Top Five Issues for 2016 Expanded: The National Center for Interstate Compacts

From transportation to health care and education, there is no shortage of issues confronting state governments across the nation. As states continue to shape priorities while still rebounding from the Great Recession, increasingly they are working--erasing the silos of state lines--to meet the needs of the American people, state by state.

The interstate compact is one of the few tools specifically granted to states by the United States Constitution, providing a sophisticated administrative mechanism and allowing states to work together to resolve complex policy and social challenges.

Compacts, which are governed by the tenets of contract law, provide states an enforceable, sustainable and durable tool capable of ensuring permanent change without federal intervention. Each state belongs to an average of 25 of the more than 215 interstate compacts in existence.

For more than a decade, The Council of State Governments’ National Center for Interstate Compacts, or CSG-NCIC, has been a leading resource for state governments and leaders across various industries to develop creative solutions to America’s most complex problems.

Below are a few compacts, issues and pieces of legislation that CSG-NCIC has identified as noteworthy for 2016.

The Interstate Medical Licensure Commission

CSG-NCIC worked with the Federation of State Medical Boards, state medical boards and subject matter experts to develop the Interstate Medical Licensure Compact, or IMLC, and accompanying legislation. The compact creates an expedited licensing process for doctors wishing to practice in multiple states.

Eleven states passed the IMLC legislation in 2015, creating the threshold to enact the Interstate Medical Licensure Commission. The inaugural meeting of the commission was held October 2015.

Several factors—including changing demographics, the need for better and faster access to medical care in rural and underserved areas, the passage of the Affordable Care Act, and the rise of telemedicine—have created unprecedented demand for health care services.

To read the final compact language or to learn more about license portability, please click here. 


Health Care Licensure Compacts

The cost of health care in the United States has grown an average of 2.4 percent faster than the gross domestic product since 1970 and now represents 18 percent of the total GDP, according to the Kaiser Family Foundation. Contributing significantly to these costs is access to health care in hard-to-serve locations, particularly rural areas. According to the American Academy of Family Physicians, 21 percent of the U.S. population lives in rural areas, but only 11 percent of medical specialists practice in those areas.

Experts expect this problem to worsen as the population grows and ages and the number of insured Americans seeking health services increases as a result of the Patient Protection and Affordable Care Act. Research published by the Annals of Family Medicine estimates the United States will need an additional 52,000 primary care physicians by 2025 to keep up with growing demands on the health care system.

CSG-NCIC is currently working to secure the passage of licensure compact legislation with the Federation of State Boards of Physical Therapy, the National Council of State Boards of Nursing and the National Association of State EMS Officials.

Each one of the efforts is being driven by a desire to make affordable health care across a variety of medical professions more accessible. 

To read the final compact language for each initiative, please click one of the following: 


State Authorization Reciprocity Agreement

Many of today’s colleges and universities employ online learning with varied degrees of onsite support for students on a national, even international, scale. Regulatory requirements and evaluative measures, however, vary considerably from state to state, making interstate reciprocity difficult to achieve. This problem is costing states and institutions significant amounts of money.

CSG-NCIC, the Presidents’ Forum, the existing regional higher education compacts and the Commission on the Regulation of Postsecondary Distance Education have collaborated to advance an effective, practical framework to achieve interstate reciprocity in the regulation of distance education. This voluntary State Authorization Reciprocity Agreement, also known as SARA, is intended to broaden the availability of and access to accredited online degree programs by reducing state regulatory barriers, while also ensuring strong consumer safeguards.

The agreement allows states and institutions to work together to address an existing patchwork of regulation across states while strengthening the states' roles in protecting students from unfair or illegal practices. With funding from the Lumina Foundation, a national office has been formed and the regional compacts are working closely with both states and institutions that wish to participate in SARA. To date 34 states have joined and that number is expected to continue growing in 2016. 

To learn more about SARA please click here


Non-Congressionally Consented Compacts

While Interstate Compacts are not new, emerging issues surrounding the implementation, enforcement and amending of compacts are readjusting the landscape.

For more than two years the case of Gillette Corporation v. California Franchise Tax Board has presented law makers, legal watchers and the interstate compact community with a variety of questions on the future of interstate compacts.

The Gillette case questions whether the California legislature, by adding language to the Revenue and Taxation Code in 1993, repealed or superseded the Multistate Tax Compact, or MTC, election or whether the election was still available to the taxpayer.

The California Franchise Tax Board argues that election was no longer available, while the taxpayer argues that the MTC is binding unless and until the state formally withdraws from the compact.

Issues surrounding the Multistate Tax Compact election are in courts not only in California, but also in Michigan, Minnesota and Oregon. While the California case is widely watched for precedence, the Michigan Supreme Court already has ruled in favor of the taxpayer in a similar case, IBM vs. the Michigan Department of Treasury. In the Michigan case the ruling raises the immediate issue of whether or not the 16  non-congressionally consented compacts of which Michigan is a member are effectively ineffective.

Seventeen states and the District of Columbia are members of the Multistate Tax Compact.

For more information on the above cases, please click the following:


International Interstate Compacts

Many states, including but not limited to border states, are entering into an increasing number of compacts that include foreign nations.

The focus of these compacts range from the Great Lakes Commission, which includes eight states and two Canadian provinces and focuses on issues of water conservation along the Great Lakes Basin; the Great Plains Interstate Forest Fire Compact, which recently included a partnership with Saskatchewan; and the Interstate Oil and Gas Compact, which not only comprises 30 members states and eight associate states, it also includes ten international affiliates including Egypt, the Republic of Georgia and British Columbia.

As states continue to assess how best to confront a range of issues from the environment to economic development and immigration, working collaboratively with one another and like-minded nations on the sharing of resources and information serves as a reminder that the power of states to meet the needs of their people does not necessarily stop at their borders.

For more information on the compacts listed above, please click the following:

To track the progress of these and other compacts, commissions or cases, please visit the CSG National Center for Interstate Compacts—the only organization of its kind—at or contact center director, Colmon Elridge at


For more information on these topics and for additional resources on interstate compacts, see