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 | 05/19/2015 | SB 125 |
| Alaska | Enacted, not live Enacted; implementation delayed. | 02/23/2026 | HB 352 |
| Arizona | Member | 05/11/2016 | HB 2502 |
| Arkansas | Enacted, not live Enacted; implementation delayed. | 03/12/2025 | — |
| California | Not a member | — | — |
| Colorado | Member | 06/08/2016 | HB 1047 |
| Connecticut | Member | 03/15/2026 | GNVR Bill 5046 |
| Delaware | Member | 06/23/2021 | HB 160 |
| District of Columbia | Member | 06/12/2023 | B 177 |
| Florida | Member | 12/20/2024 | CS/SB 7016 |
| Georgia | Member | 09/16/2021 | SB 16 |
| Hawaii | Member (limited) Issues licenses only — cannot serve as State of Principal License. | 01/01/2025 | SB 674 |
| Idaho | Member | 03/25/2015 | HB 150 |
| Illinois | Member | 07/21/2015 | HR 3680 |
| Indiana | Member | 05/01/2023 | SB 251 |
| Iowa | Member | 07/02/2015 | SB 273 |
| Kansas | Member | 05/13/2016 | HB 2456 |
| Kentucky | Member | 12/13/2018 | SB 182 |
| Louisiana | Member | 07/01/2021 | SB 27 |
| Maine | Member | 04/06/2017 | LD 1359 |
| Maryland | Member | 01/19/2018 | SB 234 |
| Massachusetts | Introduced | 01/15/2025 | HD.3377 |
| Michigan | Member | 06/01/2019 | HB 4066 |
| Minnesota | Member | 05/19/2015 | SF 253 |
| Mississippi | Member | 05/17/2016 | HB 41 |
| Missouri | Member | 10/28/2024 | SB 670 |
| Montana | Member | 04/08/2015 | HB 429 |
| Nebraska | Member | 01/05/2017 | LB 88 |
| Nevada | Member | 05/27/2015 | SB 251 |
| New Hampshire | Member | 05/05/2016 | HB 1665 |
| New Jersey | Member | 02/05/2024 | S 523 |
| New Mexico | Enacted, not live Enacted; implementation in process. | 01/22/2026 | SB 67 |
| New York | Introduced | 03/04/2026 | — |
| North Carolina | Member | 01/01/2026 | — |
| North Dakota | Member | 01/15/2019 | SB 2173 |
| Ohio | Member | 07/01/2021 | SB 6 |
| Oklahoma | Member | 01/18/2019 | HB 2351 |
| Oregon | Not a member | — | — |
| Pennsylvania | Member | 07/07/2025 | HB 1619 |
| Rhode Island | Enacted, not live Enacted; implementation delayed. | 06/29/2022 | S 2606 |
| South Carolina | Not a member | — | — |
| South Dakota | Member | 03/12/2015 | SB 63 |
| Tennessee | Member | 02/09/2017 | HB 664 |
| Texas | Member | 06/07/2022 | HB 1616 |
| Utah | Member | 03/20/2015 | HB 121 |
| Vermont | Member (limited) Issues licenses only — cannot serve as State of Principal License. | 12/21/2017 | S 253 |
| Virginia | Not a member Bills to join have been introduced but have not passed. | — | HB 527 |
| Washington | Member | 01/17/2017 | SB 5221 |
| West Virginia | Member | 03/31/2015 | HB 2496 |
| Wisconsin | Member | 12/14/2015 | AB 253 |
| Wyoming | Member | 02/27/2015 | HB 107 |
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.
Dates are the compact’s own effective dates, not the date a bill was signed. Where the two differ, the effective date is what determines whether you can actually use the pathway today.
What is not here yet
NLC, PSYPACT, Counseling Compact are scaffolded but not published. Each publishes per-state status in a form that cannot be read reliably at scale — an interactive map, a linked PDF, or an embedded infographic — and we do not publish compact status until every jurisdiction has been read off the commission itself.
- NLC — NCSBN publishes per-state implementation status only inside an interactive map and a linked PDF. Not yet transcribed against the primary source. Source
- PSYPACT — PSYPACT publishes its state map as an embedded infographic image with no machine-readable status data. Requires manual transcription before publication. Source
- Counseling Compact — Privilege-to-practice issuance began in phases; per-state status not yet verified against the commission. Source
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 with some of the tightest controlled-substance telehealth limits in the country.
Sources
- IMLC Commission — Participating States
- PT Compact Commission — Compact Map
- NCSBN — Nurse Licensure Compact
- PSYPACT — Map and States
- Counseling Compact Commission
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.