What’s Driving Public Health Legislation in 2026?

December 08, 2025 | Beth Giambrone

Drawing from ASTHO’s legislative tracking efforts and member feedback, the State Health Policy team identified five key issues state and island legislatures will likely address in their upcoming sessions. The resulting tool, ASTHO’s 2026 Legislative Prospectus Series, provides public health leaders and policymakers with a synopsis of the topics, recent policy trends, and anticipated legislation in upcoming sessions.

Public Health Funding and Administration

While the federal government has invested in long-term public health through legislation such as the Public Health Infrastructure Grant and the Prevention and Public Health Fund, states are preparing for possible reductions or cancellations in federal funding. The Public Health Funding and Administration Prospectus highlights state efforts to improve public health investments, such as creating public health rainy day funds, while still balancing their budgets. States also enacted legislation that improves core public health services at the state and local levels, a trend that ASTHO sees continuing into 2026.

Access to Care

The Access to Care Prospectus focuses on policies that reduce gaps in health care services for communities across the United States. In 2025, ASTHO saw enacted legislation that strengthened the utilization of community health workers who serve as vital links between individuals and health service providers, 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 health care providers and facilities. Iowa’s HF 972 directs the health department to seek CMS approval for a new funding model that would support rural health providers.

The prospectus also addresses legislation supporting women at multiple stages of life by increasing access to doulas, establishing programs providing increased maternal care in rural areas, and supporting women in perimenopause with increased information and access to treatment.

Behavioral Health

More than one in five people in the United States experience mental illness and opioid overdose is a leading cause of death. Given this, state legislatures continue to consider legislation to strengthen behavioral health systems, address unregulated substances, and promote access to overdose prevention tools — discussed in the Behavioral Health Prospectus.

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. State legislatures also considered bills to expand clinical research or regulate substances such as psilocybin and ibogaine, with at least three states enacting legislation to allow psilocybin prescribing if FDA approved. Additionally, at least 10 states considered legislation allowing for the study of ibogaine as a potential treatment for conditions such as PTSD and opioid use disorder.

Infectious Disease Prevention

While some infectious diseases are declining in the United States, others — like measles — are increasing. This year’s Infectious Disease Prevention Prospectus explores legislative policies to combat infectious disease through prevention, testing, and treatment. While the Advisory Committee on Immunization Practices (ACIP) updated vaccine recommendations for children and adults, several states enacted legislation expanding the sources they use for developing policies related to school immunization, universal vaccine purchase programs, and more. States also considered expanding access to testing and treatment that prevents the spread of sexually transmitted infections. At least seven states enacted bills requiring or expanding syphilis screenings during pregnancy to combat rising congenital syphilis rates, while at least ten jurisdictions considered bills expanding access to HIV pre and/or post exposure prophylaxis.

Healthy Food and Chronic Disease

The Healthy Food and Chronic Disease Prospectus highlights legislative efforts to address food’s impact on public health and combat chronic disease. In 2025, several states considered legislation prohibiting the sale of food products that contain certain artificial dyes and/or chemical preservatives, with West Virginia enacting HB 2354 to prohibit the sale or manufacturing of food containing certain dyes or preservatives. Similarly, at least three states enacted legislation prohibiting foods containing certain dyes or preservatives in school meals. States also sought to promote nutritious food choices in their USDA SNAP benefits, with at least four states enacting legislation directing their state health departments to apply for waivers that would prevent individuals from using SNAP funds to purchase candy and soft drinks.

Current Outlook for the 2026 Sessions

In 2026, 46 states will hold legislative sessions (Montana, Nevada, North Dakota, and Texas do not meet in even numbered years). Most states will conclude their 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, including some bills mentioned in the prospectus briefs. Because of this, ASTHO expects a large amount of legislative activity in the first few months of the year.

The ASTHO State Health Policy team will monitor legislation related to the Legislative Prospectus Series and other public health issues during the 2026 sessions and provide a mid-session update in the spring.