State and territorial health officials have identified five key issues likely to drive public health legislation in 2026, according to the Association of State and Territorial Health Officials (ASTHO). The organization’s 2026 Legislative Prospectus Series drew from legislative tracking efforts and member feedback to identify priorities for upcoming state legislative sessions.
States are preparing for possible reductions or cancellations in federal public health funding, despite past investment through legislation such as the Public Health Infrastructure Grant and the Prevention and Public Health Fund. States are exploring ways to improve public health investments, such as creating public health rainy day funds, while balancing their budgets. In 2025, states enacted legislation improving core public health services at the state and local levels, a trend ASTHO anticipates will continue into 2026.
Five priority areas
Access to Care legislation strengthened the utilization of community health workers through certification programs and Medicaid coverage requirements. States also considered policies supporting access to health care in rural areas, where individuals have limited access to providers and facilities. Iowa’s HF 972 directs the health department to seek CMS approval for a new funding model supporting rural health providers. States also considered legislation supporting women through increased access to doulas and establishing maternal care programs in rural areas.
Behavioral Health remains critical: more than one in five people in the United States experience mental illness, and opioid overdose is a leading cause of death. In 2025, at least 13 states considered legislation to strengthen behavioral health crisis services. Washington enacted HB 1813, directing managed care organizations to establish or expand arrangements with behavioral health administrative services organizations to provide crisis services for Medicaid enrollees. At least three states enacted legislation to allow psilocybin prescribing if FDA approved, and at least ten states considered legislation allowing study of ibogaine as a potential treatment for PTSD and opioid use disorder.
Infectious Disease Prevention legislation addressed declining measles but rising cases of other diseases. At least seven states enacted bills requiring or expanding syphilis screenings during pregnancy to combat rising congenital syphilis rates. At least ten jurisdictions considered bills expanding access to HIV pre- and/or post-exposure prophylaxis.
Healthy Food and Chronic Disease legislation addressed food’s impact on public health. West Virginia enacted HB 2354 to prohibit sale or manufacturing of food containing certain dyes or preservatives, and at least three states enacted legislation prohibiting foods containing certain dyes or preservatives in school meals. At least four states enacted legislation directing health departments to apply for waivers preventing individuals from using SNAP funds to purchase candy and soft drinks.
2026 legislative calendar
In 2026, 46 states will hold legislative sessions. Most states will conclude sessions by June 30, with at least 20 states scheduled to conclude in April. Additionally, 24 states carry over 2025 bills into the 2026 session.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.astho.org/communications/blog/2025/whats-driving-public-health-legislation-in-2026/