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State Laws · Professional Requirements

Cross-state licensing, compact by compact

Interstate compacts are the main route a clinician takes to treat patients in another state. This tracks which jurisdictions belong to which compact, with status from each compact’s own commission and, where verified, the enacting bill and effective date.

By TeleMed Today Writing TeamUpdated September 28, 2026Membership status verified for 7 of 7 compacts

Care is regulated where the patient sits. A clinician in Denver treating someone in Trenton is practicing medicine in New Jersey, and needs authority there — which is why the licensure question is the first gate on any interstate telehealth program, and the one most often assumed away.

Compacts are how that gate opens, but they do not all work the same way, and the difference matters more than the membership map. The physician compact is an expedited licensing pathway: it speeds up getting a full license in each state, and you still hold one license per state at the end. The nursing, psychology, physical therapy, counseling, and PA compacts work from a home-state license instead, but they are not automatic. A nurse with a multistate license from a compact home state can practice in the other member states. A physical therapist, counselor, or PA must obtain a compact privilege for each member state, usually for a fee and sometimes after a state jurisprudence exam (no state is issuing PA compact privileges yet), and a psychologist must apply to the PSYPACT Commission for authorization before practicing telepsychology across member states. The social work compact issues a multistate license that authorizes practice in every member state (no state is issuing social work multistate licenses yet). A physician and a nurse practising across the same two states are in structurally different regulatory positions.

Membership also is not a proxy for how easy a state is to work in. Connecticut is a full IMLC member and still bars most telehealth prescribing of Schedule I–III controlled substances. Florida runs an open registration pathway and mandates no payment parity at all. Read the licensure answer here, then read the state.

Interstate Medical Licensure Compact

Physicians

Source: IMLC Commission — Participating States (status); state codes and legislatures (bill and effective date) · checked 2026-09-14

Member
39
Member (limited)
2
Enacted, not live
4
Introduced
2
Not a member
4

51 jurisdictions

Interstate Medical Licensure Compact status by jurisdiction
JurisdictionStatusEffectiveEnacting bill
AlabamaMember

Bill and effective date not yet verified against a primary state source.

—SB 125
AlaskaEnacted, not live

Enacted as AS 08.64.253 by sec. 6; became law without the governor's signature 6/23/2026 (period expired 6/22); effective 90 days later under AS 01.10.070(b). IMLCC lists Alaska as "IMLC Passed; Implementation Delayed"; no expedited licenses yet.

09/20/2026HB 110 (ch. 28 SLA 2026)
ArizonaMember05/11/2016HB 2502
ArkansasEnacted, not live03/12/2025SB 119 (Act 269 of 2025)
CaliforniaNot a member——
ColoradoMember06/08/2016HB16-1047
ConnecticutMember

Enacted by P.A. 22-81, § 43. Statutory effective date not yet verified; 03/15/2026 was the Department of Public Health's letter-of-qualification start.

—SB 2 (2022) / P.A. 22-81
DelawareMember

Approved 06/23/2021; c. 52 § 21 made § 20 (Chapter 17A, IMLC) effective 07/01/2022.

07/01/2022HB 160 (83 Del. Laws c. 52)
District of ColumbiaMember06/05/2018B22-177 (D.C. Law 22-109)
FloridaMember03/21/2024CS/SB 7016 (ch. 2024-15)
GeorgiaMember

Enacted 2019; exact signature date not yet verified. 09/16/2021 was the compact go-live.

—SB 16 (2019)
HawaiiMember (limited)

Act 112 (2023). Compact licenses available since Jan 1, 2025; Hawaii not yet a state of principal license (DCCA, May 2026). Act 163 (2025, SB 1365) authorized the background checks needed for SPL status.

—SB 674 (2023)
IdahoMember07/01/2015HB 150 (ch. 105)
IllinoisMember07/20/2015HB 3680 (P.A. 99-76)
IndianaMember

IC 25-22.5-16. Signed 3/10/2022. The Commission's map dates Indiana 5/1/2023.

07/01/2022SEA 251 (P.L. 60-2022)
IowaMember

Codified at Iowa Code ch. 147B; effective date not independently verified.

—2015 Acts, ch. 138
KansasMember07/01/2016HB 2615 (L. 2016, ch. 92)
KentuckyMember06/27/2019SB 22 (2019, Acts ch. 77)
LouisianaMember07/01/2021SB 27 (2020 2nd Ex. Sess., Act 35)
MaineMember11/01/2017LD 1359 (PL 2017, ch. 253)
MarylandMember

Health Occupations 14-3A-01. Approved 5/8/2018. The original sunset (9/30/2022) was extended to 6/30/2030 by SB 386 (ch. 313 of 2022). The Commission's map dates Maryland 1/19/2018, the bill's first reading.

07/01/2019SB 234 (ch. 470 of 2018)
MassachusettsIntroduced

Filed in the 194th General Court; first recorded action 02/27/2025. Not enacted.

—HD.3377 / H.2393
MichiganMember

Replaces PA 563 of 2018, repealed effective 03/28/2025.

03/26/2026HB 5455 (2026 PA 6)
MinnesotaMember

Minn. Stat. 147.38. Effective upon adoption by at least six other states, but no sooner than 7/1/2015 (six had enacted by then). Signed 5/19/2015, the date the Commission's map shows.

07/01/2015SF 253 (2015, ch. 55)
MississippiMember05/16/2016HB 41
MissouriMember08/28/2023SB 70 (merged with SB 157)
MontanaMember

Montana's 2015 bill record is offline; effective date not verified.

—HB 429 (2015, ch. 203)
NebraskaMember04/26/2017LB 88 (2017)
NevadaMember

Act contains no effective-date section; Nevada's 2015 session-law volumes were unreachable.

—SB 251 (2015)
New HampshireMember

Effective date per RSA 329-C:1; the bill-to-chapter link is not independently verified.

07/04/2016HB 1665 (2016, ch. 70)
New JerseyMember01/10/2022S 523 (P.L. 2021, c. 332)
New MexicoEnacted, not live05/20/2026SB 1 (2026, Laws ch. 3)
New YorkIntroduced

S 1505 introduced 01/10/2025 and A 6362 on 03/04/2025; both re-referred to the Higher Education committees 01/07/2026. A second IMLC pair, A 1983 / S 5657, is also in committee. The Commission's map lists A 6362. Not enacted.

—A 6362 / S 1505
North CarolinaMember01/01/2026HB 67 (S.L. 2025-37)
North DakotaMember08/01/2019SB 2173
OhioMember09/30/2021SB 6 (134th GA)
OklahomaMember11/01/2019HB 2351 (ch. 85)
OregonNot a member——
PennsylvaniaMember10/26/2016HB 1619 (Act 112 of 2016)
Rhode IslandEnacted, not live06/29/2022S 2606 Sub A (P.L. 2022, ch. 285)
South CarolinaNot a member——
South DakotaMember07/01/2015SB 63 (2015)
TennesseeMember01/01/2019HB 664 (Pub. Ch. 365)
TexasMember09/01/2021HB 1616 (87R)
UtahMember05/12/2015HB 121 (2015, ch. 24)
VermontMember (limited)

Issues licenses only — cannot serve as State of Principal License.

01/01/2020S 253 (Act 115 of 2018)
VirginiaNot a member—HB 527 (2022, died in committee)
WashingtonMember07/23/2017HB 1337 (2017 c 195)
West VirginiaMember06/10/2015HB 2496 (2015)
WisconsinMember12/16/2015AB 253 (2015 Act 116)
WyomingMember07/01/2015HB 107 (2015, ch. 62)

How to read the physician compact

Of the 51 jurisdictions, 39 are full IMLC members issuing Letters of Qualification and licenses. 2 — Hawaii and Vermont — issue licenses through the compact but cannot serve as a State of Principal License, so neither can be used as a home state to enter it. 4 have enacted the compact with implementation still in process or delayed, which is the category most likely to be reported wrongly elsewhere: the law exists, the pathway does not yet work.

4 jurisdictions are not members and have no active legislation, and 2 have bills introduced but not enacted. California is the consequential one — the largest physician population in the country sits entirely outside the compact, and nothing in the current session changes that.

Physician compact dates are the statutory effective date — the day the state’s own law took effect — not the day a bill was signed and not the day the Commission began processing applications. Where a value could not be traced to a state’s code or legislature, the date is left blank rather than estimated.

Common questions

Does a licensure compact let me practice in another state without a license?
No, and this is the most common misunderstanding. The physician compact (IMLC) is an expedited pathway to obtaining a full license in another state — you still end up licensed in each state where your patients are located. The nursing, psychology, PT, counseling, and PA compacts work differently: they build on a single home-state license, but they are not automatic. Nurses need a multistate license from a compact home state; PT, counseling, and PA privileges must be obtained for each member state, usually for a fee (no state is issuing PA privileges yet); and psychologists must apply to the PSYPACT Commission for authorization before practicing telepsychology across member states. The social work compact issues a multistate license that authorizes practice in every member state (no state is issuing social work multistate licenses yet). Compacts change how you get authority, not whether you need it.
Which state's law applies during a telehealth visit?
Almost always the law of the state where the patient is physically located at the time of the encounter, not where the clinician sits. That is why cross-state licensing matters at all: a clinician in one state treating a patient in another is practicing in the patient's state and needs authority there.
What is a State of Principal License, and why do Hawaii and Vermont differ?
Under the IMLC, your State of Principal License (SPL) is the home state that verifies your credentials and issues the Letter of Qualification used to obtain licenses elsewhere. Hawaii and Vermont are IMLC member states that issue licenses through the compact but cannot serve as an SPL — so a physician cannot enter the compact using a Hawaii or Vermont license as their home base.
Which large states are outside the physician compact?
California, Oregon, South Carolina, and Virginia are not IMLC members. New York and Massachusetts have had legislation introduced but not enacted. Physicians treating patients in those states need a full license obtained through the state's ordinary process.
Does compact membership mean the state is telehealth-friendly overall?
No. Compact membership only addresses how a clinician obtains licensure. A state can be an easy state to get licensed in and still impose strict rules on prescribing, consent, modality, or payment. Connecticut, for example, is a full IMLC member that still bars most telehealth prescribing of Schedule I–III controlled substances under state law.

Sources

Compact membership changes as legislatures act and commissions bring states live. Verify current status with the relevant compact and the state licensing board before relying on it for a licensing decision. This page is educational and is not legal advice.