Texas Lawmakers Consider Interstate Health Care Compacts to Tackle Workforce Shortages
Texas Considers Interstate Compacts to Address Health Care Workforce Shortages
A coalition of health care leaders is pushing for a policy they say could help stem the tide of professionals leaving Texas: allowing certain out-of-state workers to practice in the state. The proposal would enable Texas to join existing interstate licensing compacts for nine professions, including audiology, counseling, dentistry, and social work. If approved, eligible professionals could obtain multistate licenses, similar to a driver’s license, allowing them to work across state lines.
Currently, bills to create compacts for cosmetology, counseling, and dentistry have been filed in the Texas Legislature. While the full impact on the workforce remains unclear, advocates argue the move would streamline licensing for professionals, particularly military spouses who frequently relocate.
“It’s too early to say what these compacts could add to the workforce, but they make it easier for folks to practice in multiple states,” said Bryan Mares, government relations director for the Texas chapter of the National Association of Social Workers.
Nearly a dozen professional groups, including the Texas Academy of Physician Assistants and the Texas Counseling Association, have formed the Interstate Compact Coalition to advocate for the agreements. They argue the compacts would expand the workforce pool, save time and money for traveling professionals, and address critical shortages plaguing nearly every corner of Texas’ health care system.
But skeptics worry the compacts could lead to more Texas workers leaving the state than coming in, while potentially diluting the rigorous standards of Texas’ licensing boards.
“We have really good, robust licensing through the state board, and we want to maintain those standards,” said Matt Roberts, a chair member of the Texas Dental Association. “With compacts, we’re not 100% sure those standards can be guaranteed.”
Texas faces some of the most severe health care workforce shortages in the nation. The state ranks last in the number of dental hygienists per capita, with just 37 per 100,000 people. By 2030, Texas is projected to have the third-highest social worker shortage, with an estimated deficit of 33,825 jobs.
A recent survey by the Texas Hospital Association found that 64% of hospitals are operating with fewer beds and reduced services due to nurse staffing shortages. Rural areas are particularly hard-hit, with East Texas facing a shortage of obstetricians and jails holding inmates who wait months for psychiatric treatment due to a lack of staff.
The shortages are especially acute along the Texas-Mexico border, where residents often face long trips and delayed care.
Why Interstate Compacts?
The U.S. Department of Defense has partnered with the Council of State Governments to fund the development of interstate licensing agreements. Military families, who frequently move across state lines, often face costly and time-consuming licensing processes.
“Military families can be very transitory, so the Department of Defense has funded this project to get some legislation for these states to enact,” Mares said.
Texas, with 15 active-duty military installations, would be a significant addition to these compacts. Supporters argue the agreements would streamline administrative processes, allowing licensed professionals to start working sooner without redundant vetting.
“This eliminates duplicative efforts, saving time and resources while ensuring that qualified professionals are available to serve the public,” said Darrel Spinks, executive director of the Texas Behavioral Health Executive Council.
For example, a licensed social worker moving to Texas currently must submit an application, pass a jurisprudence exam, provide clinical supervision verification, and complete fingerprinting, among other requirements—even if they’ve already met similar standards elsewhere.
The compacts could also benefit Texans living near state borders, where residents often cross state lines for care.
“Oftentimes, students at the University of Texas see a clinician, but when they go home for vacations or the summer, they can’t see that therapist anymore because they aren’t licensed in their home state,” said Betsy Cauble, a longtime social worker and board member at Preferra, an insurance company for behavioral health professionals. “The compact eliminates many of these problems.”
Cauble added that the compacts could help address Texas’ lack of multilingual providers, particularly for Spanish-speaking residents.
Challenges and Concerns
Despite the potential benefits, some critics argue that interstate compacts are not a silver bullet for Texas’ workforce challenges.
“I would liken it to rearranging the deck chairs on a sinking ship,” said John Bielamowicz, presiding member of the Texas psychologists’ licensing board. “Compacts don’t necessarily get you any more chairs.”
The social worker compact, for example, includes 22 states, and Texas would be the largest contributor. But Bielamowicz and others worry that the compacts won’t address the root causes of workforce shortages, particularly in rural areas.
“This is happening in every profession—optometrists, dental hygienists, social workers—all these folks are having trouble recruiting in rural areas,” said Roberts, who lives in Crockett. “The people who come from out of state with an interstate compact aren’t going to move to rural areas over Houston, Dallas, or Austin.”
Roberts and others suggest alternative solutions, such as loan repayment programs, increased Medicaid payments to providers, and incentives for schools to send students to rural areas. However, these options require consistent government funding, which has been difficult to secure.
Bielamowicz also raised concerns about the loss of local control. Licensing boards would cede authority to national organizations, which he argues are not accountable to Texas lawmakers or residents.
“When people have problems, they can come to us and yell or propose ideas,” Bielamowicz said. “With a compact, it’s usually an unelected board or commission made up of primarily industry participants that might meet a few times a year far away.”
Mares countered that compacts preserve each state’s authority to enforce its rules, and states with significantly different licensing standards, like New York and California, are unlikely to join.
Texas currently bars felons from obtaining social worker licenses and revokes licenses for offenses like sexual misconduct or physical harm—rules not universally followed by other states. By joining a compact, the state’s ability to enforce these standards would require negotiation with other members.
As the debate continues, one thing is clear: Texas’ health care workforce challenges are complex, and no single solution will fix them overnight.
Conclusion
As Texas grapples with some of the nation’s most pressing health care workforce shortages, the push for interstate licensing compacts represents a promising, albeit debated, solution. By joining existing agreements for professions like counseling, dentistry, and social work, Texas could streamline licensing processes, reduce barriers for out-of-state professionals, and expand access to care—especially in underserved rural and border communities. The potential benefits are notable: easing the burden on military families, addressing critical shortages, and improving continuity of care for patients who cross state lines.
Though, the proposal is not without its challenges. Skeptics raise valid concerns about maintaining Texas’ rigorous licensing standards and the possibility of exacerbating workforce outflows. Striking a balance between accessibility and quality will be crucial as lawmakers weigh the merits of these compacts.
Ultimately, the decision to adopt interstate licensing agreements could mark a pivotal step in addressing Texas’ health care crisis. By fostering collaboration across state lines and prioritizing the needs of both professionals and patients, Texas has the opportunity to lead in creating a more flexible, responsive, and equitable health care system. As the state continues to grow and evolve, such innovative solutions will be essential to ensuring that all Texans have access to the care they need.
the debate over interstate licensing compacts in Texas underscores the complexity of addressing the state’s health care workforce shortages. While the proposed compacts offer a promising solution to streamline licensing processes, reduce administrative burdens, and expand access to qualified professionals—particularly for military families and border communities—they are not without challenges. Skeptics rightly caution that the compacts may not fully address the root causes of workforce shortages, especially in underserved rural areas, and could risk diluting Texas’ rigorous licensing standards.
The success of these compacts will depend on careful implementation, robust oversight, and complementary strategies such as loan repayment programs, increased Medicaid reimbursements, and targeted incentives to attract professionals to high-need regions. As Texas lawmakers weigh the potential benefits and risks, it is clear that no single solution will suffice.A multifaceted approach,combining interstate compacts with long-term investments in workforce progress and rural health care infrastructure,will be essential to ensure that all Texans have access to the quality care they deserve. The urgency of the state’s health care crisis demands bold action, and the interstate compact initiative represents a critical step forward in meeting that challenge.