State Policy Update

A monthly series from NACHC's state policy team sharing updates on state policies that can supporting health centers.

The first half of 2025 has been marked by a surge of legislative activity across the United States, with state lawmakers addressing a wide array of pressing issues impacting Community Health Centers and the broader healthcare landscape. From bold reforms in drug pricing to forward-looking investments in workforce training and new models of maternal health care, state legislatures have acted with urgency and purpose amidst a rapidly changing federal landscape.

This blog will highlight three notable pieces of state legislation that health centers can take advantage of: allowing pharmacists to be reimbursed for their full scope of practice, expanding the pool of eligible providers to practice at health centers, and advancing maternal health initiatives. These efforts showcase state policies that support accessible, community-based care models that support resilient health center infrastructure.

Hawai'i: Expanding Pharmacist Reimbursement to Strengthen Healthcare Access

Hawai'i Governor Josh Green recently signed Senate Bill (SB) 1245 into law. Effective July 1, 2026, this legislation requires public and private health plans in the state to reimburse licensed pharmacists for providing healthcare services within their scope of practice at rates equivalent to other medical providers. These services include patient education on blood sugar monitoring, hypoglycemia prevention, safe medication use, and medication adherence strategies-core components of chronic disease management that go well beyond dispensing prescriptions.

Pharmacists undergo extensive training, often completing six to eight years of education through pre-pharmacy coursework, a Doctor of Pharmacy (PharmD) program, and sometimes a residency program. Yet, despite their clinical expertise, pharmacists in many states are not recognized as reimbursable healthcare providers for non-dispensing services. By acknowledging their qualifications and enabling proper reimbursement, SB 1245 aligns payment structures with modern team-based care models and helps fully integrate pharmacists into the healthcare delivery system.

This reform is particularly timely for Hawai'i, which faces significant healthcare workforce shortages, especially in rural communities. The state struggles to recruit and retain primary care providers, leaving gaps that pharmacists are well-positioned to help fill. Reimbursing pharmacists for services they are already trained and authorized to provide helps address these shortages, improves patient access to care, and supports the long-term sustainability of Hawai'i's health centers.

The Hawai'i Primary Care Association (HPCA) strongly supported SB 1245, with the issue first raised by pharmacists at Wahiawa Health who saw firsthand how limited reimbursement was constraining patient care. Without the ability to bill for clinical pharmacy services, health centers had to rely on their 330 funds or alternative funding sources to cover these costs, limiting their reach and scalability. SB 1245 changes that dynamic by allowing health centers to expand access to pharmacist-led care, which improves patient outcomes and builds a more resilient healthcare workforce across the state.

"The Hawaii Primary Care Association strongly supports this new law because it mandates reimbursement for services provided by pharmacists within their scope of practice by private and public health plans in the State.  This measure greatly improves the accessibility of essential health care services to patients, especially those in geographically isolated communities, by recognizing the vital role pharmacists play in team-based care models, particularly in managing chronic diseases amidst healthcare workforce shortages."

North Carolina: Internationally Trained Physician Licensure

In July 2025, Governor Josh Stein signed into law House Bill (HB) 67 , known as the "Healthcare Workforce Reforms" bill. Part of the legislation authorizes internationally trained physicians to obtain a provisional state license if they have secured full-time employment at a qualifying North Carolina hospital or medical practice, particularly in rural areas where there is a shortage of licensed physicians. After meeting certain criteria, including passing required examinations and demonstrating clinical competence, these physicians can transition to full licensure. This legislative change is expected to alleviate physician shortages in health professional shortage areas (HPSAs) and enhance the capacity of health centers to serve their communities.

Many regions of the state, particularly rural communities, are experiencing a shortage of doctors, nurses, and allied health professionals. This gap threatens timely access to care, worsens health disparities, and strains already overburdened health systems. A key challenge is the existing limited number of available providers, made worse when medical students leave the state for residency and do not return. Research shows that approximately 60% of physicians practice in the state where they completed their residency. One untapped solution lies in authorizing internationally trained medical professionals to practice within health centers.

Internationally trained medical professionals represent a highly skilled and often underutilized segment of the healthcare workforce. Many have years of clinical experience, advanced training, and specialized skills gained abroad. However, licensure barriers and complex credentialing requirements frequently prevent them from practicing in the U.S., leaving their expertise largely untapped. They bring value extending well beyond providing care. Many internationally trained providers help share cultural backgrounds or languages with immigrant and refugee patients, which improves communication, trust, and health outcomes. Providers who understand patients' cultural contexts are better equipped to address non-clinical factors of health, a key factor in chronic disease management.

North Carolina serves as a model for other states grappling with healthcare workforce shortages. By creating structured pathways for internationally trained medical professionals, states can increase the number of available healthcare providers, improve health outcomes, and strengthen the state's healthcare system. As the healthcare workforce shortage deepens, states must think innovatively about new approaches to get trained professionals out of the waiting rooms and into the clinics. It's time to bridge this critical gap and ensure that every qualified provider can contribute to building healthier communities.

Oregon: Strengthening Access to Community-Based Perinatal Services

On July 25, 2025, Oregon Governor Tina Kotek signed into law Senate Bill 692. This law expands access to maternal health services, establishing a community-based perinatal services access program to increase access to culturally specific and culturally competent community-based services during the perinatal period. In addition, it expands coverage under the state's medical assistance program and health insurance policies to include services provided by doulas, lactation counselors, and lactation educators. The law also directs the Health Licensing Office to promulgate state regulations overseeing the practice of lactation counselors and lactation educators.  

Maternal and Child Health (MCH) is a critical public health priority under the Make America Healthy Again (MAHA) plan. The health of a women during pregnancy, childbirth and postpartum, lays the foundation for the overall health and wellbeing of their families and communities. Investing in MCH is not just about reducing the maternal mortality and morbidity rates but also creating proper conditions for healthy pregnancies. By investing in community-based maternal and childcare models, and recognizing the value of responsive providers, Oregon is setting a precedent for how states can integrate innovation into their maternal and child health system.  

Community health centers are the most innovative, and most resilient part of our nation's health system. In 2023, health centers served over 32.5 million patients, including one in nine children and adolescents. With strong community ties, health centers are often the first point of contact for pregnant individuals who may face barriers accessing maternal and childcare. Health centers stand ready implementing the bill by scaling up access to doula care, lactation counseling, and other essential perinatal services in communities that need them most.

The newly signed bill creates opportunities to further leverage health centers as hubs for delivering doula services, lactation support and other responsive care during the perinatal period. With over 470,000 Oregonians- including one in six Oregon Health Plan members-receiving care at community health centers, many of which already partner with midwives and doula programs, this new legislation presents a valuable opportunity to formalize and expand those partnerships.

As we round the end of 2025 AND look ahead to the 2026 legislative session, NACHC is carefully monitoring the introduction of new state bills that could impact health centers and the patients they serve. NACHCs state policy team is actively engaging with PCAs and health centers to stay alert to legislative developments as they unfold. This groundwork ensures that we are ready to respond quickly and effectively when key issues arise. Stay tuned for our next blog, where we will take a closer look at newly introduced legislation and what it could mean for health centers across the country.