Palliative care is team-based care that provides support and relief, usually alongside curative treatment, to those with complex or life-threatening conditions. High-quality palliative care focuses on improving quality of life and can avoid unnecessary or unwanted treatment for people facing serious illness through pain and symptom management, communication, and coordinated care. State health policymakers across the country are expanding palliative care or increasing awareness of palliative care through legislative and budgetary action, task forces, and information programs. NASHP conducted 50-state research on state action related to palliative care and published the findings in a series of three interactive maps, updated in August 2022.

Findings

Eighteen states across the country have passed legislation establishing education programs to promote palliative care among health care providers and the public as of 2022. These education requirements often mandate information to be published on state public health websites for providers and consumers on the advantages of palliative care, options to access palliative care in the state, and links to further resources.

For example, Nevada’s Palliative Care and Quality of Life Consumer and Professional Information and Education Program, implemented through legislation that was enacted in 2017, requires the Department of Health and Human Services to create a website with information on palliative care, best practices, and educational and referral materials. The state’s current website, updated in 2022, meets these requirements and features additional information on the Advisory Council on Palliative Care and Quality of Life and a Frequently Asked Questions section about palliative care.

For more information on each state’s information program, view this interactive map.

As of 2022, twenty-seven states have legislation establishing palliative care advisory councils or other advisory groups and identifying tasks the group should complete. The composition and goals of these groups vary by state, but the councils typically evaluate the status of palliative care in the state and/or advise legislators and state health departments on palliative care services.

In 2017, Nebraska established the Palliative Care Council to advise the Department of Health and Human Services. The updated map includes the advisory council’s 2022 report detailing its progress and proposed recommendations on palliative care definitions, Medicaid codes for palliative care, expanded palliative care options, a palliative care summit, and legislative hearings on serious illness. While the council’s recommendations are not endorsed state policy, they still serve to guide legislators as they advance palliative care.

Tennessee’s State Palliative Care and Quality of Life Advisory Council was established in 2018 to assess the status of and barriers to palliative care in the state and to advise the Governor and General Assembly.  In 2022, the council published a report featuring the council’s accomplishments and recommendations for palliative care advancement in the state.

To learn more about palliative care advisory task forces by state, use this interactive map.

Between 2019 and 2022, seventeen states enacted legislation and/or allocated budgetary funds that support and expand initiatives around palliative care for older adults. These actions adjust or improve how palliative care is delivered, provide funds for palliative care programs and education, or create or expand palliative care advisory councils or task forces.

Maine legislation enacted in June 2021 requires the Department of Health and Human Services to adopt rules to support and standardize palliative care in the state and directs MaineCare (Medicaid) to reimburse palliative care for the entire interdisciplinary team across all health care settings.

Enacted in January 2022, Oregon legislation requires the Oregon Health Authority (OHA) to establish and administer a program that will provide in-home palliative care through Coordinated Care Organizations by an interdisciplinary team. This benefit is not yet available, but OHA is working to establish provider qualifications and eligibility criteria in collaboration with the state’s Palliative Care and Quality of Life Interdisciplinary Advisory Council.

For more detail on legislative and budgetary action by state, check out this interactive map.

Conclusion

Each of these maps demonstrate the variety of ways in which states are working to improve knowledge of and access to palliative care. Most people do not know what palliative care is nor do they use it, despite the demonstrated potential of palliative care to improve quality of life for patients and their families and lower medical costs. Thus, states are implementing legislation that creates palliative care educational campaigns and task forces to go alongside policies that improve access to palliative care and how palliative care is delivered. As highlighted in palliative care legislation, West Virginia’s legislature explained, “palliative care access remains a challenge across the state and increasing awareness of the availability of this service will align with many of the state’s goals to improve patients’ health care experience and care quality.” These maps show the progress that states have made and the various roles that states can play in advancing palliative care. For more information, view NASHP’s Palliative Care Resource Hub, and sign up for the Palliative Care Newsletter.

This work is generously supported by The John A. Hartford Foundation.