi
Republican Leader: Bryan Cutler
Minority Leader: Joanna McClinton
President Pro Tem: Kim Ward
Majority Leader: Joe Pittman
Minority Leader: Jay Costa
Rhode Island
Speaker: K. Joseph Shekarchi 
Speaker Pro Tem: Brian Patrick Kennedy
Majority Leader: Christopher
Minority Leader: Michael Chippendale
President: Dominick Ruggerio 
President Pro Tem: Hanna Gallo
Majority Leader: Ryan Pearson
Minority Leader: Jessica de la Cruz
South Carolina
Speaker: G. Murrell Smith Jr.
Speaker Pro Tem: Tommy Pope
Majority Leader: David Hiott
Minority Leader: J. Todd Rutherford
President: Thomas Alexander
Majority Leader: A. Shane Massey
Minority Leader: Brad Hutto
South Dakota
Speaker: Hugh Bartels
Speaker Pro Tem: Mike Stevens
Majority Leader: Will Mortenson
Minority Leader: Oren Lesmeister
President Pro Tem: Lee Schoenbeck
Majority Leader: Casey Crabtree
Minority Leader: Reynold Nesiba
Speaker: Cameron Sexton
Speaker Pro Tem: Pat Marsh
Majority Leader: William Lamberth
Minority Leader: Karen Camper
Lt. Governor/Speaker of the Senate: Randy
Speaker Pro Tem: Ferrell Haile
Majority Leader: Jack Johnson
Minority Leader: Raumesh Akbari
Speaker: Dade Phelan
Speaker Pro Tem: Vacant
Lt. Governor/President: Dan Patrick
President Pro Tempore: Kelly Hancock
Speaker: Brad Wilson
Majority Leader: Mike Schultz
Minority Leader: Angela Romero
President: Stuart Adams
President Pro Tem: Wayne Harper
Majority Leader: Evan Vickers
Minority Leader: Luz Escamilla
Speaker: Jill Krowinski
Majority Leader: Emily Long
Minority Leader: Patricia McCoy
President Pro Tem: Philip Baruth
Majority Leader: Alison Clarkson
Minority Leader: Randy Brock
Speaker: Todd Gilbert
Majority Leader: Terry Kilgore
Minority Leader: Don Scott Jr.
President Pro Tem: Louise Lucas
Majority Leader: Richard Saslaw
Minority Leader: Thomas Norment Jr.
Speaker: Laurie Jinkins
Speaker Pro Tem: Tina Orwall 
Majority Leader: Joe Fitzgibbon
Minority Leader: J.T. Wilcox 
President Pro Tem: Karen Keiser
Vice President Pro Tem: John Lovick
Majority Leader: Andy Billig
Minority Leader: John Braun
West Virginia
Speaker: Roger Hanshaw
Speaker Pro Tempore: Paul Espinosa
Majority Leader: Eric Householder
Minority Leader: Doug Skaff
Senate President: Craig Blair
President Pro Tempore: Donna Boley
Majority Leader: Tom Takubo
Minority Leader: Mike Woelfel
Speaker: Robin Vos
Speaker Pro Tem: Kevin Petersen
Majority Leader: Tyler August
Minority Leader: Greta Neubauer
President: Chris Kapenga
President Pro Tem: Patrick Testin
Majority Leader: Devin LeMahieu
Minority Leader: Melissa Agard
Speaker: Albert Sommers
Speaker Pro Tem: Clark Stith
Majority Floor Leader: Chip Neiman
Minority Floor Leader: Mike Yin
President: Ogden Driskill
Vice President: Dave Kinksey
Majority Floor Leader: Larry Hicks
Minority Floor Leader: Chris Rothfuss
American SamoaSpeaker: Savali Talavou AlePresident: Tuaolo Fruean
GuamUnicameralSpeaker: Therese Terlaje
Vice-Speaker: Tina Rose Muña Barnes
Minority Leader: Frank F. Blas Jr.
Northern Mariana IslandsSpeaker: Edmund S. Villagomez
Vice Speaker: Joel Castro Camacho Majority Floor Leader: Edwin Kenneth
President: Victor Borja Hocog
Vice President: Jude Untalan Hofschneider Majority Floor Leader: Justo Songao
Puerto RicoSpeaker: Rafael “Tatito” Hernández
Speaker Pro Tem: José M. Varela
Majority Leader: Angel Matos Garcia
Minority Leader: Carlos “Johnny”
Mendez Nunez
President: José Luis Dalmau-Santiago
Vice President: Marially González Huertas
Majority Leader: Javier Aponte Dalmau
Minority Leader: Thomas Rivera Schatz
U.S. Virgin IslandsUnicameralPresident: Novelle Francis Jr.
Vice President: Marvin Bylden
Source: CSG, National Conference of State Legislatures

State Approaches to Marijuana Policy

By Blair Lozier, Valerie Newberg and Dr. Dakota Thomas

The adoption of varying types of policy addressing marijuana legality continues in many states despite the drug remaining a controlled substance at the federal level. As of 2023, 20 states and the District of Columbia have legalized the recreational adult use of marijuana. By contrast, there are 20 other states to have decriminalized marijuana-related offenses such as small quantity marijuana possession, cultivation and transfer.

Legalizing marijuana allows states to create an adult-use market for cannabis products that is both regulated and taxes, whereas decriminalization typically results in the removal of criminal penalties and the possibility of incarceration for low-level marijuana offenses. Several states that moved to decriminalize or legalize marijuana have also implemented policies allowing for the expungement of low-level marijuana offenses.

State marijuana policy is enacted through legislative and executive action, or by registered voters. The legalized use of recreational marijuana was decided by voters in five states during the 2022 election. Two of those five states voted in its favor. Marijuana remains illegal in federal law and regulations, though President Joe Biden has proposed changes to this policy.

Hovering your mouse over a state will display more information about that state’s policy. Hovering your mouse over a legend category will display all states sharing the highlighted policy.

NOTE: The map shows only the highest level of legalization or decriminalization, which may only apply to specific offenses. Some states have only legalized or decriminalized possession for up to a specific amount, for example, while other related charges are subject to different rules. 

States have taken four main approaches to marijuana policy: full criminalization, legalization of medical marijuana, recreational decriminalization and recreational legalization. Marijuana remains entirely illegal in four states, with criminal penalties for its sale, possession and use. Seven states have legalized medicinal use of CBD oil with THC but no other forms of marijuana, while eight states have legalized all forms of marijuana for medicinal purposes. Twenty states have decriminalized possession/use of marijuana under certain conditions, typically meaning possession of small quantities of marijuana will not result in incarceration or criminal record for first-time offenders. Finally, 21 states have fully legalized recreational use of marijuana, thus allowing the creation of a regulated, recreational adult-use marijuana market that is taxed by the state. Each of these approaches is broken down in the following sections.

Decriminalization of Recreational Use
Decriminalization of recreational marijuana is a step short of legalization and entails removing criminal sanctions from marijuana possession/use while the drug remains illegal. Twenty states have decriminalized recreational marijuana. The drug is still illegal but punishment is not a criminal sanction like incarceration or criminal record for first time offenders. Instead, offenders may pay a civil fine or attend required treatment/education.

Legalization of Medical Use
As of December 2022, 16 states have legalized only medical use of marijuana. These states consist of Alabama, Arkansas, Delaware, Florida, Hawaii, Louisiana, Minnesota, Mississippi, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Dakota, Utah and West Virginia. In these states, a qualified individual must be diagnosed with a condition whose symptoms can be clinically treated by marijuana, such as those associated with HIV/AIDS, PTSD, glaucoma and other conditions, and receive a medical marijuana certificate.

Recreational Legalization
There are 21 states that have legalized the recreational use of marijuana. In most of these states, consumers can legally purchase marijuana products from a state-licensed and regulated facility. Use of marijuana products in public may remain punishable by law and there may be limits on possession of high quantities of marijuana. Additionally, the federal government still prosecutes marijuana offenses such as the illicit sale of marijuana (including to minors and across state lines), drugged driving and possession of marijuana on federal property in states with legal recreational use laws.

Hovering your mouse over a state will display more information about that state’s expungement policy. Hovering your mouse over a legend category will display all states sharing the highlighted policy.

Expungement Policy for Marijuana Charges
In some states where marijuana is decriminalized or legalized, the law allows for prior criminal convictions for low-level marijuana offenses to be expunged. Expungement is the legal process by which the record of a criminal conviction is destroyed or sealed from state and/or federal records. Twenty-four states and the District of Columbia have passed legislation allowing courts to expunge eligible marijuana convictions, with six of those states requiring automatic expungement for all qualifying convictions.

Recent State Changes to Marijuana Legality
In the 2022 election, five states had marijuana legalization measures on the ballot. Missouri and Maryland voted to legalize recreational use, while Arkansas, North Dakota and South Dakota voted against full recreational legalization. Medicinal uses will remain permitted in those states.

  • Arkansas voters rejected a ballot measure that would have legalized the recreational adult use of marijuana.
  • North Dakota’s citizens voted against legalizing the recreational adult use of marijuana.
  • South Dakota voters decided against legalizing the possession, distribution and recreational use of marijuana for persons 21 years and older.
  • Maryland voters approved the measure legalizing marijuana for adults 21 years and older. This ballot will allow the state Legislature to pass laws for the use, distribution, regulation and taxation of marijuana.
  • Missouri voters approved the legalization of marijuana. The amendment (1) legalized the purchase, possession, consumption, use, delivery, manufacture and sale of marijuana for person use for adults at last 21 years or older, (2) enacted a 6% tax on the retail price of recreational marijuana, and (3) allowed convicted persons with certain marijuana-related offenses to petition for release from prison, parole and probation, while also having their records expunged.

Federal Marijuana Policy
While many states have legalized, decriminalized or allowed use of marijuana in medicine, it remains illegal at the federal level and is considered a Schedule I drug, the most restrictive classification given by the Drug Enforcement Administration for substances with no accepted medical use and a high potential for abuse.

In October 2022, President Biden moved to decriminalize marijuana possession at the federal level through a three-step approach that began by pardoning all prior federal offenses of simple possession of marijuana. As of Dec. 2, 2022, Attorney General Merrick Garland is developing an administrative process to pardon eligible individuals. President Biden then urged state governors to issue similar pardons for state possession offenses. The president’s third step tasked the Department of Health and Human Services with declassifying or reclassifying marijuana as a controlled substance under federal law by petitioning the attorney general and the Food and Drug Administration for review of its risks and clinical benefits.

If marijuana is determined to have medical use and a lower level of potential for abuse and dependence, it may be reclassified or declassified entirely. However, President Biden stated that important limitations on trafficking, marketing and sales to minors should remain in place. As of February 2023, the FDA has not approved the cannabis plant for medical use.

Additional Resources
Cannabis Regulators Association:

State Approaches to Address Homelessness and Increase Affordable Housing

By Jennifer Horton

The U.S. has a shortage of affordable and available rental homes for extremely low-income households — those whose incomes are 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.

In 2022, a person working full time in the U.S. needed to earn $25.82 an hour on average to afford a modest, two-bedroom rental home — $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.

The pandemic also had a negative impact on the nationwide poverty rate, with the number of people living in poverty increasing by 3.3 million in 2020, leaving 11.4% of the population in poverty, struggling to avoid basic necessities like housing and putting them at risk of homelessness.

As of January 2020, the most recent date for which comprehensive data is available due to disruptions in surveying during the pandemic, there were 580,466 people experiencing homelessness in the United States. While this number has been steadily increasing since 2016, some subgroups of the overall homeless population, such as homeless veterans and homeless families with children, have seen significant reductions in homelessness. This is due, in part, to increased attention and resources, showing that reductions in homelessness are possible.

Rates of homelessness vary widely across the states. New York state has the highest rate at 46.9-per-100,000, while Mississippi has the lowest at 3.7-per-100,000. In some instances, the high rates could be attributed to high housing costs, while in others it could be attributed to high rates of poverty. Such nuances facing each state suggest a need for a variety of solutions.

Legislators have taken a range of approaches to address homelessness and increase affordable housing, including transitional housing, changing zoning laws and streamlining the development review process.  


Housing First
Housing First (HF) 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 HF 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 families who became homeless due to a temporary crisis and chronically homeless individuals. The U.S. Department of Veterans Affairs cites HF as a best practice and uses it in its Housing and Urban Development Veterans Affairs Supportive Housing (HUD-VASH) program which currently serves almost 90,000 veterans across the U.S.

There are two common models that utilize the HF approach depending on a person’s needs and whether they need long or short-term assistance. One model, permanent supportive housing, provides long-term rental assistance and supportive services to individuals with chronic illnesses, disabilities, mental health issues, or substance use disorders 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.

Research indicates people assisted through the HF 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 also be cost-efficient, generating savings through reduced usage of emergency services, hospitals, jails and emergency shelters.

Through city council resolution number 20110728-031 passed in 2010, the city of Austin, Texas, directed the city manager to develop a comprehensive strategy to construct and operate permanent supportive housing units and prioritized the city’s affordable housing resources, including local and federal funding, for permanent supportive housing (PSH). Elected officials also pledged to create 350 housing units for those most vulnerable to homelessness by 2014. The goal was surpassed, leading to the passage of resolution number 20141002-043, which established PSH as the primary intervention to end homelessness in the city and set another target of 400 additional PSH units in four years.  

California SB 1380 (2016) required all housing programs in the state to adopt the HF model, which it defined with specific core components

Transitional Housing
Some states have paired rapid re-housing with Critical Time Intervention (CTI). Referred to as Critical Time Intervention for Rapid Re-Housing (CTI-RRH), the evidence-based model provides support for vulnerable individuals during periods of transition by facilitating housing stability, community integration and continuity of care. CTI has successfully supported a return to housing for people in a variety of situations, including those with serious mental illness, veterans and others experiencing homelessness.

Several states have implemented CTI-RRH or some form of transitional housing to prevent homelessness in vulnerable populations.

California CA A 592 (2021) requires a transitional housing unit with a host family to include supervised transitional housing services provided by the licensed transitional housing placement provider and authorized a transitional housing placement provider to provide supportive services to a non-minor dependent placed in a certified family home or resource family of a foster family agency if that provider signs a memorandum of understanding with the foster family agency.

In 2010, Connecticut leveraged the American Recovery and Reinvestment Act’s Homelessness Prevention and Rapid Re-Housing Program (HPRP) to expand its rapid re-housing services, re-housing 3,100 people in more than 1,600 households in three years. The Connecticut Coalition to End Homelessness looked at the outcomes for these 3,100 people and found that 82% of singles and 95% of families had not returned to a state shelter three years after being housed. Currently, the state’s Department of Housing’s rapid re-housing programs are conducting a pilot program directed by the National Alliance to End Homelessness and the Center for the Advancement of CTI implementing CTI as a way to prepare individuals for independent living.

The state’s Department of Housing was established by Public Act 12-1 as the lead agency for all housing-related matters, including housing development, community development, housing affordability, and individual and family support programming, and provides assistance funds to a wide variety of programs utilizing rapid re-housing and other methods to address homelessness.

Hawaii S 471 (2019) appropriated funds to homeless programs, including outreach, rapid re-housing, the Housing First Program, family assessment centers, law enforcement-assisted diversion programs, and coordinated statewide homelessness initiatives, and established and appropriated funds for a long-term rental assistance pilot program for certain categories.

New Hampshire HB 400 (2017) instructed the department of health and human services to develop a 10-year plan for mental health services, the findings of which were released in 2019 and led to the launch of a statewide CTI program designed to connect people discharging from psychiatric hospitalization with services and supports. The nine-month, no-cost program provides participants with help securing housing, finding employment, and arranging additional mental health and social supports to improve quality of life and prevent homelessness and/or readmission.

The Veterans Administration (VA) has developed a CTI toolkit to assist in the implementation and evaluation of CTI across 32 sites in seven regions over four years. While homelessness has been trending upward in recent years, veteran homelessness has gone down by 47% since 2009. Three states and 83 communities have announced they’ve ended veteran homelessness, defined as having systems in place that ensure homelessness is prevented or is rare, brief and occurs only once.

Washington WA H 1860 (2022) seeks to prevent homelessness among persons discharging from inpatient behavioral health settings, in part by mandating housing-related care coordination services.

West Virginia WV H 3304 (2021) authorized the Division of Corrections and Rehabilitation to establish a Reentry and Transitional Housing Program.

Affordable Housing

Zoning Changes to Facilitate the Construction of Higher-Density Housing
Florida Statute 163.31771 (2021) 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.

Streamlining Development Review Process
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.  

Iowa House File 772 (2019) amended the administration of the workforce housing tax incentive program, allocating $10 million to qualified housing projects in small cities located in counties that have been declared a major disaster and where individuals are eligible for federal individual assistance.  

Additional Resources

State Actions to Improve Health Care

By Jennifer Horton

Location can be crucial in determining a patient’s experience with the U.S. health care system. For example, residents of Texas are six-times more likely to be uninsured than those living in Massachusetts. In Utah, the rate of premature death from preventable causes in adults under 75 is half that of West Virginia.

The Commonwealth Fund’s Scorecard on State Health System Performance, which provided the aforementioned data, assesses state performance across several measures, including overall health outcomes, access and affordability, and prevention and treatment. The 2022 scorecard was the first to assess the impact of the COVID-19 pandemic on Americans’ health.

While all states suffered, the impact of COVID-19 depended on how stable a state’s public health foundations were before the pandemic began. States with stronger health systems, indicated by low uninsured rates, strong primary care capacity and effective care management, experienced lower rates of preventable deaths due to COVID-19 and had healthier populations. The health of a population is marked by rates of premature death, health status, health risk behaviors and other factors.

To address health care deficits — some that predated the pandemic and those that were created by it — states are taking a wide variety of policy approaches, including expanding access to care, improving maternal health outcomes, reducing the cost of prescription drugs and expanding direct care.

Access to Care 

Opponents of Medicaid expansion object to the lack of a work requirement for eligible parties and worry an expansion could impact a state’s budget, among other concerns. The federal government covers 90% of the cost of Medicaid coverage for adults under the expansion, leaving states to pay the remaining 10%. The American Rescue Plan Act of 2021 offered states an additional fiscal incentive to implement the expansion by increasing the federal match to 95% for two years, an estimated net benefit of $9.6 billion to the eligible states, but no states accepted the offer. Proponents pushed back on economic concerns caused by the potential influx of federal dollars on local economies, citing analyses conducted by expansion states suggesting the expansion actually reduced total state spending.

In 2014, the Affordable Care Act gave states the option to expand Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level and provided states with an enhanced federal matching rate. As of December 2022, all but 11 states had adopted the expansion. An analysis by the Kaiser Family Foundation revealed states that adopted the expansion experienced budget savings, revenue gains and overall economic growth. Research indicated the expansion also improved access to care, affordability, utilization of services and led to coverage gains and reductions in the number of uninsured citizens, particularly among low-income and vulnerable populations.

While the debate continues, several states took action to expand Medicaid or make enrollment easier:

  • In January 2016, Gov. John Bel Edwards signed executive order JBE16-01, instructing the Louisiana Department of Health and Hospitals to expand Medicaid to adults who are ages 19-64, have an income less than 138% of the federal poverty rate, do not already qualify for Medicaid or Medicare, and meet the citizenship requirement. The state’s Medicaid Expansion Dashboard compiles data on the order’s impact on residents and access to health services.
  • Maryland Senate Bill 802 (2019) established the Easy Enrollment Program, allowing state residents to indicate their interest and facilitate enrolling in Medicaid, the Children’s Health Insurance Plan or subsidized exchange coverage by checking a box on their tax return.
  • Utah House Bill 3 (2022) directed $3 million to establish the One Utah Health Collaborative, an initiative designed to reduce health care costs, improve health outcomes, close gaps in health care and improve quality of life through a public-private partnership centered on patient needs.
  • Washington Senate Bill 5526 (2019) established “Cascade Care,” a semi-public option health care plan offering premium subsidies to allow individuals whose incomes are less than 500% of the federal poverty level to purchase individual market coverage on the state health benefit exchange.

Maternal Health 

Roughly 700 women die each year from pregnancy-related causes in the U.S., resulting in the highest maternal mortality rate among all developed countries. In 2018, the latest available year of data, the national average was 17.3 pregnancy-related deaths per 100,000 live births. But the averages cover up crucial differences in sub-populations: Black people are three times more likely to die in childbirth than white people. Some states have taken steps to address racial disparities in maternal mortality rates:

  • California Senate Bill 464 and Maryland House Bill 837 require health care professionals involved in perinatal care to undergo an evidence-based training program.

States have approached improving the maternal mortality rate from a variety of angles, including doula care, home visiting programs and workforce training.

Research shows pregnant people who receive doula care are more likely to have healthy birth outcomes and positive birth experiences. Medicaid reimbursement for doula services can increase access to health care and strengthen birth outcomes for Black people experiencing pregnancy.

  • Minnesota (SPA 14-07, 2014), New Jersey (SPA 20-0011, 2021), Oregon (SPA 17-0006, 2017) and Virginia (SPA 21-0013, 2021) reimburse doulas as an optional Medicaid benefit. A chart summarizing the components of each state’s Medicaid doula benefits can be viewed here.

Home visiting programs, which helps deliver babies and connect pregnant people and new parents to social, health and educational services, are another strategy for improving health outcomes. Studies show the programs can reduce child abuse and domestic violence and improve maternal and child health outcomes while also delivering long-term cost savings. Federal funding is available to support home visiting services in the U.S., with at least 20 states using Medicaid to support their programs.

  • New Jersey Senate Bill 690 and Oregon Senate Bill 526 established voluntary statewide home visiting programs providing free services to support healthy child development, strengthen families and provide parenting skills. 

Prescription Drug Pricing 

At least twenty states have enacted co-payment caps to reduce the cost of insulin, with most caps only applying to people with private insurance. Minnesota is one of the only states with a co-payment cap for the uninsured and requires insulin manufacturers to provide universal discounts. Other states take different approaches to help make prescription drugs like insulin more affordable, as shown in Table 1 below.


State Actions To Make Prescription Drugs More Affordable

StateBill or ActionStatusSummary
AlabamaHouse Bill 2492021 EnactedRequired a health benefit plan that provides coverage for prescription insulin to cap the total amount of any cost sharing or co-payment, without regard to the policy deductible, regardless of the amount or type of insulin needed.
CaliforniaState Budget2022-2023 EnactedAllocated $100 million to launch an effort allowing the state to contract and make its own insulin at a lower price.
IllinoisHouse Bill 1192021 EnactedFormalized the legal process for donating unused prescription drugs to certified pharmacies or health departments for reuse by eligible populations.
KentuckyHouse Bill 952014 EnactedCapped the cost-sharing requirements for prescription insulin.
LouisianaSenate Bill 1652014 EnactedRequired health benefit plans that cover prescription drugs and use a specialty drug tier to cap copayments or coinsurance.
Maryland House Bill 7612014 EnactedCapped copayments and coinsurance for specialty prescription drugs.
MinnesotaHouse File 31002020 EnactedCreated the Insulin Safety Net Program, allowing eligible individuals to receive a free 30-day supply of insulin in an emergency and caps the insulin copayment for a 90-day supply at $50.
OklahomaHouse Bill 10192021 EnactedCapped cost sharing for a 30-day supply of covered prescription insulin. The bill also requires insurers to provide coverage for equipment and supplies for the treatment and management of diabetes.

Direct Care Direct Care Workers, a broad umbrella term that includes personal care aides, home health aides and nursing assistants, who support older adults and people with disabilities, comprise the largest workforce in most states and provide essential support to millions of people in a variety of settings. Currently, both a worker shortage and an inability to meet the growing demand for long-term services and support hinders the field’s growth. States approach the long-term care crisis from a variety of angles:

  • New Jersey Senate Bill 3847 (2020) established a program allowing a family member or approved individual of an enrollee in Medicaid or NJ Family Care who is under 21 years old to be certified as a certified nursing assistant and provide services to the enrollee under the established reimbursement rates.
  • Washington state’s Long Term Services and Supports Trust Act (2019) established the WA Cares Fund, a long term care insurance benefit for all eligible Washington state residents to address the future long-term care crisis. The law provides individuals with access to a lifetime benefit amount up to $36,500.

Additional Resources

Bridging the Gap Between Policy and Technology: Statewide Data Privacy Laws

By Caroline Wills

The need for critical data privacy and protection laws continues to increase in the digital era, where sensitive information can be compromised due to data breaches or collected by third-party companies without consent.

According to the United Nations Conference on Trade and Development, 137 out of 194 countries have passed laws ensuring personal data and information collected by third-party organizations and individuals is secured and protected. As of January 2023, the United States has no single comprehensive personal data protection law. In absence of a comprehensive federal privacy law, state and federal legislators have passed hundreds of data privacy and protection laws related to sector or specific kinds of data.

Given the rapid pace of digital innovation and advancement, and the relatively slow process of passing legislation, addressing data privacy in the U.S. is often reactive rather than proactive. As conversations about data privacy and the business that collect, store and sell users’ personal data become more common, Americans are growing concerned and confused about the safety and security of their personal data. The PEW Research Center found in 2019 that 75% of Americans think there should be more government regulations on what companies can do with personal data.

What are data privacy laws and why are they important?
Data privacy laws are federal or state laws or regulations that provide a legal framework on the protection and privacy of personal data in how companies, organizations and individuals collect, store and use personal information or data. The Health Insurance Portability and Accountability Act of 1996 and the Family Educational Rights and Privacy Act of 1974 are federally mandated data privacy laws designed to secure and protect personal data within the health care and education sectors. These acts specify how certain data is stored, who has access to it, and who is allowed to release it under what circumstances.

Data privacy laws and regulations are important to secure and protect vulnerable and sensitive personal data and information. With personal data being weaponized and misused, from widespread data breaches to cyberattacks, data privacy and integrity laws are essential to safeguarding the fundamental individual right of privacy and freedom in the digital world. Policy solutions to data privacy concerns in the U.S. include allowing consumers to access and delete their personal information, opt out of having their data sold to third parties, and consumers getting immediately notified after a data breach.

States with Comprehensive Data Privacy Laws
In 2023, there are five states that have passed comprehensive legislation to secure data privacy: California, Colorado, Connecticut, Utah and Virginia.


  • The California Consumer Privacy Act of 2018 (CCPA) allows California consumers to have more control over their personal information collected by businesses. The CCPA allows customers the right to ask companies to reveal any personal information they may have on them, as well as the complete list of third parties with whom their data has been disclosed. CCPA also permits consumers the ability to opt out of the sale of their personal data and delete any personal information the company may have collected. CCPA also ensures that companies cannot discriminate against consumers who exercise these rights.
  • The California Privacy Rights Act (CPRA), also known as Proposition 25, effective January 2023 through the enforcement of the California Privacy Protection Agency, amends and expands the California Consumer Privacy Act. According to, the Consumer Privacy Right Act gives specific provisions to CCPA and consumer data protections including the right:
    • For consumers to correct inaccurate personal information.
    • For personal data collected by firms subject to purpose limitations and data minimization.
      • Definitions:
        • Purpose Limitations — Personal data collected must be for a specific and legitimate purpose or objective and may not be used for a different purpose.
        • Data Minimization — Limiting and restricting data collection for what is necessary for a specified purpose.
    • To opt out of a firm’s uses and disclosures of sensitive personal information — health, specified demographic, personal communication information, geolocation and more.


  • Colorado SB 21-90 (2021) establishes the Colorado Privacy Act within the Colorado Consumer Protection Act, effective July 1, 2023. The Colorado Privacy Act regulates and protects the collection, use and dissemination of a consumer’s personal data collected by companies operating in Colorado. It also authorizes the attorney general and district attorney to enforce the law and violations of SB 190 (2021), and defines terms relevant to the Colorado Privacy Act.


  • The Connecticut Personal Data Privacy and Online Monitoring Act (Public Act 22-15), effective July 1, 2023, offers a comprehensive framework of consumer data protections in how personal data is controlled and processed by companies. Public Act 22-15, like other state data privacy laws, allows consumers to obtain a copy of their personal data, correct inaccurate information and opt out in a company’s selling or sharing of their information.


  • The Utah Consumer Privacy Act, SB 227 (2022), is effective Dec. 31, 2023, and grants consumers the right to know what personal information a firm collects, how the data is used and if their information is sold to third parties. Utah SB 225 (2022) safeguards consumers’ personal data by allowing consumers to access and delete their information and opt out of data collection.
  • The Utah Consumer Privacy Act provides companies with guidelines and regulations of how to protect consumer data and is enforced by the attorney general.


  • The Virginia Consumer Data Protection Act, effective Jan. 1, 2023, establishes a framework for how businesses control and process data in the Commonwealth. The bill outlines responsibilities and privacy protection standards for data controllers and processors. This bill also allows consumers the ability to access, delete, correct their data, obtain a copy of their data and opt out of the processing of personal data for advertising purposes. The Consumer Data Protection Act only applies to non-government companies that (I) control or process data of at least 100,000 consumers, or (II) earn over half of their gross revenue from the sale of personal data of at least 25,000 consumers. This law is exclusively enforced by the attorney general and the Consumer Privacy Fund.

Data privacy laws are necessary in the digital age for allowing individuals the right to have control over their personal information and making informed decisions about who has access to their data. Michigan, New Jersey, Ohio and Pennsylvania have proposed comprehensive data privacy laws using previously enacted laws as model legislation. With states enacting data privacy and protection laws to protect individual liberties, policymakers can close the gap between technology and public policy.

Additional Resources

State Executive Salaries: Regional and State-level Comparisons

By Caroline Wills and Rebecca Halpryn

The annual salaries for the five highest-ranking state-level executive positions- governor, lieutenant governor, secretary of state, attorney general and treasurer- have considerable variation. CSG’s annual publication The Book of the States is a comprehensive resource for state policymakers containing in-depth information that is comparable to all 50 states on a variety of major aspects of state government operations. Within The Book of the States, Table 4.11 “Selected State Administrative Officials: Annual Salaries” provides the annual salaries for selected state administrative officials in all 50 states. The Council of State Governments collects this data annually by surveying state executive branches.  

Overview of State Executive Positions

In state governments, governors are directly elected by constituents to head the executive branch. Governors are responsible for managing state executive branches and overseeing the implementation of state laws. On behalf of the state, governors serve as intergovernmental liaisons to the federal government. Additional powers and duties by state for governors can be found in Table 4.4 and 4.5.

The lieutenant governor serves as the second-highest executive office, is usually subordinate to the governor, and typically assumes the gubernatorial role when governor is absent from office. Arizona, Maine, New Hampshire, Oregon and Wyoming do not have a lieutenant governor position. More information about the lieutenant governor’s powers and duties are available within Table 4.14 in The Book of the States.

The secretary of state is usually the third in the line of succession and is responsible for overseeing all state and local elections within a state. The secretary of state in an executive state branch also has additional registration, custodial, publication, legislative and administrative powers and duties (The Book of the States: Table 4.17 & 4.18). In Alaska, Hawaii and Utah, the secretary of state position does not exist. In Utah and Alaska, the lieutenant governor takes on most of the duties of the secretary of state.

The state attorney general (The Book of the States: Tables 4.21, 4.22, & 4.23) serves as the chief legal officer and law enforcement within a state advocating for the public interest by representing their state legislature and agencies. In a majority of states, the attorney general has significant influence on how a state undertakes law enforcement procedures and services.

In an executive office, the treasurer (The Book of the States: Table 4.26) typically serves as a state’s chief financial officer by overseeing a state’s revenue and finances responsible for ensuring the safety and security of a state’s money. In Florida, Hawaii, Minnesota, Montana and Texas, the treasurer’s duties are taken on by other officials.  

The average annual gubernatorial salary across all 50 states in 2022 is $148,939, a 4.12% increase from 2021. At the state-level, New York has the highest gubernatorial salary at $250,000 whereas Maine has the lowest gubernatorial salary at $70,000. Computing the average gubernatorial salary by CSG region shows that governors in the East region earn the highest salary, $170,545, on average compared to the other regions, South, $149,060, Midwest, $139,520 and West, $138,487. The difference between the highest and lowest regional averages for the annual gubernatorial salary is $32,508, whereas the difference between New York and Maine is $180,000.

The average annual lieutenant gubernatorial salary across the 45 states with lieutenant governors in 2022 is $108,380, a 0.28% decrease from 2021. New York has the highest lieutenant governor salary at $220,000 compared to Texas, which has the lowest salary at $7,200. The highest-paid lieutenant governor earns $212,800 more per year than the lowest-paid lieutenant governor. The CSG East region has the highest average lieutenant gubernatorial salary at $142,922 compared to the CSG South region, which has the lowest average salary at $78,274. This is a difference of $64,648.

Across all 47 states, the 2022 average salary for the secretary of state position is $121,628, a 2.95% annual increase from 2021. Arizona has the lowest annual salary at $70,000 while Tennessee has the highest salary at $222,252 for the secretary of state position. The CSG region with the highest average salary for a secretary of state is the Eastern region at $137,041, and the CSG region with the lowest is the Midwestern region at $103,946. 

The average salary for state attorney general in 2022 is $139,075 across all 50 states, a 1.05% annual increase from 2021. Oregon has the lowest annual salary for an attorney general at $82,220 and New York has the highest salary at $220,000. The difference between New York and Oregon is $137,780. A CSG regional analysis indicates the Eastern region has the highest average salary for the attorney general position, $155,126, while the Midwestern region has the lowest at $125,841. 

The average annual salary for treasurer in 2022 across all 45 states is $126,015, a 2.15% increase from $123,358 in 2021. The state with the lowest salary for Treasurer is Arizona at $70,000 and the state with the highest salary is Tennessee at $222,252. The CSG East region has the highest average salary, $143,298, for the treasurer position while the Midwest region has the lowest, $110,124. 

Data notes:

  • Annual salaries reported do not include benefits and other compensation for selected state officeholders. General wage and salary adjustments for officials within states’ executive branches are automatically increased with the rate of inflation or must be negotiated and legislatively approved.  
  • Connecticut was the only state that did not respond to the 2022 CSG Survey of State Personnel Agencies and State Salary Databases, data from the 2021 CSG SPA&SSD Survey was used.
  • The Council of State Governments Regions are defined by the regional offices and the states as listed below:
    • West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming
    • Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin
    • South: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia
    • East: Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont

School Psychologist Compacts: What You Should Know

By Grant Minix

Last spring, The Council of State Governments announced the selection of the National Association of School Psychologists for technical assistance on the development of an interstate compact for licensed school psychologists. The opportunity is a result of a cooperative agreement between CSG and the Department of Defense to develop interstate licensure mobility compacts.

The introduction of the Interstate Compact for School Psychologists will facilitate licensure mobility for the profession, which can improve access to services and care for school-age children. Schools are facing a national shortage of school psychologists. According to NASP, the recommended ratio of school psychologists to students is 1:500. However, the national ratio currently stands at 1:1,211. Some states are approaching ratios of 1:5,000. These shortages are especially evident in rural schools and historically underserved school districts.

The development of the Interstate Compact for School Psychologists also offers substantial benefits to military families by allowing for increased licensure portability for military spouse. Additionally, it increases portability for school psychologists providing care for military children which will increase continuity of care.

As part of the project kickoff, CSG and NASP hosted a compact kickoff meeting in August 2022. The meeting featured CSG, NASP and DOD officials outlining the need for increased licensure mobility for licensed school psychologists and the process to develop the compact. During this meeting, and as part of a larger stakeholder review and public comment process, participants were invited to ask questions regarding the project.

Following the kickoff meeting, CSG and NASP worked to identify individuals and organizations throughout the country to serve on the compact technical assistance group, including school psychologists, regulators, state legislators and individuals representing key organizations in education. The technical assistance group is tasked with providing recommendations on numerous aspects of the compact, such as state and licensee requirements to join the compact, the makeup of the compact commission and how to integrate telepractice into the compact, which all will be considered by the document writing team.

As of December 2022, CSG and NASP are in the process of assembling the document writing team and working with the technical assistance group to develop recommendations. In early 2023, the document writing team will meet write the model language for the school psychologist interstate compact. After an initial draft of the language is developed it will be shared with the technical assistance group and then released for public stakeholder review.

CSG, NASP and the working group will continue to work on the language until it is properly vetted and fully capable of meeting the needs of the profession and the public. Once the model compact language is finalized it will be released for state enactment. CSG anticipates the model language will be released for 2024 state legislative sessions. For more information on the Interstate Compact for School Psychologists, visit the compact web page or send an email to [email protected].

Physician Assistant Compacts: What You Should Know

In June 2019, a joint initiative by The Council of State Governments, Federation of State Medical Boards, American Academy of Physician Associates and the National Commission on Certification of Physician Assistants, was created to develop an interstate compact for the interstate practice of physician assistants (PAs). Funding support for this initiative came from the Department of Health and Human Services.

The Physician Assistant Licensure Compact (PA Compact) will facilitate the ability of licensed PAs to practice in multiple states without having to obtain an individual state professional license in each state of practice. The compact will provide for greater in-person and telehealth access to care and will significantly enhance practitioner mobility, including in times of public health emergencies. The PA Compact will also strengthen public protection by establishing a data system that facilitates information sharing and coordination on disciplinary action between participating states.

In the PA Compact licensure mobility is facilitated through a “privilege to practice” model, which allows individual licensees to seek a compact privilege in any compact member state they choose. The licensee’s application for a privilege to practice in a specific state is expedited by utilizing the compact data system to ensure the individual is eligible for that privilege by meeting the requirements in the compact.

The PA Compact includes various requirements for states to adhere to prior to enacting the model legislation. These requirements ensure there are baseline standards to be met for states to start issuing compact privileges. Some of these requirements include requiring a national exam and continuing education for all PA licensees. To obtain privileges to practice in compact member states individual licensees must also meet specific requirements laid out in the compact, such as obtaining NCCPA certification and graduating from a nationally accredited PA program.

The partner organizations met as a working group throughout the compact development process to develop the compact language. As part of the development process, the working group engaged stakeholders within the PA profession and the healthcare industry to solicit input and feedback. The working group utilized stakeholder feedback to revise the compact and respond to received concerns and suggestions.

One of the major motivations behind the desire to develop an interstate compact for physician assistants is the success of other compacts for health care professions, such as the Nurse Licensure Compact and the Interstate Medical Licensure Compact for physicians. Both compacts have been enacted in nearly 40 states. The development of interstate compacts for health care professions have been extremely popular amongst states because of their ability to strengthen state’s health care workforce and provide additional pathways to care for patients. The PA Compact working group considered and incorporated many aspects of other compacts for health care professions. While the PA Compact is similar to other compacts in how it facilitates multistate practice, each compact is unique and responds to the specific needs of the profession.

The working group approved the final version of the PA Compact in October 2022, which is being made available to states for 2023 legislative sessions. CSG and the project partners will provide educational and technical assistance for stakeholders and states interested in the compact. Supporting resources and information about the compact may be found at

How State Policymakers Will Shape the Future of Cash

By Valerie Newberg

The prevalence of cash payments in the United States has been steadily declining over recent years as technological innovations have introduced new options to complete transactions. Roughly 41% of Americans say none of their typical weekly purchases are made in cash, compared to 29% in 2018. Other related consumer behaviors indicate a move from cash to cashless transactions, such as the decline in the number of cash purchases of less than $25.

The proliferation of credit and debit cards, payment apps such as Venmo and PayPal, as well as the expansion of e-commerce have created new opportunities for cashless purchases. Additionally, entirely cash-free businesses, meaning those that only accept bank cards or digitally managed forms of currency such as online-only businesses (namely the ridesharing industry and some entertainment venues) do more than just create new opportunities for cashless payments – they require consumers to participate in cashless transactions to access goods and services.

The circumstances created by the COVID-19 pandemic heavily favored the use of cashless payments, exacerbating the decline in cash payments. Many businesses relied on remote payments as online purchases increased. Research suggested at the time that the virus could spread through physical currency. The number of cash transactions dropped dramatically even though market uncertainty, consumer demand and temporary aid programs from the federal government substantially increased the currency in circulation (CIC) and cash holdings. Although the number of weekly cash payments Americans made rose in 2021 for the first time since 2016, the share of businesses handling little to no cash in 2021 was still double the 2019 total. Business owners and the National Retail Federation cite the operating costs, national cash shortages, safety from robbers and prevention of employee skimming as reasons to abandon the practice of accepting cash. Additionally, credit card companies have incentivized business owners to transition to digitally reliant models, such as through Visa’s 2018 Cashless Challenge, which awarded businesses $10,000 to move away from accepting cash payments.

Proponents of transitioning to a cashless society say business owners are foreshadowing a future where bills and coins are not accepted as legal tender. In other countries like Sweden, cash is predicted to be functionally obsolete by March 2023 as most consumers have moved to different forms of payment and policy decisions continue to decrease CIC. When a retailer’s cash sales dip below 7%, scholars expect that accepting physical currency will no longer be profitable for businesses, but low consumer use is not a factor that guarantees the success of a cash-free model. Countries that have transitioned to cash-free or nearly cash-free societies are also marked by widespread digital banking infrastructure and use of debit and credit cards, conditions that are not met in all the states. For example, Mississippi, the state with the highest proportion of unbanked people in the United States (11.1%), is also the state with the lowest number of credit cards per capita (2.57).

The impact of businesses moving to digital-only forms payment options is not evenly felt. Opponents of cash-free businesses argue that historically marginalized groups, such as Black, Indigenous, people of color (BIPOC), those with disabilities, undocumented immigrants and older people are more likely to rely on cash for all of their weekly purchases as they have less access to banking. Nearly 6 million Americans were considered unbanked in 2021 and almost 19 million more are underbanked. With economic stressors like recessions and pandemics, the number of Americans who have access to stable banking decreases further as more rely on nonbank transactions and credit. Additionally, the geographic dispersion of unbanked Americans is uneven across states: in New Mexico, 7% of households do not have a checking account compared to around 1% in Utah.

Several state and local government policymakers have taken a business regulation approach to the issue by proposing laws and ordinances requiring most in-person retail businesses to accept cash payments. In Massachusetts, New Jersey and Rhode Island, lawmakers were successful in passing such bills. Other solutions available to state lawmakers focus on making digital payments and banking more accessible instead of restricting allowed business practices. Innovative policies include increasing bank card use among those who are least likely to be fully banked, like people experiencing homelessness, older people, formerly incarcerated populations and undocumented immigrants. By allowing users of electronic benefit transfer cards, like those issued for SNAP, to add cash to their cards and use them regularly in the retail market, policymakers can integrate traditionally cash-reliant communities into the digital economy.

Some states have addressed both business practices and accessibility of digitally managed payment options. In New York, state lawmakers recently passed a bill to address bank overdraft fees that can prevent low-income residents from accessing stable banking. Additionally, the city of New York bans retail outlets from refusing to accept cash payments and operates IDNYC, a photo ID program that allows residents to qualify for government financial services and apply for a bank account without a driver’s license.

The pivotal economic circumstances surrounding the COVID-19 pandemic offer a unique opportunity for policymakers to evaluate the future of the American economy and implement necessary rules and changes. As motivations for businesses and consumers to go cashless grow in an increasingly digital economy, it is essential that policymakers actively consider how to ensure fairness in the future of retail transactions. Cash as a universal currency offers payment options for disenfranchised populations but can also burden small businesses, and it is the role of state policymakers to balance these priorities by encouraging equitable progress in digital banking infrastructure and consumer involvement in the banking process.

Aligning Policy Goals: How States can Pair Continuing Education Requirements with Mentorship Programs

By Sandi Abdelshehed

The Economic and Workforce Health Subcommittee of the CSG Healthy States National Task Force recently explored ways to fill workforce gaps with paid pathways to employment, including ways state governments may expand apprenticeships.

In September 2022, the subcommittee issued a recommendation from these discussions that, “states should consider allowing mentorship to satisfy any continuing education requirements as an incentive for industry-based mentorship. Industry professionals could count activities such as mentoring a career aspirant or hosting a job shadowing session.”

Apprenticeships are a work-based learning model that provide participants with opportunities to connect classroom instruction to work activities. Career mentorship is a key piece of the apprenticeship experience. Knowledgeable mentors are often able to translate written instruction into the mechanics of the job, they are also beneficial to the entity offering these programs since the retention rate for mentees is significantly higher than those not mentored, and turnover rates are lowered as a result.

Employees can also view mentorship programs as informal leadership training that also improves the mentor’s understanding of their field by teaching apprentices and other aspiring workers. To recruit capable mentors for apprenticeship programs, states may consider the recognition of mentorship as professional development, counting toward continuing education requirements (if required).

Continuing education requirements are set by states to ensure licensees maintain competencies and stay current with legal and professional standards in their respective fields. There is the potential to pair these requirements to achieve dual policy goals, which is why some states have implemented exemptions to continuing education requirements in other instances. State leaders, in partnership with private sector employers, credentialing organizations and other stakeholders, could incentivize mentors by allowing mentorship to count toward a licensee’s continuing education requirements. If licensees are allowed to use mentorship programs to fulfill their requirements, they will have the opportunity to support the growth of their career field.

While a preliminary scan found no current state examples of this recommendation, some states offer flexibility to the established continuing education requirements to achieve other policy goals.

For example, New York requires licensed professional engineers to obtain 36 hours of continuing education. Licensees directly employed on a complete full-time basis by the state of New York are exempt from this continuing education requirement. Another example of states implementing exemptions comes from Maine; the state requires public accountant and certified public accountant license applicants to complete a minimum of 20 hours, but no more than 40 hours, of continuing professional education. Maine allows the fulfillment of other states’ continuing professional education requirements to attain Maine’s requirement for continued education requirement.