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​​StateView compiles up-to-date information on state policy trends and resources for chapter advocacy efforts and focuses on important state-level child health advocacy issues, and summarizes valuable resources from the AAP and other public and private sector sources.​​​​​​​​​​​

October 16, 2018: 2018 State Immigration Policies and Laws | AAP Public Charge Toolkit
With the official release of the federal government’s proposed public charge rule, immigration continues to be at the forefront at the state and federal level. On the state side, 116 laws related to immigration have been enacted so far in 2018. Thirty-six percent (36%) of these laws appropriated funding for immigration enforcement, immigrant integration, English language and citizenship classes, and migrant and refugee programs, 15% were related to education, and 13% were related to public benefits, such as eligibility, care of children, or special immigrant juvenile status.

Given the focus on this policy issue at all levels of government, AAP chapters can play a role in recognizing the unique challenges and strengths that many immigrants experience and work to ensure that this population receives the care needed.

For more information on the proposed public charge rule, see the AAP Public Charge Advocacy Toolkit.

For more information on immigrant child health, see the AAP Council on Community Pediatrics Immigrant Child Health Toolkit​​​.

October 15, 2018: Make Sure You’re Registered, Then #VoteKids!
Earlier this month, we noted that voter registration deadlines were approaching in the states that require a 30-day window between eligible registration and Election Day. That first wave of voter registration deadlines recently passed, and the second comes tomorrow, October 16, for states that use a 21-day threshold. Check your registration status online today.

If you are attending the 2018 AAP National Conference and Exhibition in Orlando, the last day of the conference, Tuesday, November 6, is Election Day. Be sure to vote by Be sure to vote by absentee ballot or participate in early voting before traveling to the conference. 

Important issues facing child health and wellness are at stake this year. Learn more about the AAP get out the vote campaign, #VoteKids.

October 11, 2018: Children’s Environmental Health Month
October is Children’s Health Month, and today, Thursday, October 11th is Children’s Environmental Health (CEH) Day. Despite the many successes and advancements in the field of children’s environmental health over the past few decades, today’s children face an epidemic of illness and chronic diseases linked to environmental exposures and our changing climate.

Concerns raised by advocates regarding the US Environmental Protection Agency (EPA)’s
commitment to children’s environmental health means that states must
continue to take a leadership role in preventing and reducing toxic exposures and countering the effects of climate change. As EPA continues to acknowledge, children aren’t little adults; children are particularly susceptible to the potential respiratory, reproductive, neurotoxic, endocrine, behavioral, and carcinogenic harms posed by exposures to toxic substances in the environments in which they live, learn, and play.

For more from the AAP, see the Council on Environmental Health Web page. Contact the Pediatric Environmental Health Specialty Unit for your region for support from experts in pediatrics, allergy/immunology, neurodevelopment, toxicology, occupational and environmental medicine, nursing, reproductive health, and other specialized areas.

October 9, 2018: Reducing Disparities in State Immunization Rates

The importance of childhood immunizations in keeping children healthy is well known, but access to care and incomplete immunization records can pose barriers to fully protecting children from vaccine preventable diseases. A new federally funded state level project enlists the National Academy for State Health Policy and AcademyHealth to help overcome some of these obstacles for low income children and families.

The $880,000 project aims to better connect Medicaid with state immunization information systems in 5 states: Colorado, Hawaii, Kentucky, Montana, and New Mexico. The project aims to improve vaccination rates of Medicaid eligible children and pregnant women by identifying state level gaps in immunization coverage and improved utilization of immunization information systems. Disparities in vaccination rates between the privately and publicly insured are a persistent challenge, but one that may be mitigated with better data collection. 

For more from the AAP, see our Immunization Information Technology resources on our easy-to-find Immunization Initiatives page, Also see our State AdvocacyFOCUS resource on Childhood Immunizations, and our Child Vaccination Across America interactive infographic.

October 8, 2018: 2018 State Ballot Initiatives—The Voice of the People

While the outcomes of the local, state, and federal elections will draw great interest, it’s also important to be aware of the numerous important initiatives and referenda that will appear on ballots on November 6, 2018. From Medicaid expansion and access to health care to taxation, fiscal policy, and civil rights, voters will make decisions that will have significant consequences for children and families after the election and beyond.

Ballot initiatives and referenda can be an advocacy opportunity for AAP chapters. Ballot measure advocacy is a permissible lobbying activity for both 501(c)(3) and (c)(6) tax exempt AAP chapters for the purposes of compliance with IRS regulations of nonprofit organizations. Learn more about nonpartisan engagement in campaigns and elections by AAP chapters from the AAP Advocacy Guide.

Learn more from the AAP #VoteKids Get Out the Vote campaign Web site about ballot measures in your state and remember to have a plan in place to make your voice heard via absentee ballot or participation in early voting if you’re attending the National Conference and Exposition in Orlando this year. Don’t forget, voter registration deadlines begin tolling in states tomorrow, Tuesday, October 9.

October 4, 2018: How Does Your State’s Early Childhood System Share Data?
A state early childhood data system is designed to allow for the effortless sharing of data between early childhood programs and services. 2018 State of Early Childhood Data Systems, a new interactive report, from The Early Childhood Data Collaborative (ECDC), examines how state early childhood data systems link child, program, and workforce level data to improve the quality of services being provided. Currently, only 8 states (MN, MS, OK, PA, RI, UT, VT, and WI) link early childhood education data with a child’s health history, which includes immunization records, Medicaid Data, and more. Use the interactive map to see how your state links its early childhood data.

For more information on early childhood, visit the AAP Council of Early Childhood site.

October 2, 2018: Tennessee Child Passenger Safety Bill Turns 40 | Dr Robert Sanders Honored
Tennessee recently celebrated the 40th anniversary of its groundbreaking child passenger safety law last month. Enacted in 1977 and implemented a year later, the Tennessee Child Passenger Protection Act was the first law in the country to require that parents secure children in appropriate child safety seats. By 1985, all 50 states had a child passenger law on the books.
Throughout the late 1970s and early 1980s Dr Robert S. Sanders, a pediatrician and chair of the AAP Tennessee Chapter Accident Prevention Committee, and his wife Patricia Sanders, were instrumental in passing child passenger safety laws, not only in Tennessee, but in states across the country. To commemorate the advocacy efforts of Dr Sanders, a plaque was installed outside the Ruthersford County Health Department, where Dr Sanders was a director from 1969-1991. Joining Mrs Sanders at the historical marker dedication ceremony was Michael Warren, MD, MPH, FAAP, Deputy Commissioner for Population Health, Tennessee Department of Health.

For more from the AAP, see our Child Passenger Safety State AdvocacyFOCUS resource and Car Seats: Information for Families from

October 1, 2018: 2018 Elections and Youth Voter Registration

One of the most striking takeaways from the March for our Lives events in the response to the Parkland, FL school shooting earlier in 2018 was the deep involvement of youth acting as their own advocates. One of the pledged goals of those youth advocates was to increase youth participation in elections, and early indicators suggest that they are having an impact; data released by the Florida Division of Elections shows that voter registration for the 2018 general election is up in comparison to 2014, and that primary election turnout among youth nearly doubled.

Rigid registration requirements are cited by elections experts as one of the key barriers to citizen participation in elections. Voter registration deadlines are fast approaching in the many states that impose a 30-day window between eligible registration and Election Day. And don’t forget—if you are attending the 2018 AAP National Conference and Exhibition in Orlando—the last day of the conference, Tuesday, November 6, is Election Day, so make sure have a plan in place to make your voice heard via absentee ballot or participation in early voting. Learn more from the AAP Get Out the Vote campaign Web site, #VoteKids.

September 27, 2018: Medicaid Flexibility in Times of Emergency
As part of broader recovery efforts in times of emergency and disaster, states can operationalize Medicaid authorities to make obtaining and retaining coverage and care more readily accessible, as we recently saw with state responses to Hurricane Florence. Based on whether relevant agencies have declared states of emergencies, state Medicaid programs can provide coverage for people out-of-state or at higher income levels; develop simplified applications; adopt presumptive eligibility; add optional benefits and take many other actions.

New resources from the Centers for Medicare and Medicaid Services (CMS) Medicaid and CHIP Learning Collaborative detail these authorities, including a Disaster Preparedness Toolkit and Inventory of Medicaid and CHIP Flexibilities and Authorities in the Event of a Disaster. These resources can be helpful to AAP chapters and states as components of disaster preparedness efforts.

For related information and consultation, contact the AAP State Advocacy team.

September 25, 2018: State Advocacy for Safe Teen Driving
Motor vehicle crashes remain the leading cause of deaths for teens ages 15-19. The AAP has released The Teen Driver, an updated policy statement to reflect current research on policies to reduce deaths and injuries due to teen driver crashes. The statement reaffirms the importance of graduated driver licensing laws, including nighttime and teen passenger restrictions, learner’s permits requirements, and behind the wheel requirements.

The statement also emphasizes the effectiveness of mobile phone bans and primary enforcement seatbelt laws for all drivers and passengers in reducing deaths and injuries due to teen crashes. Policies that suspend or revoke the license of teen drivers for alcohol and marijuana use for all drivers have also been shown effective in reducing crashes due to impaired driving by teens.

For more from the AAP see our State AdvocacyFOCUS resources on Teen Driving and Distracted Driving and our infographic State Roads to Safe Teen Driving.

September 24, 2018: What Are Gubernatorial Candidates Saying About Poverty?
Many different state policy issues, from access to care to education to workforce issues, play a role in alleviating poverty among children and their families. Election 2018: What Are Candidates for Governor Saying About Poverty, a new report from Spotlight on Poverty & Opportunity, examines candidate positions on poverty related issues. If you are among the 36 states holding elections for governor in November, learn about the policies your candidates are proposing, and stand up for those that are speaking up for kids.

The AAP Get Out the Vote campaign, #VoteKids, encourages pediatricians and others who care for children to vote with kids in mind this election. The campaign Web site includes information on what's at stake for children, what you can do to speak up for children during the elections, and how and where to vote. If you are attending the 2018 AAP National Conference and Exhibition in Orlando—the last day of the conference, Tuesday, November 6, is Election Day, so make sure to cast an absentee ballot or participate in early voting if you will not be home in time to cast your ballot in person. Your vote matters!

September 20, 2018: School Nurse Scope of Practice and Role in Managing Concussions
Though the AAP recommends that all schools have a full time school nurse on staff, only 21 states currently mandate that school districts employ a school nurse and no state requires a full-time school nurse in every school. School nurse scope of practice varies from state to state.

A new resource from the Network for Public Health Law (NPHL) provides a survey of school nurse scope of practice laws for all 50 states. In addition, NPHL has released a fact sheet on the role that school nurses play in managing students with mild traumatic brain injuries.

For more from the AAP on school nurses, see the policy statement Role of School Nurse in Providing School Health Services, and for more on concussions, see the State AdvocacyFOCUS resource Concussion Management: Return to Play.

September 18, 2018: State Policymakers Act to Protect Health Plan Consumers
In the last several months, the Trump administration has taken several steps to advance the use of insurance products—association health plans (AHPs) and short-term limited-duration (STLD) plans—­­that are not required to follow Affordable Care Act (ACA) consumer protection rules. In addition to leaving families open to considerable risk of loss of benefits and higher cost-sharing, these plans also serve to destabilize the ACA-compliant insurance market.

States can play a large role in limiting the damaging effects of these types of plans. Several states have already moved forward with actions to limit the sale of STLD plans and/or to allow for additional state oversight of AHPs.

For more from the AAP, see our guidance for AAP chapters and advocates, New Rules Advance Insurance Plans Without ACA Protections. If your state is considering action on these types of plans, please contact us at for consultation.

September 17, 2018: Minnesota Chapter Plans Gubernatorial Candidate Forum
The Minnesota Chapter of the AAP (MNAAP) is using this year’s gubernatorial election to speak up for kids and remind candidates for office about putting children first. In partnership with the Children's Minnesota, the Children's Defense Fund, and UCare, MNAAP will host "Conversations on Child Health" with the 2 major party candidates for governor. Democratic (DFL) candidate and current US Representative Tim Walz will discuss important child health issues at a forum on October 25, from 12:30 to 1:30 at Children's Hospital in Minneapolis. Hennepin County Commissioner Jeff Johnson, the Republican candidate for governor, has been invited to participate at a future date, with planning currently underway.

This event is a great example of how AAP chapters can leverage elections to focus public attention on child health and wellness issues via nonpartisan campaign and elections activities. The AAP #VoteKids campaign encourages pediatricians and others who care for children to vote with kids in mind this election, so be sure to review the campaign materials and consider adapting them for outreach to your chapter members.

IMPORTANT REMINDER | The last day of the 2018 AAP National Conference and Exhibition in Orlando (Tuesday, November 6) is Election Day, so if you are attending, don’t forget to vote! Many states offer absentee and early voting options, so make sure you are prepared in advance of the meeting, and that your ballot is cast.

September 13, 2018: Local Governments Act to Raise Tobacco Purchase Age
Massachusetts recently became the 6th state to raise the legal age for purchase of tobacco products, including e-cigarettes, to age to 21. These state laws build on related advocacy successes in at least 340 localities of all sizes across the country.

This advocacy is making a difference, too. The CDC reports that overall youth tobacco use is dropping significantly. However, e-cigarettes are now reported as the most commonly used products for teenagers, with a total of 2.1 million teenage users. The AAP issued a response to actions taken yesterday by the FDA on e-cigarette use by youth, urging the agency to instead use its authority to regulate all e-cigarettes, and take stronger, immediate action to deter youth initiation of their use.

For more from the AAP, see our Raising the Tobacco Purchase Age State AdvocacyFOCUS resource and visit the AAP Julius B. Richmond Center of Excellence. Also see our state advocacy infographic on Tobacco 21 and our Electronic Nicotine Delivery Systems (ENDS) State AdvocacyFOCUS resource.

September 11, 2018: New AAP State AdvocacyFOCUS Resource | Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws
As you begin to plan your chapter’s advocacy agenda in advance of the 2019 state legislative session, the AAP has released a new State AdvocacyFOCUS resource on Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws. ERPO laws allow family members or other concerned parties to petition for the removal of firearms from the environment of a person deemed at risk of harming themselves or others.

2018 was hailed by the Giffords Law Center to Prevent Gun Violence as “the year of the ERPO law” with 8 states (Delaware, Florida, Illinois, Maryland, Massachusetts, New Jersey, Rhode Island, and Vermont) enacting such measures and joining the 5 states (California, Connecticut, Indiana, Oregon, and Washington) that previously had these laws in effect.

For more from the AAP on gun violence prevention, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. For information on state-level gun violence research and data collection options, see our State Advocacy Engagement on Firearm Data Collection resource.

September 10, 2018: How the Midterms Could Impact Medicaid
The upcoming midterm elections could have a big impact on Medicaid programs at the state level. Currently Idaho, Nebraska, and Utah have Medicaid expansion questions on the November ballot. In Michigan and Ohio—both Medicaid expansion states where the current governors are term-limited—race outcomes could have far reaching implications on the future of the programs as the candidates have divergent views on existing work requirement proposals. In Maine, where Medicaid expansion was approved by voters in 2017 but Governor LePage has refused its implementation, the will of the voters to expand Medicaid will fall to the next governor.

The Academy's Get Out the Vote campaign, #VoteKids, encourages pediatricians and others who care for children to vote with kids in mind this election. The campaign website,, includes information on what's at stake for children, how and where to register to vote and what you can do to speak up for children at the ballot box.

Are you attending the 2018 AAP National Conference and Exhibition in Orlando? The last day of the conference, Tuesday, November 6, is Election Day. Many states offer absentee and early voting options to ensure your ballot is complete and will be counted. More here.

September 6, 2018: AAP Updates Child Passenger Safety Guidance
The AAP Child Passenger Safety policy statement was recently updated to recommend that all children sit rear-facing in vehicles until they meet the height and weight limit that their convertible car seat allows. Though the age 2 milestone is no longer part of the statement, the AAP continues to support chapter efforts to advocate for laws requiring rear-facing seats until age 2, at a minimum.

Currently, 12 states (California, Connecticut, Illinois, Nebraska, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, and Virginia) have laws that require children younger than 2 years of age ride rear-facing in car seats.

For more from the AAP, see our Child Passenger Safety State AdvocacyFOCUS resource and Car Seats: Information for Families from

July 31, 2018: States Responding to Federal Efforts to Weaken ACA
In recent months, Congress and the Administration have taken several steps that may make Affordable Care Act (ACA)- compliant plans less accessible and affordable, including: zeroing out the individual mandate penalty; advancing insurance products without ACA protections; limiting navigator funding; and freezing risk-adjustment payments. These efforts are likely to contribute to an erosion of the insurance gains made following passage of the ACA, as has already evident in the  2017 rates of the uninsured.

To stave off coverage losses and protect patients and families, states are beginning to take steps to counterbalance these actions, including: creating reinsurance programs; implementing state individual mandates; regulating short term, limited duration (STLD) and other less adequate plans; extending open enrollment periods; and promoting marketplace competition, among other actions. A new Commonwealth Fund resource provides information on steps each state is taking and offers insight about possible future actions.

For more from the AAP on efforts to prevent the expansion of inadequate coverage, please see our recent Advocacy Action Guides on Short Term, Limited Duration and Association Health Plans as well as the importance of robust Essential Health Benefits.

StateView’s Summer Vacation
StateView is taking a short break in August. We’ll be back after Labor Day to help guide you through your fall state advocacy activities and to prepare you for the 2019 state legislative sessions.

July 30, 2018: Additional Cuts to ACA Navigator Funding Hits States

The Affordable Care Act (ACA) requires funding for Navigator programs to help with outreach, education, and enrollment assistance to consumers who are eligible for marketplace and Medicaid coverage. The Centers for Medicare and Medicaid Services (CMS) has funded these programs in the 34 states that use the federally operated marketplace under an agreement that ends on September 1, 2018. However, CMS cut funding to the program from $62.9 million to $36.1 million in 2017. This year, CMS is again reducing funding to a total of $10 million for all states.

An overview from the Kaiser Family Foundation (KFF) looks at funding cuts for the 34 states that will be affected and discusses the work and effectiveness of the Navigator program. Also highlighted are the CMS-directed changes to the program, such as educating consumers about coverage options that do not necessarily meet the requirements of the ACA (such as Association Health Plans and short-term limited duration plans) and elimination of the requirement that Navigators maintain a physical presence in the state in which they serve.

July 26, 2018: State Telehealth Reimbursement Law and Medicaid Policies
Laws and regulations for payment of telehealth care services in both the private insurance market and Medicaid vary greatly from state to state. 50 State Scan of Telehealth Reimbursement Laws and Medicaid Policies, a resource from the The Center for Connected Health Policy, looks at state trends in Medicaid payment, including which types of telehealth care services are covered, such as live video, remote patient monitoring, and store-and-forward. Developments with private insurance payment, online prescribing, consent, and licensure related to telehealth care are also examined.

For more from the AAP, please see our Advocacy Action Guide for AAP Chapters | Telehealth Care: Advocacy Opportunities to Remove Barriers and Expand Access. If your chapter is interested in more information or targeted consultation related to telehealth care, please contact us at

July 24, 2018: Illinois Enacts New Gun Violence Protection Laws
Illinois recently became the  8th state in 2018 to enact an Extreme Risk Protection Order (ERPO) law, also known as a “red flag” law. Delaware, Florida, Maryland, Massachusetts, New Jersey, Rhode Island, and Vermont also enacted ERPO legislation, which allows for the removal of firearms from the possession of those at risk of harming themselves or others.

Illinois also extended its 72-hour mandatory waiting period to apply to the purchase of all firearms, including assault weapons, but Governor Bruce Rauner vetoed legislation that would have required stores that sell firearms to be licensed by the state. 

For more from the AAP, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. For information on state-level gun violence research and data collection options, see our State Advocacy Engagement on Firearm Data Collection resource. 

July 23, 2018: Collaborating with Cooperative Extension

The nation’s Cooperative Extension System CES connects land grant universities and the public, bringing academic research to rural and urban communities where it can be applied to daily living. Historically, direct education regarding agricultural research and evolving practices was primary focus of Extension educators. More recently, though, Extension programs have branched out to reach both rural and urban communities on issues including child health and wellness, nutrition an obesity, family systems, mental health, and financial literacy. Currently, a 10-year CES is working in partnership with National 4-H Council and the Robert Wood Johnson Foundation, to support youth leadership in building a “Culture of Health” in communities across the nation.

AAP chapters can explore opportunities for partnering with Extension to improve child health. CES programs operate in nearly every state at a regional or county level, and offer grant opportunities, research and implementation expertise, and a network of additional partners to amplify your efforts.

For more, see Cooperative Extension as a Partner in Creating Healthy Communities from the Network for Public Health Law.

July 19, 2018: State Traffic Safety Trends
Car crashes continue to be the leading cause of death and injury to children over the age of 1. In 2017 alone, more than 2000 pieces of traffic safety legislation was introduced to address this trend. 

A new report from the National Conference of State Legislatures (NCSL) examines traffic safety state legislative trends on child passenger safety, school bus safety, teen driving restrictions, and distracted and impaired driving. In addition, the report includes state legislative efforts to address pedestrian and bicycle safety.

For more from the AAP on these issues, see our State AdvocacyFOCUS resources on Child Passenger Safety, Distracted Driving, and Teen Driving. 

July 17, 2018: New AAP Resource | State EPSDT Profiles
The AAP is pleased to release new state profiles on Medicaid’s Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefit and how it aligns to the AAP/Bright Futures 4th Edition Guidelines and corresponding Periodicity Schedule of preventive care screenings and health supervision visits. The state profiles also look at select 2016 state Medicaid pediatric preventive care quality measures and performance and include medical necessity definitions used for EPSDT and promising practices related to pediatric preventive care.

For tips on ways AAP chapters and advocates can use these profiles to improve preventive care for children in your state, please see the corresponding Using Your State EPSDT Profile resource.

July 16, 2018: What Happens to Medicaid Work Requirements After KY Ruling?
Earlier this month, a federal judge stuck down a Medicaid waiver in Kentucky that would require low-income adults to work in order to receive coverage. The decision leaves an open question as to how it will impact other states. While Kentucky would have been the first state to implement a Medicaid work requirement, three other states (AR, IN, NH) have already had their work requirements approved by the Centers for Medicare and Medicaid Services (CMS) while 7 others (AZ, KS, ME, MS, OH, UT, WI) have waivers pending. Arkansas is currently moving forward and having beneficiaries prove they are meeting the work requirement while the new Medicaid rules in Indiana and New Hampshire do not go into effect until January 2019.

It’s unclear if CMS will move forward on any of the 7 pending waiver requests while the Kentucky lawsuit continues. However, officials in Arizona, Ohio, and Utah have all stated they continue to work with CMS and are waiting to see how the agency responds to the court decision before deciding how they would like to proceed. CMS has 60 days from the ruling to decide whether to appeal.

For more from the AAP, please see our state waivers resource for chapters and waiver principles. If your state is considering imposing a work requirement or other Medicaid waiver provision, please contact for more information and consultation.

July 12, 2018: New Research Shows “Red Flag” Laws Reduce Suicide Deaths

Extreme Risk Protection Orders (ERPOs) also known as “Red Flag” policies, represent a significant trend in state gun violence prevention legislation this year. These laws allow law enforcement, family members, and in some cases physicians or teachers, to petition to remove firearms from the environment of people at risk of hurting themselves or others. So far this year, more than 20 states have introduced ERPOs and 4 states (Florida, Maryland, Rhode Island, and Vermont) have enacted this type of law.

A recent
study examined the effect that Connecticut and Indiana’s laws have had and found that they were associated with a decrease in suicide rates. In addition, a separate study found that gun permits were associated with lower rates of homicide.

For more from the AAP, see our State Advocacy Engagement on
Firearm Data Collection resource. 

July 10, 2018Colorado Chapter Joins Governor in Letter on Family Separation Policy

The AAP Colorado Chapter recently joined Governor John Hickenlooper and other state youth advocacy groups, in a letter calling on US House and Senate Judiciary Committee leadership to investigate the Administration’s family separation and detention policies.

The appeal emphasizes concerns about the health and well-being of youth, noting, “Children who are separated often experience mental health issues, poor social functioning, insecure attachment, disrupted stress reactivity, and even death.  Many child health and development experts have identified the practice of separation as causing trauma and stress child abuse.”

For more, see the AAP Statement on Executive Order on Family Separation and AAP and UNICEF USA Commend Federal Court Ruling on Family Separation Case.

July 9, 2018: California Enacts Law Prohibiting Soda Taxes
A new California law will prohibit localities from instituting sugar-sweetened beverage (SSB) taxes until 2030. State lawmakers were pressured into enacting this law following a threat by the American Beverage Association to pour millions of dollars into advertising opposing a ballot initiative that would have prohibited localities from instituting new taxes. Under the new law, 4 California cities (Albany, Berkeley, Oakland, and San Francisco) will be permitted to keep their existing SSB taxes.    

State laws preempting stronger public health laws are not new. An op/ed published in The Hill this week notes the similarities between the tactics used by the American Beverage Association and by tobacco manufacturers to preempt local tobacco taxes and clean indoor air laws. This policy statement from the American Public Health Association (APHA) discusses the negative impact that preemption laws have on public health.

For more from the AAP on sugar-sweetened beverages, see our policy statements Snacks, Sweetened Beverages, Added Sugars, and Schools and Fruit Juice, in Infants, Children, and Adolescents. For more on tobacco, see the policy statement Protecting Children from Tobacco, Nicotine, and Tobacco Smoke or visit the Julius B. Richmond Center of Excellence

July 5, 2018: 2018 KIDS COUNT Data Now Available
The 2018 KIDS COUNT Data Book, an annual report from The Annie E. Casey Foundation, examines state level child health, education, and well-being data. The 2018 report finds that although the poverty rate for children has declined, 1 in 5 children still live in poverty. Additionally, fewer families are living with high housing costs and the teen birth rate has continued its recent decline, resulting in the lowest rate ever.

State and topic specific data are easily searchable through the KIDS COUNT Data Center. This customizable resource is an excellent tool to lend support to a wide variety of AAP chapter advocacy initiatives.

July 3, 2018: Stay Safe this 4th of July, Leave the Fireworks to the Experts
In 2015, more than 10,000 people visited US emergency rooms with firework-related injuries and children under 15 accounted for a quarter of these injuries. To prevent injuries to children, the AAP recommends that families visit community firework displays run by professionals and avoid the use of fireworks at home. In addition, the AAP recommends that the sale and use of all consumer fireworks be prohibited. 

Currently, 46 states allow the sale of some or all types of consumer fireworks allowed by federal law, 3 states (Illinois, Ohio, and Vermont) only allow the sale or use of sparklers and other novelty items, and Massachusetts bans the sale of all consumer fireworks.

For more from the AAP, see our policy statement Firework-Related Injuries to Children and Stay Safe this 4th of July from

July 2, 2018: 17 States and DC Sue Administration Over Family Separation Policy
Washington State Attorney General Bob Ferguson recently filed a 128-page legal complaint in the US District Court in Seattle, describing the administration's practice of refusing asylum and separating families at the US southern border as a "cruel and unlawful policy" that already has resulted in the separation of more than 2,000 immigrant children and infants from their parents. The suit contends children have been "left to languish in makeshift detention facilities—where staff are sometimes told not to comfort them—until a placement is found for the child." The lawsuit asks the federal court to declare the practice of denying asylum-seekers entry and separating immigrant families illegal and order the administration "to stop implementing them immediately." It also asks the court to order the United States "to reunite every family separated by these unlawful acts immediately."

Joining Washington State in the suit are California, Delaware, the District of Columbia, Illinois, Iowa, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, and Virginia.

For more from the AAP, see our joint statement with UNICEF USA on a ruling in another case related to separation and reunification.

June 28, 2018: CDC Youth Risk Behavior Surveillance Report Finds Wide Variation Among States
New survey data from the Centers for Disease Control and Prevention (CDC) paints a complicated picture on the health and safety of adolescents. The Youth Risk Behavior Surveillance (YRBS) report monitors 6 categories of behaviors among youth and young adults—namely, unintentional injuries and violence, tobacco use, alcohol and other drug use, sexual behaviors related to unintended pregnancy and sexually transmitted infections, unhealthy dietary behaviors, and physical inactivity.

The latest YRBS survey finds that fewer adolescents are smoking, using alcohol or other drugs, or engaging in sexual intercourse than in past years. However, as the YRBS Youth Online data tool illustrates, there is wide variability among states in the frequency of various risky behaviors by adolescents, offering powerful insights for advocacy in your state. 

For more from the AAP, see our Web pages from the Committee on Adolescence (COA), Council on School Health (COSH), and Council on Injury, Violence, and Poison Prevention (COIVPP).

June 26, 2018: Fearing Deportation, Immigrant Parents Are Opting Out of Health Benefits for Kids 
With the fear of deportation and family separation growing among immigrant families, many parents are making the difficult choice to pull their American citizen children out of programs like Medicaid.
Kaiser Health News reports advocates and health care groups are observing a growing number of immigrant parents making this difficult decision because of policy changes, such as more in-depth application requirements for programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP). Even though the children are eligible for these programs, fear of repercussions due to a parent’s immigration status is preventing them from getting the care they need.

Families opting out of the Medicaid program will be forced to seek care in settings such as emergency departments which could result in care that is more fragmented, has higher costs for states, and often comes with diminished outcomes. Consequently, the number of uninsured children is likely to increase. In states like Texas, where the immigrant population is larger, this change would be more profound as almost one quarter of children there have at least one parent who is not yet a US citizen.

The AAP continues to strongly support the needs of immigrant children and families

June 25, 2018: State Disaster Spending and Data Limitations: What We Don’t Know
The frequency and severity of natural disasters is taking a growing toll on states, with commensurate impacts on state budgets. The uneven tracking of state spending on disaster response is an impediment to better intergovernmental coordination in response to disasters, and ultimately, outcomes for those impacted by disasters. A recent review by the Pew Charitable Trust found wide variability in state expenditures on natural disaster response, and within states, a complicated mix of local, state, and federal funding streams. With better data, states can better prepare for disasters, and ensure that response efforts are adequately resourced.

For more from the AAP, see the AAP Advocacy Action Guide on disaster preparedness and our Children & Disasters page.

June 21, 2018: State Officials Respond to Child Separation at the Border
Yesterday President Trump signed an executive order that aims to end the Administration’s practice of separating children from their families at the US southern border. The move comes after widespread outcry from pediatricians, advocates, and the public. In addition to a growing opposition from federal lawmakers, state officials have weighed in with statements and actions to push back against the practice. The Association of State and Territorial Health Officials (ASTHO) issued a statement echoing the AAP’s concerns that “… these separations interrupt these bonds and may lead to serious consequences for children who do not heal from this trauma.”

The AAP agrees with ending the abhorrent practice of separating children from their families, however, the signed executive order continues to maintain the "zero tolerance" policy which will put more children in detention facilities, an environment the AAP states is no place for a child, even if they are accompanied by their families. The order also fails to address the more than 2,300 children who have already been cruelly separated from their parents.

The Academy’s mission is to protect the health and well-being of all children—no matter where they or their parents were born—and we hold our federal and state leaders to that same standard. These vulnerable families deserve our compassion and assistance.

For more information, see the AAP Statement on Executive Order on Family Separation.

June 19, 2018: States Eye Mandates to Shore Up Insurance Markets
The Affordable Care Act (ACA) required payment of an annual penalty for not maintaining health insurance coverage; this provision was included in the law as a mechanism to stabilize premiums and insurance markets as it encouraged healthier individuals to maintain coverage. Federal tax legislation enacted at the end of 2017 zeroed out this penalty for not having coverage beginning in 2019. As a result, a small number of states are beginning to examine state-level mandates that would require residents of the state to have meaningful insurance coverage or pay a state-level penalty.

Massachusetts has had a state coverage requirement that dates to its health reform activities of the mid-2000s, however this year New Jersey and Vermont also passed legislation to add individual mandates in their states. A handful of other states considered similar measures this year; the Commonwealth Fund examines the details of this legislation.

States will continue to play a critical role in the regulation of health insurance, particularly as the federal government continues to weaken federal ACA insurance standards. For more information on such efforts and opportunities for state advocacy, please see the recent AAP  Advocacy Action Guides on Association Health Plans (AHPs)/Short Term, Limited Duration (STLD) Plans and Essential Health Benefits.

June 18, 2018: National Transportation Safety Board Recommends Seat Belts on School Buses
The National Transportation Safety Board (NTSB) has issued a recommendation that all new school buses in the United States be equipped with a seatbelt. The NTSB statement also recommends that all states requiring only a lap belt on school buses, upgrade their to a 3-point seat belt.  

Currently, 6 states (California, Florida, Louisiana, New Jersey, New York, and Texas) require seat belts on school buses.  California and Texas require 3-point seat belts and Florida, Louisiana, New Jersey and New York require lap seat belts in buses.

For more from the AAP on school bus safety, see School Transportation Safety policy statement and the School Bus Safety state advocacy infographic. Chapters are encouraged to use the infographic in related advocacy efforts and share it via social media.

June 14, 2018: Six States Require Drug Price Transparency
California, Connecticut, Maine, Maryland, Nevada, and Vermont are the 6 states that have, to date, enacted prescription drug pricing transparency laws requiring drug makers to report the reasons behind dramatic price increases. Maryland’s law—which is currently undergoing legal review—goes a bit further by identifying “unconscionable” price increases and taking legal action against drug manufacturers. A new resource from the National Academy for State Health Policy’s Center for State Drug Pricing examines the requirements of these state laws as well as the enforcement actions states may take.

For more from the AAP, see our guidance for chapters on State Advocacy Engagement on Epinephrine Autoinjector Costs.

June 12, 2018: New Research Shows “Red Flag” Laws Reduce Suicide Deaths
Extreme Risk Protection Orders (ERPOs) also known as “Red Flag” policies, represent a significant trend in state gun violence prevention legislation this year. These laws allow law enforcement, family members, and in some cases physicians or teachers, to petition to remove firearms from the environment of people at risk of hurting themselves or others. So far this year, more than 20 states have introduced ERPOs and 4 states (Florida, Maryland, Rhode Island, and Vermont) have enacted this type of law.

A recent study examined the effect that Connecticut and Indiana’s laws have had and found that they were associated with a decrease in suicide rates. In addition, a separate study found that gun permits were associated with lower rates of homicide.

For more from the AAP, see our State Advocacy Engagement on Firearm Data Collection resource.

June 11, 2018: Legislative Approaches to Prevent Child “Hot Car” Deaths
As summer months heat up, the risk of hyperthermia, also known as heatstroke, increases. Children in cars are especially at risk. The rate of deaths to children due to heatstroke have steadily increased over the last 20 years, with 742 children dying from heat stroke inside a motor vehicle between 1998 and 2017. 

Kids in Hot Cars: One Child is Too Many, a report from The National Safety Council (NSC), outlines public policy strategies to reduce deaths due children being left in hot cars, including:

  • Prohibiting children from being left unattended in cars for any reason and any length time.
  • Protecting those who act in good faith to remove a child from a hot car.
  • Increasing punishments for those who intentionally leave a child unattended in a hot car.

For more from the AAP, see Prevent Child Hot Car Deaths and Protecting Children from Extreme Heat: Information for Parents from and the Pediatrics article Heat Stress From Enclosed Vehicles: Moderate Ambient Temperatures Cause Significant Temperature Rise in Enclosed Vehicles.

June 7, 2018: NC Peds White Coat Wednesday
Members of the North Carolina Pediatric Society recently visited Raleigh as part of the state medical society’s White Coat Wednesday program. Chapter members met with legislators to advocate for their 2018 Legislative Agenda, which includes supporting legislative improvements to the state’s 1115 Medicaid Waiver, improving the state’s primary care and subspecialty pediatric workforce, requiring suicide prevention training in schools, and appropriating $250,000 for Reach Out and Read.​

June 5, 2018: New AAP Resource | New Final Rule Threatens Essential Health Benefits (EHB)
The recently released 2019 Notice of Benefit and Payment Parameters (NBPP) final rule gives states options to significantly weaken several Affordable Care Act (ACA) protections, most notably with respect to essential health benefits (EHB) coverage. The ACA requires 10 categories of health care benefits for individual and small group plans, and the ACA’s cost sharing and out-of-pocket spending protections are linked to benefits in the EHB package. The new rule allows states to choose EHB benchmark packages that offer considerably less coverage than is currently required; while states are not required to make any changes for 2020, they have until July 2, 2018 to do so if they so choose. The new rule also makes selecting EHB an annual decision for states.

A new AAP Advocacy Action Guide provides details of the rule and advocacy guidance for AAP chapters. While the rule’s short timeline for a 2020 plan year EHB selection may mean few states make a decision this year (and default to the existing EHB, which may be more protective), AAP chapters are encouraged to remain vigilant for state plans to weaken EHB. AAP chapters are encouraged to contact the Academy at should your state have plans to change EHB, and for more information and targeted consultation.​

June 4, 2018New Jersey Enacts Individual Insurance Mandate
As part of the last’s year tax reform legislation, Congress reduced the penalty for not having health insurance to $0, essentially ending the Affordable Care Act (ACA) individual mandate. Elimination of the individual mandate could serve to destabilize health insurance markets by discouraging younger and healthier individuals from obtaining coverage. In response to this action, New Jersey lawmakers have enacted a law requiring all residents to have health coverage or pay a penalty, becoming the 3rd state to do so. Massachusetts enacted a mandate in 2006 as part of its health care reform efforts and Vermont’s Governor Phil Scott signed a bill last month that will establish a mandate in that state beginning in January 2020.

New Jersey’s mandate includes an annual penalty of 2.5% of a household’s income or a per-person charge, whichever is greater. If based on a per-person charge, the maximum penalty would be $2,085. There will also be a “hardship exemption” for those who cannot afford coverage. The revenue collected by the state would fund a reinsurance program which will help insurers cover the cost of the most expensive patients. The state will apply for a 1332 waiver to reallocate those funds. These types of waivers have already been approved in Alaska, Minnesota, and Oregon.

For more from the AAP, please see our state waiver guidance for AAP advocates

May 31, 2018: Virginia to Become the 33rd State to Expand Medicaid as Other States Eye Ballot
After many years of advocacy and debate, Virginia is poised to become the 33rd state (plus the District of Columbia) to expand its Medicaid program under the Affordable Care Act (ACA). The move is expected to provide insurance coverage for 400,000 residents who otherwise would likely go uninsured. After failing to garner enough votes for years, lawmakers in the state reached a final compromise this week, which includes the addition of work requirements and other provisions, and the bill is expected to be signed by Governor Ralph Northam.

Other states that have not yet expanded Medicaid are considering taking the issue to voters this fall. Last year, Maine was the first state to approve a ballot initiative on Medicaid expansion. While that state has faced resistance from their governor on implementing the expansion, other states continue to move forward with similar proposals. Just recently, petitions gathered by advocates in Utah were certified and the measure will appear on the ballot this November. Idaho and Nebraska also have advocacy groups collecting signatures for inclusion of a ballot initiative on Medicaid expansion.

For more from the AAP, please see our State Advocacy Focus | Medicaid Expansion as well as our state waivers resource and principles on waivers document.  ​

May 29, 2018: California Collaborative in Community Pediatrics and Legislative Advocacy
Recently, the California Collaborative in Community Pediatrics and Legislative Advocacy, representing faculty and residents from all 14 pediatric residency programs in the state, visited Sacramento to advocate for children’s health and well-being. Participants met with lawmakers to advocate for CA SB 982, which would increase the amount of aid children and families are eligible to receive under the state’s California Work Opportunity and Responsibility to Kids (CalWORKs) program. AAP District IX, representing all 4 AAP California chapters, also supports the bill.

Before heading off to meet with legislators, California State Senator Richard Pan, MD, FAAP (D-6) joined the group to prepare the attendees for the day and provide them with some key policy updates.​

May 24, 2018: States Serve Children with Special Health Care Needs With Medicaid Managed Care
States continue their work to transform health care delivery systems and improve quality of care. As more states move children and youth with special health care needs (CYSHCN) to a Medicaid managed care model, there is a greater need for care coordination and other system changes to ensure these children have their health care needs met. The National Academy for State Health Policy (NASHP) has developed new resources to support state efforts to strengthen the delivery of this care.

The first report examines how states structure their Medicaid managed care systems to meet the needs of CYSHCN. Common approaches to ensuring quality care to this population of children include the establishment of network adequacy standards for specialty providers and policies to promote continuity of care for transitions. An additional issue brief explores how states provide care coordination in their Medicaid managed care systems and partner with other stakeholders to meet the needs of CYSHCN.

Learn more about care coordination for CYSCHN from the National Center for Medical Home Implementation.​

May 22, 2018: New AAP Chapter Advocacy Action Guide | Disaster Preparedness
Pediatricians and other physicians play an important role in the response effort following disasters, and AAP chapters can provide support after, during, and even before disaster strikes. By planning ahead for disasters, AAP chapters can better support disaster recovery efforts of their members and help them return to providing care as soon as possible following a disaster event. AAP chapters are also uniquely positioned to serve as advocates for children and pediatricians in state level disaster planning and response.

To support this important work, a new AAP Advocacy Action Guide on disaster preparedness is now available. The guide details the importance of disaster planning for both individual pediatric clinics and AAP chapters, and provides tips on what AAP chapters can do to advocate for disaster preparedness and response efforts in their states.

For more from the AAP, see our Children & Disasters page.​

May 21, 2018: Montana Medicaid Helps Enrollees Succeed in the Workforce​
Many states are considering the implementation of work requirements in the Medicaid program, either through Medicaid waivers or proposed legislation. There is little evidence to show that programs like this aid Medicaid beneficiaries in finding and keeping work, however, and the result could be diminished access to health care for low-income families. Montana, however, has implemented a program that targets outreach and services to the small number of Medicaid enrollees who do not work due to issues such as limited skill sets, lack of transportation or child care, and other necessary work supports.

Montana’s Health and Economic Livelihood Partnership Link (HELP-Link), connects individuals who are looking for work or better jobs with services such as career counseling, on-the-job training programs, and subsidized employment. The first 2 years of the program has generated strong participation due to Montana’s intensive outreach, offering of meaningful services, and trainings to service providers on how to meet the needs of low-income Medicaid enrollees. This program could serve as a model alternative for states currently considering Medicaid work requirements. A recent Center on Budget and Policy Priorities report examines the program and how it avoids harmful counterproductive effects of work requirements.

For more from the AAP on Medicaid waivers and work requirements, please see our resources: State Waivers Guidance for AAP Advocates AAP Principles on Waivers, and our Webinar, State Waivers: How They Could Alter Coverage and Care for Children. For consultation and technical assistance, please contact us at ​

May 17, 2018: Partnering With State Highway Safety Offices​
Though the number of deaths and injuries due to car crashes has declined significantly since the early 1970s, car crashes still represent the number one cause of death or injury to children over the age of 1. The Federal Highway Safety Act of 1966 created a partnership between federal and state transportation officials that has culminated in public policies attributed to reducing deaths and injuries.

A Guide to Effectively Partnering with State Highway Safety Offices (SHSOs), from the Governor High Safety Association (GHSA), can help AAP chapters learn how to partner with SHSOs by providing an overview of the roles of SHSOs, explaining traffic safety planning and programming rules, and the state goal-setting processes and requirements.

For more from the AAP on traffic safety issues, see our State AdvocacyFOCUS resources on Child Passenger Safety, Distracted Driving, and Teen Driving.

May 15, 2018: New AAP Resource | Association Health Plans (AHPs) and Short Term, Limited Duration (STLD) Plans

In recent months, newly proposed federal rules on Association Health Plans (AHPs) and short term, limited duration (STLD) plans would advance the use of insurance products that do not offer important Affordable Care Act (ACA) protections. While these rules await finalization, states may begin acting to expand use of such products as a way of offering consumers cheaper insurance that provides significantly less coverage. Such plans pose a risk both to families that enroll in such coverage, as well as the ACA-compliant market.

A new AAP Advocacy Action Guide provides details of these proposed rules, as well as steps states may take to prevent the expanded use of such insurance products that may harm families. We will update this resource and alert chapters as these rules are finalized. In the interim, please contact for more consultation and technical assistance.​

May 14, 2018: MCAAP Residents and Fellows Day at the State House
A record number of pediatricians and pediatric residents from all over Massachusetts gathered at the state capitol for the annual Residents and Fellows Day at the State House (RFDASH) to advocate for legislation on gun violence prevention, youth tobacco use, and youth sexual education in schools. Numerous guest speakers provided overviews of the issue, and former AAP Board of Directors and Committee on State Government Affairs member, Carole Allen, MD, FAAP, provided an inspiring keynote address on the importance of advocacy as part of a pediatrician’s career.

May 10, 2018: Learning a New Way to Serve
Engaging in state advocacy with your AAP chapter can occur throughout, or at any point during, a pediatricians’ career. No one knows this better than AAP Section on Seniors member and AAP Washington Chapter (WCAAP) member Ruth Conn, MD, FAAP. In her blog post, Learning a New Way to Serve, Dr Conn discusses how she became involved in the chapter’s state advocacy work after retiring from practice.

Click here for more information on advocacy and the AAP Section on Seniors.​

May 8, 2018: Pennsylvania Pediatricians Visit Harrisburg
On April 27, 24 pediatric residents, representing 9 residency programs, and 23 pediatricians and faculty members from the AAP Pennsylvania Chapter spent the day in the state capitol learning advocacy skills and reviewing current state legislation on gun violence protection. The day cumulated in visits with legislative leadership staff explaining the impact of gun violence on children and youth and urging action on proposed gun safety legislation.​


May 7, 2018: ICAAP Annual Advocacy Day in Springfield
The AAP Illinois Chapter recently visited the state capitol to advance the chapter’s 2018 Advocacy Priorities. Forty-five (45) medical students, residents, and pediatricians met with legislators to discuss the importance of immunizations, gun violence and safety, raising the purchase age of tobacco to 21, and legislation that will codify the requirement that children remain in rear-facing car safety seats until the age of 2.​

May 3, 2018: Drinking Water Quality Webinar​
The Flint Water Crisis has served to draw public attention to the hazards posed to children by lead contamination of drinking water and the many regulatory gaps in water monitoring for lead. Learning from the Flint Water Crisis: Legal Implications and Community Public Health Impacts, a Webinar from the Network for Public Health Law, will examine the Flint Water Crisis, the key legal issues and authorities at heart of the crisis, lessons learned from the incident, and how the health of the public continues to be impacted in Flint.

The Webinar will be held May 15, 2018 at 1:00 Eastern/12:00 Central. Register now to participate.  

For more from the AAP, see our policy statement, Prevention of Childhood Lead Toxicity, and visit the AAP Council on Environmental Health Web page. Guidance on lead exposure in children is also available from​

May 1, 2018: States Make Progress on Gun Violence Prevention
Governors from Connecticut, Delaware, Massachusetts, New Jersey, New York, Rhode Island and Puerto Rico have announced efforts to launch a multistate consortium to study gun violence. The new research consortium will work across participating state universities and government agencies and will compile findings, along with existing data from institutional, federal, and multistate sources, into a clearinghouse available for public review.

In addition, lawmakers in Maryland have banned bump stocks (also known as trigger accelerators), which allow semiautomatic assault weapons to function similar to fully automatic weapons. In addition, the state enacted laws to create an “extreme risk protection order" (ERPO), which allows families to petition to remove firearms from the environment of a person at risk of harming themselves or others and to remove guns from the homes of domestic violence perpetrators.

For more from the AAP, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. For information on state-level gun violence research and data collection options, see our State Advocacy Engagement on Firearm Data Collection resource.​​

April 30, 2018: CDC Warns States on Synthetic Marijuana and Vitamin K Supply
The US Centers for Disease Control and Prevention (CDC) recently alerted states and territories to a growing number of cases of individuals presenting to emergency departments with serious, unexplained bleeding. It has since been determined that these cases were a result of consumption of synthetic marijuana that later tested positive contamination with brodifacoum, a rodenticide. High doses of vitamin K are used to treat this kind of bleeding, and the CDC bulletin noted that hospital supplies of vitamin K may be at risk; the implication for pediatrics could be a shortage of intravenous vitamin K to prevent bleeding in newborns.

The State of Illinois (where a majority of these cases have been treated) recently announced that it will receive a donation of 800,000 doses of oral vitamin K from its manufacturer, but intravenous vitamin K is still part of the initial treatment of these brodifacoum-related bleeding cases.

If you experience shortages of vitamin K in the clinical setting, please contact the Food and Drug Administration directly to file a report.

April 26, 2018: Interstate Medical Licensure Compact At Age 1
The Interstate Medical Licensure Compact (Compact) is marking the 1st anniversary of its licensure process by highlighting physician utilization across the country. The Compact, supported by the AAP, has created a streamlined mechanism for licensing physicians in multiple states. It allows qualified pediatricians, pediatric medical subspecialists, and pediatric surgical specialists (and other physicians) to practice medicine across state lines while protecting patients and expanding access to care.

New data released by the Compact shows that as of March 2018, 906 physicians have used the process and were able to secure 1,301 medical licenses in member states. State specific information is also presented regarding the number of licenses issued by member medical boards. There are currently 22 states (AL, AZ, CO, IA, ID, IL, KS, ME, MN, MS, MT, NE, NH, NV, PA, SD, TN, UT, WA, WI, WV, WY) that have passed legislation to become Compact member states.

For more on the Compact from the AAP, please see our Interstate Medical Licensure Compact Advocacy Action Guide for AAP Chapters. 

April 24, 2018: State of the Air 2018
While significant progress has been made to improve air quality in the US since the 1970s, especially with the passage of the National Environmental Protection Act and the Clean Air Act, significant challenges to protect the public from the harms of air pollution remain. Currently, 40% of Americans live in counties with unhealthy levels of ground level ozone and particulate matter pollution.

State of the Air 2018, a report from the American Lung Association, assesses local and regional differences in air quality and its impacts on human health, along with data specific to the risks posed to children and the prevalence of pediatric asthma in those areas. The report also highlights the primary ongoing threats to clean air, the role of climate change in the worsening of overall air quality, and guidance to advocates for mitigating these threats.

For more from the AAP on air quality and child health, see the resources available from the Council on Environmental Health and our policy statement, Ambient Air Pollution: Health Hazards to Children.​

​April 23, 2018: Infant Safe Sleep Laws
A valuable resource from the Network for Public Health Law examines state safe sleep laws, including policies that address safe sleep parent education, child care training/procedures, and adoptive/foster care training/procedures. Also included is are the states and localities that prohibit the sale of crib bumpers.

So far in 2018, 3 states (Missouri, New York, and Vermont) have introduced bills to ban the sale of crib bumpers.  In addition, New Jersey is considering bans on the sale of supplemental mattresses for portable cribs. A similar bill in New Jersey was  vetoed last year.

For more from the AAP on safe sleep, see the AAP technical report SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for Safe Infant Sleeping Environmentand How to Keep Your Sleeping Baby Safe: AAP Policy Explained.​

April 19, 2018: The State of Preschool
​According to The State of Preschool 2017, a new report  from the National Institute for Early Education Research, enrollment in state funded preschool programs has surpassed 1.5 million young children for the first time. Most of these young children (almost 86%) were 4 years old, with the remainder being 3 years of age, but the number of young children enrolled varies from state to state. Four (4) states (FL, OK, WI, and VT) and Washington, DC served more than 70% of 4-year-olds, while 12 states (AL, AZ, DE, HI, IN, MA, MN, MO, MS, NV, RI, and WA) enrolled less than 10% of children of the same age.

The 43 states and DC that offer state funded preschool programs spent a combined $7.6 billion, an increase of $155 million compared to 2015-2016. Washington, DC provided the most funding per pupil at $16,996, while Nebraska spent the least at $2,000 per pupil.

You can find out your state’s preschool enrollment, funding, progress on quality indicators, and more by taking a closer look at these state profiles.

For more on early childhood from the AAP, visit the AAP Council on Early Childhood.​

April 17, 2018: America's Opioid Crisis: The Unseen Impact on Children
The AAP has partnered with the Annie E Casey Foundation to synthesize national and state data related to the opioid crisis, child welfare systems, Medicaid, and child health. As part of this work, the AAP has released state and national fact sheets that examine the intersection of the opioid epidemic, child welfare systems, and child health. These fact sheets can support chapter efforts to seek policy solutions for vulnerable children and families.

The AAP also highlighted state policy strategies to address the opioid epidemic at the 2018 AAP Annual Leadership Forum (ALF). Margaret Wile, Policy Associate from the National Conference of State Legislatures provided an overview of how states were addressing the opioid crisis through addressing prevention, treatment, intervention, and recovery.  

For more from the AAP, see our Activities to Address the Opioid Epidemic resource.​

April 16, 2018: Medicaid Work Requirements Will Harm Working Adults
Pediatricians know that parental health insurance coverage has a positive effect on the likelihood a child will obtain and maintain coverage, and that in most families enrolled in Medicaid, adult family members are already working. AAP chapters have been opposing AAP chapters recent proposals to require work as a condition of Medicaid coverage for adults.

New research from the Center on Budget and Policy Priorities indicates work requirement proposals will not only harm adults unable to find employment but will also negatively affect those adults who are already employed. This research indicates as many as 46% of likely Medicaid-eligible low-income working adults would have been at risk of losing their Medicaid coverage for at least 1 month of a year under Kentucky’s work requirement. Moreover, even for those adults working an average of 80 hours/month, 25% would be at risk of losing coverage due to their inability to work 80 hours every month.

For more, please see the Academy's Principles on Waivers, and our resource, State Waivers Could Significantly Alter Coverage and Care for Children and contact us at for consultation and technical assistance if you’re facing a waiver proposal in your state.​

April 12, 2018: Missouri Pediatric Advocacy Day
Nearly 100 pediatricians, pediatric specialists, and residents joined the AAP Missouri Chapter (MOAAP) and the Missouri Collaborative for Advocacy and Residential Education (MOCARES)—a partnership of the 4 pediatric residency programs in the state—recently visited Jefferson City to advocate for their child health priorities. Chapter members met with lawmakers to educate them about protecting anyone younger than 18 from the dangers of indoor tanning, requiring car seats to be rear facing until age 2, and extending postpartum Medicaid coverage for women with substance abuse disorders.

April 10, 2018: Vermont Enacts Comprehensive New Gun Law​
Today, more than 350 pediatricians, pediatric medical subspecialists, pediatric surgical specialists, and pediatric trainees will be on Capitol Hill as part of the AAP Legislative Conference. This year, leaders from the Academy's chapters, committees, councils and sections will participate alongside conference attendees to send a strong message to Congress: pass comprehensive legislation to protect children from gun violence.

As pediatricians advocate for stronger federal gun laws in Washington, progress is also being made at the state level. Last week, the Vermont legislature enacted a package of gun bills, expected to be signed by Governor Phil Scott, to prohibit private sales of firearms, ban bump stocks or trigger accelerators that allow semiautomatic weapons to fire like automatic weapons, raise the minimum purchase age of all firearms to 21, and prohibit the sale and possession of high capacity ammunition. Along with the package of firearm laws enacted in Florida earlier this year, progress is being to protect children from gun violence.

For more from the AAP, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. For information on state-level gun violence research and data collection options, see our State Advocacy Engagement on Firearm Data Collection resource.​

April 9, 2018: 2016-2018 State Child Care Development Plans
Quality early education and child care plays a pivotal role in the development of young children. As part of the federal Child Care and Development Fund reauthorization, states were given new requirements and goals to improve their early education and child care programs. State Policies for Addressing Access: Analysis of 2016-2018 Child Care Development Plans, a new report from The Early Childhood Data Collaborative, examines how states have chosen to work towards addressing several of these new requirements and goals.

For more from the AAP on child care and early childhood education efforts, see our policy statement Quality Early Education and Child Care and visit the AAP Council on Early Childhood.​

April 5, 2018: Washington State and Maryland Move to Protect Children from Conversion Therapy
New legislation to protect children from attempts to change their sexual orientation or gender identity was enacted last week and signed into law by Washington Governor Jay Inslee. A similar bill has also passed the Maryland Legislature, and awaits signature by Governor Larry Hogan.

AAP policy states that these therapies are not effective, may be harmful to LGBTQ individuals by increasing internalized stigma, distress, and depression, and therefore are never indicated. Ten (10) states and the District of Columbia have now banned conversion therapy, as have 35 municipalities around the country.

For more from the AAP, see our policy statement Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth.​

March 27, 2018: New Gun Violence Prevention Resources

The Giffords Annual Gun Law Scorecard ranks all states by their firearm safety laws. Only California received an “A” rating by the group and more than half of states received a “D” or an “F” rating, signifying the need for the need for continued advocacy on gun violence prevention. The report also notes that the states with lower ratings have higher rates of gun deaths.   

GVPedia is a new comprehensive resource providing public access to the largest gun study database in existence and to GVP University, a repository of white papers and fact sheets about gun violence. Overseen by the executive director of Marylanders Against Gun Violence, the resource is searchable by issue, author, and publication and provides 50 years if gun violence prevention research.    

For more from the AAP on state gun violence prevention efforts, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. Also see our State Advocacy Engagement on Firearm Data Collection resource.

March 26, 2018: Infant Safe Sleep State Laws

Infant Safe Sleep Laws, a new resource from the Network for Public Health Law, outlines the status of state law on policies designed to reduce unsafe sleep practices. The policies outlined address parent education, child care training, child care education, adoptive/foster parent training, foster care procedures and other policies such as crib bumper or supplemental mattress bans.   

For more from the AAP on Safe Sleep, see the Technical Report: SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment.

March 22, 2018: States Act on Flame Retardant Chemicals
States are taking a leadership role in preventing and reducing toxic exposures and this year 16 states have introduced legislation to restrict the use of flame retardants in various consumer products. In 2017, Maine enacted similar legislation, following an override of the governor’s veto, and other states are now replicating those efforts.  

Firefighters—who are concerned about occupational exposure to these chemicals when ignited during residential fires—have been the primary advocates on this issue at the state level, and AAP chapters have added their voices to support these bills. Like other toxic substances, children are particularly susceptible to the potential reproductive, neurotoxic, immunotoxic, endocrine, behavioral, and carcinogenic harms posed by these chemicals.

For more from the AAP, see the Council on Environmental Health Web page and the Chemical-Management Policy: Prioritizing Children’s Health policy statement.​

March 20, 2018: AAP Chapter Engagement on Gun Violence Prevention

In a March 8, 2018 message to all Academy members, AAP President Colleen Kraft, MD, FAAP encouraged pediatricians to participate in the March 24 Day of Action in Washington, DC or in local events around the country. Many AAP chapters and members are already engaged, and we’re taking an additional opportunity to remind StateView readers to support this student-led initiative to oppose gun violence.

AAP chapters have also participated in days at the capitol to address gun violence prevention, and supported students at last Wednesday’s walkout events. In addition, more than 50 AAP chapter leaders met last week at the Annual Leadership Forum to discuss gun violence prevention and share effective strategies to influence change. Tomorrow, members of the state advocacy team will participate in the monthly Chapter Chat conference call to brief AAP chapter leaders on current gun violence prevention state policy actions. On Saturday, marches will be held across the country, and then in April, over 400 pediatricians from across the country will meet in Washington, DC at the AAP Legislative Conference and Leadership Fly-In to bring this issue to Capitol Hill. Sustained effort and momentum is the key to building a foundation for social and policy change, and the AAP is committed to supporting your efforts.

For more from the AAP on state gun violence prevention efforts, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. Also see our State Advocacy Engagement on Firearm Data Collection resource.

March 19, 2018: MNAAP Pediatrics Day at the Capitol
Nearly 150 pediatricians and pediatric trainees from the Minnesota Chapter (MNAAP) gathered at the Minnesota Capitol on March 7th to advocate for stronger immunization laws, funding for mental health training and access, and other key issues such as gun safety.

Minnesota State Representative Ilhan Omar, the highest-ranking Somali-American elected official in the US, thanked the Minnesota pediatric community for its response to the measles epidemic and noted that more resources are needed for outreach and prevention. "It was fascinating to see how many of you were saddled up for that fight, ready to give out proper information for all of us to be equipped with the tools to help all of our communities..." she said. Representative Omar described her challenge to state lawmakers, "If the kids looked like your kids you wouldn't hesitate", recapping her fight for funding to combat the measles outbreak which primarily affected unvaccinated Somali children last year.

After reviewing and discussing the chapter's priority issues, attendees branched out to meet with 45 representatives and 32 senators to discuss child health issues, while outside the Capitol, more than 2,000 high school students rallied to #ProtectKidsNotGuns.​

March 15, 2018: 52 Ways AAP Chapters and Districts Improved Child Health in 2017
AAP chapters and districts had tremendous success in their advocacy work for children and pediatricians in 2017. 52 Ways AAP Chapters and Districts Improved Child Health in 2017 highlights these achievements.

Celebrate your victories and learn about great ideas from other chapters and districts. Thanks for all you do to improve the health and well-being of children!​

March 13, 2018: Michigan Chapter Polls Voters on Gun Violence Prevention
A new statewide poll in Michigan, commissioned by the AAP Michigan Chapter finds that 70% of voters support legislation to create extreme risk protection orders for potential perpetrators of gun violence. The legislation, introduced last year but still under consideration in the Michigan House, would permit a family member, someone in close relationship, or law enforcement officers to petition a court to not allow the defendant to purchase or possess a firearm for 1 year in instances where the defendant poses a danger to themselves or others. Currently, California, Connecticut, Indiana, Oregon, and Washington have these “red flag” laws on the books but several other states are now considering them.

Gun violence prevention will be an important part of discussions at this week’s AAP Annual Leadership Forum. On Saturday March 17, chapter leaders will gather from 1:45-3:15 (in the Nirvana AB room) to discuss the challenges and opportunities posed by gun violence prevention efforts. Experiences, lessons, ideas, and strategies from chapters across the country will be shared to inspire and support our collective advocacy work on this critical public health issue.  

For more from the AAP on state gun violence prevention efforts, see our Safe Storage of FirearmsUniversal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. Also see our State Advocacy Engagement on Firearm Data Collection resource.​

March 12, 2018: Who’s Speaking Up For Kids?—AAP State Advocacy Resource
State of the state and inaugural addresses offer a quick look at governors’ top line priorities and are a great way for your chapter to identify shared interests, make a connection, and offer your expertise.

The AAP State Advocacy team has been listening in to what governors are saying, and we’re keeping track of some things you’ll want to know in our Who’s speaking up for children? resource. So, take a look, identify policy priorities or issues of concern for your chapter, reach out to your governor’s office, and connect with advisors, staff…even the governor, to discuss common interests, share your experience and expertise, and build a relationship.​

​​March 8, 2018: AAP Alabama Chapter Weighs In on Medicaid Waiver
On February 27, Alabama became the latest state to release a Medicaid Section 1115 waiver proposal to require work as a condition of coverage for adults in the state’s Medicaid program. Knowing that this waiver proposal would disproportionately affect parents and other caretaker relatives of children in the state—the clear majority of whom are women—the AAP AL Chapter sprang into action. On March 5, just a week after the proposal was released, AAP AL Chapter Executive Director Linda Lee raised significant chapter concerns with this proposal at a state sponsored public forum. Together with other advocates, Ms Lee highlighted how the state’s proposal would lead these parents directly into a health insurance “coverage gap,” and disproportionately harm low-income children and families in the state.

AAP Alabama Chapter joins the growing list of chapters on the front lines of defense against Medicaid work requirements, increased premiums, elimination of retroactive coverage, and other harmful Medicaid Section 1115 waiver provisions. This week, a broad coalition lead by the AAP and Georgetown Center for Children and Families issued a letter to the HHS Secretary Azar, outlining serious concerns with recent 1115 waivers. This letter, the Academy's Principles on Waivers, and our resource, State Waivers Could Significantly Alter Coverage and Care for Children can be helpful to AAP chapters working on waiver proposals. Chapters are encouraged to contact the AAP at for consultation and technical assistance.​

March 6, 2018: States Move Forward on Gun Violence Prevention

In the wake of last month’s mass shooting at Marjory Stoneman Douglas High School, states continue to move forward on policies to reduce gun violence. States are considering bills that address bump stock bans, age restrictions on assault weapon purchases, and gun violence restraining orders or “red flag” bills. In addition, Connecticut, New Jersey, New York and Rhode Island announced that they would be sharing criminal databases and coordinating research related to potential firearm purchases, gun trafficking and violent crime.

States are also considering filling the gaps in the research on gun violence. In 2016, California established the country’s first state funded gun violence prevention research center at the University of California-Davis. Following in California’s footsteps, New Jersey is considering a bill that would establish a gun violence research center at Rutgers University.

For more from the AAP on state gun violence prevention efforts, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. For more on gun violence research and data collection opportunities, see our State Advocacy Engagement on Firearm Data Collection resource.​

March 5, 2018: INAAP Advocacy Day at The Statehouse
Members of the AAP Indiana Chapter recently gathered in Indianapolis to advocate for the chapter’s 2018 priorities, which include reducing infant mortality, increasing immunization rates, ensuring all children have access to high quality preschool, promoting Reach Out and Read, raising the tobacco purchase age to 21, and increasing tobacco taxes.

Gathered in the capitol are (left to right) Kate Hannaford, medical student; Brittany Byerley, medical student; Sarah Stelzner, MD, FAAP, Chapter Government Affairs Committee Chairperson; Marshall Criswell, MD, FAAP, Chapter Board of Directors–North Region Representative; Indiana State Representative Carey Hamilton (D-87); Sarah Bosslet, MD, FAAP, Chapter President; and chapter members Meagan O’Neill, MD, FAAP, Deanna Reinoso, MD, FAAP, and Nerissa Baur, MD, FAAP.

March 1, 2018: The Cost of Medicaid Work Requirements
​Currently, Medicaid waivers implementing work requirements for adults in Indiana and Kentucky have been approved, and 9 other states (AR, AZ, KS, ME, MS, NC, NH, UT, WI) await approval of similar plans from the Centers for Medicare and Medicaid Services (CMS). Early analysis reveals these types of policies will require massive changes to Medicaid programs will result in greater costs to states.

Implementing work requirements and other changes to Medicaid eligibility will result in 2 major costs: updating or creating IT systems that include this new beneficiary data and the hiring and training of staff to track compliance and appeals. States can receive a federal match, usually 50%, for some of the new administrative costs to implement changes, but CMS has said it would not help states pay for job training, child care assistance, or other supports to aid individuals insured by Medicaid with seeking and gaining employment.

For more from the AAP, please see our waiver principles as well as our educational piece, State Waivers Could Significantly Alter Coverage and Care for Children. If your state is considering a waiver, please contact us at for consultation and technical assistance. ​

February 27, 2018: Oversight of Network Adequacy Shifting to States
Under the Affordable Care Act (ACA), health plans sold on marketplaces are required to maintain an adequate network of in-network physicians (including specialists in the plan’s service area), hospitals, and other providers. However, through a federal rule that went into effect at the beginning of the year, the Trump administration has reduced federal oversight and shifted the responsibility for monitoring and enforcing network adequacy rules to the states. In addition to giving states more accountability for maintaining sufficient provider networks, the federal rule also no longer requires states using the federally facilitated marketplace to follow specific quantitative measures of network adequacy (such as time and distance standards).

The removal of a federal floor for network adequacy could leave children across the country with no access to needed pediatric specialists and subspecialists and wide variation in monitoring and enforcement across states. Chapter and member advocacy on this issue can help shape network adequacy that supports the care children need.

For more from the AAP, please see our Network Adequacy Advocacy Action Guide for AAP Chapters and contact us at for consultation and technical assistance.​

February 26, 2018: Pediatric Advocacy Day in Wisconsin
The AAP Wisconsin Chapter (#WIPeds) recently engaged more than 40 residents, physicians, and other advocates with a day of advocacy in Madison. Chapter President Dr Mala Mathur and Vice President Dr Dipesh Navsaria hosted a rich program of speakers, advocacy training, and legislator visits to discuss the chapter’s legislative priorities during a very busy time in the current legislative session.

State Representative Joan Ballweg (R-Markesan), co-chair of Wisconsin’s Children’s Caucus, Mark Grapentine of the Wisconsin Medical Society, and Jim Pawelski of AAP State Advocacy provided their perspectives on child health policy and advocacy strategies. Discussion focused on the power of stakeholder engagement, coalition building, in-district contact with legislators, and the advocacy support available from the chapter and AAP national.

Below, attendees gather at the steps of the capitol.​

​February 22, 2018: Mississippi Chapter Urges Policymakers to Put Kids First
Pediatricians and trainees from the  AAP Mississippi Chapter recently spent the day in Jackson advocating for children’s health and well-being. The group met with both Governor Phil Bryant and Lieutenant​ Governor Tate Reeves, was introduced on the floor of the Senate, attended committee meetings in the House, and visited their legislators. Among the advocacy priorities promoted that day were: increasing the cigarette tax by $1.50 per pack; strengthening the state’s distracted driving prevention law; protecting Medicaid; ensuring adequate physician payment; and keeping the state’s strong immunization exemption laws.​

February 20, 2018: A Look at 2018 State Gun Policy
​​In the wake of the mass shooting at Marjory Stoneman Douglas High School in Florida, advocates continue their work to strengthen state gun laws to prevent future tragedies. Last month, New Jersey banned bump stocks, which are trigger-accelerating devices that can be attached to semiautomatic weapons to increase firing speed. At least 27 other states are considering similar bills. Gun Violence Restraining Orders (GVRO), bills which would allow a friend or family member to petition a court to remove firearms from the home of a person who is deemed at risk or harming his/herself or someone else, are pending in 17 states. Meanwhile, 21 states are considering bills that would close domestic violence loopholes. Oregon passed a bill out of committee that would close the “boyfriend loophole” by including dating partners in the state’s domestic violence firearm protections. Similar bills are moving in Kansas, Washington, and Utah.  

In response to the shooting, the Academy issued a statement, renewing its call for stronger state and federal gun laws. The State Advocacy Team is ready to assist AAP chapters with resources and strategy guidance on state policy options.

For more from the AAP on state gun violence prevention efforts, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources.​

February 19, 2018: AAP West Virginia Chapter Holds First Advocacy Day
Last week, the AAP West Virginia Chapter visited the state capitol to promote the chapter’s 2018 Legislative Priorities to lawmakers. Included among the priorities is establishing EPSDT or the CHIP benefit package as the state’s benchmark plan for insurers, increasing the tobacco purchase age to 21, responding to the state’s opioid epidemic and protecting the state’s strong school immunizations laws. The chapter also discussed firearm injury prevention and obesity with lawmakers.

In honor of the chapter’s advocacy day coinciding with Valentine’s day, the West Virginia Senate adopted Senate Resolution 40, designating February 14, 2018 as Tiny Hearts Day. The resolution highlights the chapter’s priorities and extends the Senate’s gratitude and appreciation for all the work the chapter does on behalf of all children and families in the state.​

February 15, 2018: American Lung Association State of Tobacco Control 2018
There’s great news in tobacco control—smoking rates by both adolescents and adults have fallen to historic lows—but much more remains to be done to protect children from exposure to tobacco smoke and initiation of use.

State of Tobacco Control 2018, a report from the American Lung Association, grades state progress on several key tobacco control measures. The report highlights where states have made strides in curbing tobacco use, and where additional efforts are required. The overall key findings of the report highlight the uneven progress in policy change to reduce tobacco use, which has left vulnerable populations behind—including low income families, those living in public housing, and LGBTQ individuals.

For more from the AAP on tobacco prevention efforts, see our policy statement Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke and visit the AAP Julius B. Richmond Center of Excellence. Also see our Tobacco 21 and Electronic Nicotine Delivery Systems (ENDS) State AdvocacyFOCUS resources.​​

February 13, 2018: AAP Washington Chapter Visits Olympia
This month, 85 members of the AAP Washington Chapter (WCAAP) visited the state capitol to advocate for the chapter’s 2018 legislative priorities. Chapter members met with their legislators and discussed increasing Medicaid payments, improving access to behavioral health care, raising the tobacco purchase age to 21, and preventing children’s access to firearms. A new component of the chapter’s advocacy day included inviting legislators to for lunch to lead table group discussions on child health issues. Below, Washington State Senator David Frockt (D-46) leads a discussion with members of the chapter.​

Below, WCAAP members gather on the steps of the capitol.

February 12, 2018: States Consider Banning Tackle Football for Children
As more research about the potential long-term effects of head trauma become available, states have turned their attention to reducing the number of concussions sustained by student athletes. All 50 states and the District of Columbia now have laws that require children suspected of sustaining a concussion during a game or practice to be removed from play and medically cleared prior to returning to play.

Some states are now addressing the sports where children are most likely to sustain concussions. So far this year, Illinois, Maryland, and New York have introduced bills to ban tackle football for children. The Illinois bill would ban tackle football for children younger than the age of 12 and the Maryland and New York bills would prohibit the sport for children younger than 14.

For more information from the AAP on tackle football, see our clinical report Tackling in Youth Football.

February 8, 2018: State Funding of PreK
Over the last 5 years states have increased funding for prekindergarten (PreK) programs by 47%, and 44 state-funded PreK programs now serve nearly 1.5 million children. How States Fund Pre-K: A Primer for Policymakers, a new report from the Education Commission of the States (ECS), examines how states use federal, state, and local funding to provide these programs to young children. Most federal funds come from Head Start, while state funds flow from the state general funds, block grants, or state education funding formulas.

To learn how much funding your state provided to PreK in 2016-17, see the ECS resource, State Pre-K Funding 2016-17 Fiscal Year: Trends and Opportunities.

For more from the AAP on PreK and other early childhood education initiatives, visit the AAP Council on Early Childhood site.​

​​February 6, 2018: Medicaid Managed Care and Social Determinants of Health
State Medicaid programs have several options to modify payment and delivery systems in ways that can impact social health factors to meet the nonclinical needs of Medicaid enrollees. But is this possible now that the clear majority of Medicaid enrollees receive care through managed care organizations (MCOs)? Enabling Sustainable Investment in Social Interventions: A Review of Medicaid Managed Care Rate-Setting Tools, a new publication from the Commonwealth Fund, provides insight into mechanisms available to state Medicaid managed care programs to finance and sustain services addressing social determinants of health. This resource can be helpful to your chapter if your state is examining options to engage or expand Medicaid managed care in social determinants of health efforts.

To learn more about state efforts to address social determinants of health and other system transformation activities, please see the AAP System Transformation page.​

February 5, 2018: Medicaid and CHIP Critical Among Children Ages 3 and Younger
Health Insurance Coverage Among Children Ages 3 and Younger and Their Parents in 2016, a new brief from the Urban Institute, examines 2016 American Community Survey (ACS) data on coverage rates among children age 3 and younger and their parents. Findings show 48.5% of young children were insured by CHIP and Medicaid, while just 3.3% of children aged 3 or younger remained uninsured. The parents of these children were also more likely to be covered by Medicaid than parents of older children.

Coverage rates varied across states, with relation to adoption of Medicaid expansion. Approximately 8.7% of parents of children younger than 3 in expansion states were uninsured, while 18% of parents in nonexpansion states did not have coverage.

For help with your chapter’s Medicaid and CHIP advocacy efforts, contact us at

​February 1, 2018: Banning “Conversion Therapy” for LGBTQ Youth
​​Over 20,000 LGBTQ youth could be subjected to potentially harmful counselling by a licensed health care professional, with another 57,000 at risk of receiving similar treatment from clergy or other spiritual advisors. That is the conclusion of a new report from the Williams Institute on Sexual Orientation and Gender Identity Law and Public Policy at the UCLA Law School. The report cites the recent statewide trend in bans on so-called “conversion therapy”, sometimes referred to by its proponents as “reparative therapy”, which is intended to elicit changes in sexual orientation or gender identity of children and adolescents. AAP policy states that these therapies are not effective, may be harmful to LGBTQ individuals by increasing internalized stigma, distress, and depression, and therefore are never indicated.

Nine (9) states (California, Connecticut, Illinois, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, and Vermont) and the District of Columbia have now banned these practices from being used with children, as have 32 municipalities around the country. AAP chapters have been on the forefront of this issue at the state level, and related legislation introduced in Congress in 2015 was endorsed by the AAP.

For more from the AAP on this issue, see our policy statement Office-Based Care for Lesbian, Gay, Bisexual, Transgender, and Questioning Youth. ​

January 30, 2018: Florida Chapter Joins Children’s Week
The AAP Florida Chapter recently came together with advocates from across the state as part of Children’s Week, to advocate for the health and well-being of Florida’s children. To prepare for meeting with lawmakers, residents took part in a Webinar led by the chapter’s lobbyist and learned more about the chapter’s advocacy priorities, which include immunizations, perinatal mental health, and curbing texting while driving. The following day, residents and chapter leaders attended house and senate committee meetings and met with their representatives and senators to promote the chapter’s advocacy agenda.

Here, chapter leaders, residents, and members of iCAN Florida’s Kids Team gather with Senator Aaron Bean after touring the senate chamber.

January 29, 2018: AAP Kentucky Chapter Advocates for Children
AAP Kentucky Chapter recently joined hundreds of advocates at the state capitol as part of the Kentucky Youth Advocates (KYA) annual Children’s Advocacy Day at the Capitol. The chapter is a partner in the development of the Blueprint for Kentucky’s Children, which prioritizes policies to improve the health and well-being of children.

Chapter leaders met with state lawmakers to promote increasing the state’s tobacco tax, making schools smoke-free, requiring bike helmets for children younger than 12 years of age, and safe disposal of opioids. As the day gets underway, AAP Kentucky Chapter officers (left to right) Past President Kim Boland, MD, FAAP; President Pat Purcell, MD, FAAP; Secretary/Treasurer Jaime Pittenger, MD, FAAP; and Vice President/President Elect Scottie Day, MD, FAAP gather in the capitol.

​January 25, 2018: Roadmap of State Highway Safety Laws
2018 Roadmap of State Highway Safety Laws, a report from Advocates for Highway and Auto Safety, examines laws that dramatically improve highway and auto safety, including child passenger safety, distracted driving, teen driving, impaired driving, and occupant protection. Progress toward achieving these policy goals in each state is also evaluated.

Child passenger safety advocates celebrated multiple victories in 2017. Five states (Connecticut, New York, Oregon, Rhode Island, and South Dakota) enacted rear-facing until age 2 laws; 3 states (Alabama, Iowa, and Texas) upgraded their distracted driving or teen driving laws from secondary to primary enforcement; and North Dakota raised the booster seat requirements to age 8.  

For more from the AAP on these issues, see our State AdvocacyFOCUS resources on Child Passenger Safety, Distracted Driving, and Teen Driving.​

January 23, 2018: AAP 2017 State Advocacy Report
As you prepare for the 2018 state legislative sessions, take time to celebrate the successes you achieved last year by reviewing the AAP 2017 State Advocacy Report, which details 23 significant child health and pediatric practice state policies. Thanks to the dedicated advocacy work of AAP chapters and members, significant achievements have been made across the country to shape the health policy landscape in every state. Your efforts in 2018 to preserve and build on these gains are vital to children’s health and well-being. The State AdvocacyFOCUS resources included in the report are updated regularly and available at Use them to raise awareness about key child health issues with your members, policymakers, and other stakeholders.

We’re here to help you with your state advocacy work! Please contact the AAP State Advocacy team at​

January 22, 2018: Pediatrics Supplement on Tobacco and Secondhand Smoke
Tobacco and Secondhand Smoke, a supplement to the January 2018 edition of Pediatrics explores the role of research and advocacy in protecting children from tobacco and secondhand smoke. Highlighted issues include the impact of smokefree car legislation, the relationship between tobacco control laws and pediatric asthma, and the changes in adult attitudes towards tobacco control laws designed to protect children.  

Although states continue to strengthen laws regulating electronic nicotine device systems (ENDS) and raising the minimum purchase age of tobacco products and ENDS to 21, they still underfund tobacco prevention programs. Last month, the Campaign for Tobacco-Free Kids released its report Broken Promises to Our Children: A State-By-State Look at the 1998 Master Settlement 19 Years Later examining this ongoing policy concern.

For more from the AAP, see our State AdvocacyFOCUS resources Raising the Tobacco and ENDS Purchase Age to 21 and Electronic Nicotine Device Systems ENDS, and our Advocating for Tobacco 21 in Your State Advocacy Infographic.

January 18, 2018: State Use of Accountable Care to Promote Population Health
As the laboratories of health reform, states are continuing their efforts to address factors affecting health that extend beyond clinical care.
State Approaches to Addressing Population Health Through Accountable Health Models, a new brief from the National Academy for State Health Policy (NASHP), examines how 10 states are using accountable care entities to integrate health-related social needs into their health care delivery systems. The resource looks at accountable care alignment with Medicaid, use of value-based payment, multisector measurement, and numerous other features of these transformational efforts. This information can be helpful to other states looking to build on emerging efforts.

For more from the AAP, visit the AAP System Transformation and Practice Transformation pages.​​

January 16, 2018: Almost Half of States Could Exhaust CHIP Funding by March
estimates from the Georgetown Center for Children and Families (CCF) show that 11 states are expected to run out of federal CHIP funds during the month of February, and by March, as many as 24 states could be in shortfall positions. The   continuing resolution (CR) approved by Congress in December 2017 extends $2.85 billion in federal CHIP funding, but also changes how redistributed CHIP funds are awarded. Because of the change, it’s not clear how much of—or even if—redistributed funds will be available to states to continue their programs when they exhaust existing funds.

Congressional inaction has created a dire situation for children, families, and state governments. The AAP continues to call on Congress to take immediate action to extend federal CHIP funding for 5 years. Thank you to all AAP members for your ongoing advocacy to make sure Congress extends CHIP funding—please keep using the CHIP Advocacy Toolkit​to support your ongoing efforts.​

​January 15, 2018: State Children’s Cabinets | Partners in Advocacy
A new survey from the Forum for Youth Investment (FYI), 2017 State Policy Survey: Child and Youth Coordinating Bodies in the US, examines the structure of state children’s cabinets, state children’s commissions, state early learning advisory councils, and other state youth coordinating bodies; trends in their use of evidence and promotion of equity; and their challenges and accomplishments. These entities are excellent partners for your chapter’s 2018 advocacy work.

To learn how more about how your chapter can and collaborate with existing groups, or for tips on how to launch or reenergize them in you state, please contact the AAP State Advocacy Team at ​

January 11, 2018: Medicaid Expansion States See Fewer Hospital Closures
Hospitals in states that have expanded Medicaid under the Affordable Care Act (ACA) were approximately 6 times less likely to close than those in nonexpansion states, according Understanding The Relationship Between Medicaid Expansions and Hospital Closures, a Health Affairs research article. Hospitals in states that expanded Medicaid also saw more patients that were covered by insurance and provided less free care than they had in the past.

The Rural Health Research Program has identified 83 rural hospital closures since 2010, most of which occurred in nonexpansion states. Rural hospitals, often vulnerable to closure, improved financial performance more than their suburban and urban counterparts. The study also showed that financial improvements for hospitals were greatest in counties that had the highest number of uninsured residents prior to the expansion.

For more on Medicaid expansion from the AAP, please see our State AdvocacyFOCUS resource and State Advocacy Infographics

January 9, 2018: Connect with the AAP State Advocacy Team
2018 is off and running and with the multitude of issues facing state policymakers this year, the AAP State Advocacy Team is ready to support your chapter efforts through consultation, technical assistance, resources, strategy development, and learning and engagement opportunities. In addition, a quick connection to all our resources can be found at

To ensure two-way communication about important state advocacy work, please consider adding us, by using, to your chapter’s state advocacy communications. This can include your advocacy updates, calls to action, meeting information, messages to your chapter legislative or government affairs committees, and anything else related to your chapter’s advocacy efforts. We look forward to an exciting and productive year. Thanks for all you do!​

​​January 8, 2018: Medicaid Payment Increase Improved Pediatrician Participation

A new study demonstrates that pediatricians responded to the Affordable Care Act (ACA) 2013-2014 Medicaid payment increase for primary care services by increasing their participation in the Medicaid program.

Increased Medicaid Payment and Participation by Office-based Primary Care Pediatricians, published in the January 2018 issue of Pediatrics, compared survey data collected during 2011-12 and 2015-16 by the American Academy of Pediatrics (AAP) from state-stratified random samples of over 10,000 pediatrician members. Researchers found that Medicaid participation increased nationally after the increase in Medicaid payment by most indicators. Physicians accepting at least some new patients insured by Medicaid increased 3 percentage points to 77.4%; those accepting all new patients insured by Medicaid increased 5.9 percentage points to 43.3%; those accepting patients at least as often as new privately-insured patients increased 5.7 percentage points to 55.6%. This new research reiterates the important link between appropriate Medicaid payment levels and access to care.

Working on Medicaid payment advocacy in your state? Contact AAP State Advocacy at for assistance.​

January 4, 2018: Prescription Drug Monitoring Program (PDMP) Improvements
To address an increase in opioid overdose deaths, states are
working to improve their Prescription Drug Monitoring Programs (PDMPs). Currently 25 states require physicians to check a PDMP before prescribing opioids, while 14 states and the District of Columbia have PDMPs, but do not require physicians to use them. The National Alliance for Model State Drug Laws provides more information about PMDP requirements by state

Sharon Levy, MD, FAAP, immediate past chair of the AAP Committee on Substance Use and Prevention (COSUP) recently gave the TEDx Beacon Hill Talk: Opioid Addiction is Treatable. Why Aren’t We Doing It? Dr Levy also represents the Academy on the American Medical Association (AMA) Opioid Task Force.

For more from the AAP, see our clinical reports Neonatal Drug Withdrawal and Medication-Assisted Treatment of Adolescents with Opioid Use Disorders

December 5, 2017: Coming Soon: 2018 State Legislative Sessions
With all but 4 states (Montana, Nevada, North Dakota, and Texas) set to convene regular legislative sessions shortly after the start of the new year,
State Net Capitol Journal takes a look at the road ahead and examines some of the priority issues that are likely to rise to the forefront at the state level next year. Leading the list are health care concerns, opioids, marijuana legalization and state preemption of local laws—all issues of concern for AAP chapters.

As we head into the end of 2017, StateView will be taking a short break. The AAP state advocacy team is here to provide you with one-on-one consultation, technical assistance, and strategy guidance as you prepare for 2018—contact us at

We wish you a happy holiday season and a new year filled with peace and happiness, and thank you for all you do to advocate for children in your states. We’ll see you in 2018!

December 4, 2017: Maine’s Vote to Expand Medicaid Revives Debate in Other States
Last month, voters in Maine overwhelmingly voted to expand their Medicaid program. Almost 60% of voters approved a ballot measure that will allow more low-income adults to become eligible for Medicaid under the Affordable Care Act (ACA). While Governor LePage has said he would only implement the measure under specific circumstances, the win has reenergized advocates hoping to do the same in their states.

A 2012 Supreme Court ruling made Medicaid expansion an option for states, and 32 states and the District of Columbia have now chosen to expand their programs. Advocates in states that have not yet expanded coverage such as Idaho, Nebraska, and Utah continue to push for expansion, and are working to put their own ballot initiatives to voters. In Virginia, the election of Governor-Elect Ralph Northam, MD and the flipping of more than a dozen seats in the state’s House of Delegates improve the chances of Medicaid expansion there as well.

For more from the AAP, please see our Expanding Medicaid Matters infographics.

November 30, 2017: Ending the Opioid Epidemic: A Practical Guide for State Policymakers
A guide from the National Center on Addiction and Substance Abuse outlines strategies that state policymakers can enact to prevent opioid misuse and reduce the number of deaths and injuries caused by opioids every year. The guide supports a public health approach to address the opioid epidemic and invest in the implementation of evidence-based substance misuse prevention and treatment initiatives.

Included within the strategies are expanding access to public and private insurance coverage for treatment programs, improving access to medication-assisted treatment programs, and improving prescription drug monitoring programs (PDMPs).

For more from the AAP, see our clinical reports Neonatal Drug Withdrawal and Medication-Assisted of Adolescents with Opioid Use Disorders. The AAP is also a member of the AMA Opioid Task Force.​

November 28, 2017: States Make CHIP Contingency Plans
Nearly 2 months have passed since the federal funding deadline to extend the Children’s Health Insurance Program (CHIP), with October projections indicating that as many as 11 states could run out of CHIP funds by the end of 2017. As states await Congressional action, some are beginning to take steps to address the program’s funding uncertainty. Most recently, West Virginia announced it would be shutting down its CHIP program on February 28, and Colorado and Virginia are beginning to inform families that their programs will end. Oregon, meanwhile, announced it would spend $35 million of state funds to keep the program operational, and Minnesota has tapped its own funds to keep its program running after exhausting leftover funds.

To advocate for an immediate extension of CHIP funding, the AAP is joining other child health advocacy organizations for a CHIP Day of Action Thursday, November 30, 2017. AAP chapters and members are encouraged to participate using the newly updated CHIP Advocacy Toolkit, which contains the latest state of play, talking points, social media messages, graphics, and other helpful resources to help you advocate. ​

November 27, 2017: Vigils Commemorate Sandy Hook Anniversary
As the 5th anniversary of the Newtown, Connecticut elementary school shooting approaches, Moms Demand Action will host over 200 vigils in 40 states from December 2 until December 17, 2017. To find a vigil in your state, consult this list or check the Nationwide Vigils and Events to #EndGunViolence Facebook page.

​​​As you prepare for your 2018 state legislative sessions, our State AdvocacyFOCUS resources on Assault Weapon Bans, Safe Storage of Firearms, and Universal Background Checks for Gun Purchases are available to support your advocacy efforts.

​StateView Archive Page​

E-mail your comments and suggestions to the AAP State Advocacy team. Please contact us at 630/626-6240 if you require additional assistance or information.​​​