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 the effective date and enacting bill for each, read off the compacts’ own commissions.
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, and counseling compacts grant a privilege to practice — one home-state license carries authority into every other member state. 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 compact member and still bars telehealth prescribing of most 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
- 39
- 2
- 4
- 2
- 4
| Jurisdiction | Status | Effective | Enacting bill |
|---|---|---|---|
| Alabama | Member Bill and effective date not yet verified against a primary state source. | — | SB 125 |
| Alaska | Enacted, not live Referred to House Labor & Commerce; status date 02/23/2026. Not enacted. | — | HB 352 |
| Arizona | Member | 05/11/2016 | HB 2502 |
| Arkansas | Enacted, not live | 03/12/2025 | SB 119 (Act 269 of 2025) |
| California | Not a member | — | — |
| Colorado | Member | 06/08/2016 | HB16-1047 |
| Connecticut | Member 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 |
| Delaware | Member | 06/23/2021 | HB 160 (83 Del. Laws c. 52) |
| District of Columbia | Member | 06/05/2018 | B22-177 (D.C. Law 22-109) |
| Florida | Member | 03/21/2024 | CS/SB 7016 (ch. 2024-15) |
| Georgia | Member Enacted 2019; exact signature date not yet verified. 09/16/2021 was the compact go-live. | — | SB 16 (2019) |
| Hawaii | Member (limited) Bill and effective date not yet verified against a primary state source. | — | SB 674 |
| Idaho | Member | 07/01/2015 | HB 150 (ch. 105) |
| Illinois | Member | 07/20/2015 | HB 3680 (P.A. 99-76) |
| Indiana | Member Indiana Code 25-22.5-16; enacting session not yet verified against a primary state source. | — | SEA 251 |
| Iowa | Member Codified at Iowa Code ch. 147B; effective date not independently verified. | — | 2015 Acts, ch. 138 |
| Kansas | Member | 07/01/2016 | HB 2615 (L. 2016, ch. 92) |
| Kentucky | Member | 06/27/2019 | SB 22 (2019, Acts ch. 77) |
| Louisiana | Member | 07/01/2021 | SB 27 (2020 2nd Ex. Sess., Act 35) |
| Maine | Member | 11/01/2017 | LD 1359 (PL 2017, ch. 253) |
| Maryland | Member | 07/01/2019 | SB 234 (ch. 470) |
| Massachusetts | Introduced Filed in the 194th General Court; first recorded action 02/27/2025. Not enacted. | — | HD.3377 / H.2393 |
| Michigan | Member Replaces PA 563 of 2018, repealed effective 03/28/2025. | 03/26/2026 | HB 5455 (2026 PA 6) |
| Minnesota | Member | 05/19/2015 | SF 253 (2015, ch. 55) |
| Mississippi | Member | 05/16/2016 | HB 41 |
| Missouri | Member | 08/28/2023 | SB 70 (merged with SB 157) |
| Montana | Member Montana's 2015 bill record is offline; effective date not verified. | — | HB 429 (2015, ch. 203) |
| Nebraska | Member | 04/26/2017 | LB 88 (2017) |
| Nevada | Member Act contains no effective-date section; Nevada's 2015 session-law volumes were unreachable. | — | SB 251 (2015) |
| New Hampshire | Member Effective date per RSA 329-C:1; the bill-to-chapter link is not independently verified. | 07/04/2016 | HB 1665 (2016, ch. 70) |
| New Jersey | Member | 01/10/2022 | S 523 (P.L. 2021, c. 332) |
| New Mexico | Enacted, not live | 02/05/2026 | SB 1 (2026, Laws ch. 3) |
| New York | Introduced Introduced 03/04/2025; re-referred 01/07/2026. Not enacted. | 03/04/2025 | A 6362 / S 1505 |
| North Carolina | Member | 01/01/2026 | HB 67 (S.L. 2025-37) |
| North Dakota | Member | 08/01/2019 | SB 2173 |
| Ohio | Member | 09/30/2021 | SB 6 (134th GA) |
| Oklahoma | Member | 11/01/2019 | HB 2351 (ch. 85) |
| Oregon | Not a member | — | — |
| Pennsylvania | Member | 10/26/2016 | HB 1619 (Act 112 of 2016) |
| Rhode Island | Enacted, not live | 06/29/2022 | S 2606 Sub A (P.L. 2022, ch. 285) |
| South Carolina | Not a member | — | — |
| South Dakota | Member | 07/01/2015 | SB 63 (2015) |
| Tennessee | Member | 01/01/2019 | HB 664 (Pub. Ch. 365) |
| Texas | Member | 09/01/2021 | HB 1616 (87R) |
| Utah | Member | 05/12/2015 | HB 121 (2015, ch. 24) |
| Vermont | Member (limited) Issues licenses only — cannot serve as State of Principal License. | 01/01/2020 | S 253 (Act 115 of 2018) |
| Virginia | Not a member | — | HB 527 (2022, died in committee) |
| Washington | Member | 07/23/2017 | HB 1337 (2017 c 195) |
| West Virginia | Member | 06/10/2015 | HB 2496 (2015) |
| Wisconsin | Member | 12/16/2015 | AB 253 (2015 Act 116) |
| Wyoming | Member | 07/01/2015 | HB 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, and counseling compacts work differently: they grant a privilege to practice across member states from a single home-state license. 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
- IMLC Commission — Participating States (status); state codes and legislatures (bill and effective date)
- PT Compact Commission — Compact Map
- Nurse Licensure Compact — participating jurisdictions and implementation dates
- PSYPACT — participating states with enacted and effective dates
- Counseling Compact Commission — member states and states issuing privileges
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.