States Offer Flexibility to Shore Up Healthcare Workforce

April 29, 2020 | ASTHO Staff

As COVID-19 began to spread across the United States, it was inevitable that it would significantly strain our healthcare workforce. While social distancing measures have been implemented to “flatten the curve” and reduce the burden on the health system, increasing the availability of skilled healthcare providers to treat COVID-19 patients and deploying them to hard-hit areas is important. Also key is allowing healthcare providers to work within the broad capacities appropriate to their education, training, and experience.

In these unprecedented times, it is reasonable and necessary to loosen and make flexible the restrictions and requirements governing the provision of healthcare services. Policy actions to remove legal and regulatory barriers are often implemented through executive orders or legislation. State governors and/or legislatures use these policy tools to:

• Waive, modify, or suspend licensing or credentialing requirements for certain providers.
• Authorize out-of-state providers to practice within the state.
• Allow retired individuals or those whose licenses are inactive to return to the workforce.
• Provide opportunities for medical students to enter the workforce.

Below is an overview of policy strategies that states have taken at the executive and legislative level to increase the healthcare workforce to more effectively and efficiently respond to the COVID-19 pandemic.

Licensing and Scope of Practice Requirements

As of April 23, 48 states and the District of Columbia have modified, suspended, or waived licensure requirements for healthcare providers in response to COVID-19. Most of those states taking this action established general waivers of licensure requirements. Executive orders issued in Guam, Nebraska, and Nevada are good examples. In Michigan, the governor signed Executive Order No. 2020-61 suspending all statutory provisions relating to scope of practice, supervision, and delegation to allow licensed, registered, or certified healthcare professionals to provide medical services necessary to support the COVID-19 response. The services must be appropriate to the professional’s education, training, and experience. New Jersey Executive Order No. 112 suspends statutory provisions that may limit the scope of practice of advanced practice nurses and physicians.

The District of Columbia and Maine enacted legislation allowing their governors to suspend, waive, or modify professional licensing and registration requirements. The Ohio legislature is considering a bill to suspend physician assistant practice requirements.

Out-of-State Practitioners

New Mexico’s governor issued two executive orders allowing out-of-state practitioners to enter the workforce. Executive Order 2020-004 states that the Department of Health and the Department of Homeland Security and Emergency Management shall credential out-of-state professionals who can render aid and necessary services. Executive Order 2020-020 states that all nursing professionals who are licensed and in current good standing in any province or territory of Canada may be authorized to work in any New Mexico healthcare facility. Similarly, New Hampshire Emergency Order No. 15 requires that all out-of-state medical providers be issued an emergency New Hampshire license at no cost.

Alaska enacted a bill authorizing a professional or occupational licensing board to grant an expedited license to an individual holding a corresponding license in good standing in another jurisdiction. Kentucky enacted legislation giving the Board of Medical Licensure, Board of Emergency Medical Services, and Board of Nursing the ability to waive or modify statutes and regulations for licensure or certification requirements for health care providers who are licensed or certified in other states to provide services in Kentucky.

Inactive and Retired Practitioners

As of April 23, 34 states established waivers to expedite licensure for inactive or retired licensees in response to COVID-19. New Jersey governor issued Executive Order No. 112 reactivating the licenses of healthcare professionals previously licensed to practice in New Jersey who retired. Delaware Executive Order issued by the Department of Health and Social Services as well as the Emergency Management Agency allows providers who held an active license or certification within the last five years to provide healthcare services if the license was active and in good standing for the five-year period prior to the date it went inactive, expired, and lapsed.

Kentucky enacted a bill giving the Board of Medical Licensure, Board of Emergency Medical Services, and Board of Nursing the ability to waive or modify statutes and regulations to reactivate the licenses of inactive and retired health care providers, including emergency medical providers and nurses. New York companion bills (A10204 and S8126) would allow state and local governments to hire retired public health officials and workers in public health emergencies.

Medical Students

Indiana’s governor issued two executive orders making it easier for medical students to enter the workforce. Executive Order 20-19 waives the requirement that physician assistant students must take the Physician Assistant National Certifying Examination and complete a background check before a license is issued. Executive Order 20-13 allows medical students to be issued license permits if they are in the last semester of a four-year program or if they have completed a four-year program in the last 90 days.

Michigan Executive Order No. 2020-61 allows students enrolled in programs to become licensed, registered, or certified health care professionals to volunteer within a designated health care facility in whatever roles are necessary to support the facility’s response to COVID-19. The executive order also allows medical students, physical therapists, and EMTs to volunteer or work within the facility as “respiratory therapist extenders” under the supervision of physicians, respiratory therapists, or advanced practice registered nurses to assist in the operation of ventilators or related devices.

A strong COVID-19 response requires state and territorial health departments to quickly mobilize manpower and resources, including trained and educated healthcare providers. It is critical for health agencies to work with executive leaders to utilize policy and increase the capacity of the healthcare workforce. In additional to healthcare providers, health agencies have an opportunity to expand the public health workforce and utilize public health practitioners and students in response activities, such as contact tracing. ASTHO will continue to track this important public health issue as the COVID-19 response continues.