Healthcare licensing has long been a state-by-state process, making it difficult for providers to expand their services across borders and for patients to access specialized care in other states. To solve this challenge, multi-state licensing compacts were introduced. These agreements create streamlined pathways for providers to practice in multiple states without having to undergo repetitive licensing processes.

For providers and healthcare organizations, these compacts reduce administrative hurdles, support telehealth expansion, and improve patient access to care—especially in rural or underserved regions.

Understanding Multi-State Licensing Compacts

Multi-state licensing compacts are agreements between states that maintain each state’s regulatory authority while allowing for easier cross-state practice. Instead of requiring separate applications for every jurisdiction, these compacts allow eligible providers to obtain practice privileges in multiple states more efficiently.

The push for such agreements gained momentum during emergencies, such as natural disasters and the COVID-19 pandemic, when states needed rapid provider deployment across borders to manage surging demand.

Nursing: The Widest Adoption with the NLC

The Nursing Licensure Compact (NLC) is the most established model, with 41 states plus Washington, D.C. participating. Nurses in compact states can hold a single multi-state license that allows them to practice in all other compact states.

This model has proven particularly effective in addressing nursing shortages, enabling mobility, and supporting telehealth nursing services.

States still pending or considering NLC participation include Alaska, Connecticut, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, and Washington.

The Interstate Medical Licensure Compact (IMLC)

Launched in 2017, the IMLC offers physicians an expedited pathway to obtain licenses in other participating states. While providers still hold individual state licenses, the process is far faster and less burdensome than applying independently.

Currently, 29 states, Washington, D.C., and Guam are active members of the IMLC, making it a growing tool for physician mobility in an era of rising demand and telemedicine adoption.

Expanding into Mental Health and Specialized Care

• Psychology (PSYPACT): With over 20 states participating, this compact allows psychologists to practice telepsychology or provide short-term in-person services across member states. It has been particularly valuable in addressing mental health provider shortages.
• Physical Therapy (PTLC): Enables licensed PTs to practice across state lines, supporting broader access to rehabilitative care.
• Occupational Therapy (OTLC): Gives OTs greater flexibility to expand services across compact states.
• EMS Personnel (REPLICA): Helps first responders and EMS teams work across borders during emergencies.

Benefits for Providers and Patients

Multi-state licensing models deliver measurable benefits:

• Improved patient access to specialists, especially in underserved regions
• Greater provider mobility for staffing across multi-state organizations
• Telehealth expansion, making virtual care legally compliant across borders
• Faster emergency response during disasters and public health crises

For healthcare organizations, these models simplify recruitment, reduce credentialing delays, and strengthen provider networks.

Challenges and Considerations

Despite their benefits, these models come with considerations:

• State sovereignty: Each state must balance its licensing authority with compact participation.
• Regulatory variation: Continuing education and disciplinary rules differ between states.
• Revenue impact: States relying on licensing fees may hesitate to adopt compacts.

Still, the trend is clear—multi-state models are expanding, with dentistry, pharmacy, and other professions exploring similar pathways.

Why Multi-State Licensing Matters for Today’s Healthcare

As healthcare continues to move toward integrated systems and telehealth, multi-state licensing models are becoming essential tools for workforce flexibility and patient care delivery.

At Konnext Solutions, we help providers and organizations navigate these evolving compacts by aligning credentialing processes, ensuring compliance with state regulations, and supporting multi-state practice strategies.

Konnext Solutions, simplifying credentialing, licensing, and billing for providers nationwide.