Which States Allow Telehealth Across State Lines in 2026

Practicing telehealth across state lines is one of the most common compliance questions in virtual care today, and one of the most misunderstood. The short answer is that providers must be licensed in the state where the patient is physically located during the visit, regardless of where the provider is based. The more useful answer involves understanding exactly how interstate licensing works in 2026, which compacts apply to which provider types, and which states have created special telehealth pathways that change the picture.

At Bask Health, we work with clinicians and healthcare brands building telehealth services across multiple states. Our full-service telehealth platform is designed to support multi-state care delivery, with provider credentialing workflows and compliance infrastructure built for the complexity of operating across jurisdictions. This guide lays out the 2026 landscape clearly so providers and telehealth businesses can plan accordingly.

Key Takeaways

The fundamental rule of telehealth across state lines: providers must be licensed in the state where the patient is located, not where the provider is based
The Interstate Medical Licensure Compact (IMLC) now includes 44 states plus DC and Guam, covering the large majority of the U.S. for physicians.
The Nurse Licensure Compact (NLC) covers 41 states with one multistate license for registered nurses.
PSYPACT covers 40+ states for licensed psychologists practicing telehealth
Several states, including Texas, Arizona, and Florida, have created specific telehealth-friendly pathways for out-of-state providers
States NOT in the IMLC as of 2026 include California, New York, and Oregon, each requiring full individual licensure

The Fundamental Rule: Where the Patient Is Located

Before getting into compacts and state-by-state rules, it is worth being precise about the governing principle. Telehealth is legally considered to occur where the patient is located, not where the provider is. This means a physician practicing in Texas who conducts a telehealth visit with a patient sitting in California is practicing California medicine and must hold a California medical license.

This principle is consistent across all U.S. jurisdictions and applies to every provider type. It does not change based on which platform the visit takes place on, how the appointment was scheduled, or where the provider's primary practice is located. Interstate compacts and special telehealth pathways exist to make the licensing process easier, but they do not change the underlying legal requirement.

For telehealth businesses building multi-state operations, this means provider licensing coverage must map precisely to patient geography. Our patient management tools support the credentialing and state verification workflows that make this operationally manageable at scale.

The Interstate Medical Licensure Compact (IMLC): Physicians

The IMLC is the primary pathway for physicians to practice telehealth across state lines efficiently. Rather than requiring a separate full application to each state's medical board, the IMLC allows eligible physicians to file one application and receive expedited licenses in multiple member states.

As of July 2026, 44 states plus Washington, D.C., and Guam are members of the IMLC. Alaska became the 44th member state in June 2026. The typical timeline from application to first compact license is 4 to 8 weeks, with additional licenses after the first typically issued in 7 to 21 days each.

How the IMLC Works

Physicians designate one state as their State of Principal Licensure (SPL), which must be the state where they hold an active, unrestricted license and where they have a significant connection such as residency or primary practice. They apply through the IMLC Commission portal, and the Commission issues a Letter of Qualification that member states use to issue individual state licenses on an expedited basis.

The IMLC does not issue a single license that works in all states. Physicians still receive a separate license per state. The compact expedites the verification process, not the concept of licensure itself.

Who Qualifies for IMLC

To be eligible, a physician must hold a valid, unrestricted MD or DO license, have no history of disciplinary action, be board certified or meet equivalent criteria, and designate an IMLC member state as their SPL. Hawaii and Vermont are members but are not eligible as States of Principal Licensure, meaning physicians can receive licenses for those states through the compact but cannot enter the compact through a Hawaii or Vermont license.

States NOT in the IMLC in 2026

States that have not joined the IMLC as of 2026 include California, New York, and Oregon, among others. Physicians wishing to practice telehealth with patients in these states must apply for a full license through that state's individual medical board, on the same timeline as any other license application. For high-volume states like California and New York, this is a significant operational consideration for telehealth businesses planning national coverage.

According to PayerReady's 2026 IMLC guide, the IMLC was designed primarily for telemedicine and locum tenens practice, and both use cases have seen significant growth since 2020, which has driven continued expansion of compact membership.

The Nurse Licensure Compact (NLC): Registered Nurses

The NLC operates differently from the IMLC. Rather than issuing separate state licenses on an expedited basis, the NLC allows nurses who live in a compact state to hold a single multistate license that is valid in all other compact states without additional applications or fees.

As of June 2026, the 41 NLC member states include Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Pennsylvania implemented the NLC in July 2025, and Connecticut went live in October 2025, bringing significant expansion to the Northeast. Massachusetts has enacted NLC legislation, but implementation is still pending as of mid-2026.

Key NLC Rules for Telehealth Nurses

The multistate license is issued by the nurse's primary state of residence, not their state of employment. A nurse living in Texas holds a Texas multistate license that is valid across all compact states. If that nurse moves to another compact state, they have 60 days to apply for a new multistate license in their new home state.

Notable non-compact states as of 2026 include California, New York, Illinois, and Michigan. Nurses providing telehealth services to patients in these states must hold individual licenses in each.

PSYPACT: Psychologists

PSYPACT is the interstate compact for licensed psychologists, and it operates with a meaningfully different mechanism from both the IMLC and NLC. Rather than requiring separate state licenses, PSYPACT issues an Authority to Practice Interjurisdictional Telepsychology (APIT) that allows psychologists to practice telehealth into any PSYPACT member state without obtaining a separate license in that state.

As of 2026, PSYPACT covers 40+ states, making it one of the most telehealth-friendly licensing compacts in operation. Psychologists must hold a full, unrestricted license in a PSYPACT member state, have no history of disciplinary action, and meet education and supervised experience requirements to participate.

For telehealth businesses with behavioral health services, PSYPACT significantly simplifies the multi-state licensing burden for psychologists compared to what physicians face under the IMLC model.

Other Provider Compacts in 2026

Counseling Compact

The Counseling Compact covers licensed professional counselors (LPCs) and licensed mental health counselors (LMHCs). Membership has expanded significantly in 2025 and 2026, making it easier for mental health providers to deliver telehealth across state lines under one privilege to practice rather than multiple individual licenses.

APRN Compact

The Advanced Practice Registered Nurse (APRN) Compact allows APRNs, including nurse practitioners, certified nurse midwives, and certified registered nurse anesthetists, to practice across compact states. Delaware, North Dakota, South Dakota, and Utah currently issue multistate APRN Compact licenses for RNs with over 2,000 practice hours. The APRN Compact is newer and less widely implemented than the NLC, but its expansion is a priority for organizations working to address provider shortages in rural and underserved areas.

Physician Assistant Licensure Compact (PALC)

The Physician Assistant Licensure Compact follows a model similar to the IMLC, allowing PAs to obtain expedited licenses in member states. Membership has grown steadily, and PAs practicing telehealth across state lines should verify current membership status as the compact continues to expand.

States With Telehealth-Specific Pathways

Beyond the major compacts, several states have created specific provisions that make it easier for out-of-state providers to deliver telehealth services to their residents.

Texas

Texas permits out-of-state health professionals to provide telehealth services as long as they are licensed and in good standing in their home state, within defined parameters. This makes Texas one of the more accessible states for out-of-state telehealth providers operating under its specific exemption framework.

Florida

Florida permits out-of-state providers to conduct telehealth consultations for second opinions without a full Florida license, and has also created a telehealth registration pathway for certain provider types. Telehealth businesses operating in Florida should review the specific registration requirements under Florida Statute 456.47.

Arizona

The Arizona Board of Behavioral Health Examiners does not restrict which license types can practice telehealth, making it a relatively open environment for behavioral health providers. Arizona also participates in PSYPACT and multiple other compacts, giving it among the broadest interstate telehealth access for various provider types.

States With Telehealth-Only Registration

A small but growing number of states, including Florida, Arizona, Vermont, and Colorado, have created special telehealth registration pathways that allow out-of-state clinicians to offer virtual services without obtaining a full license. These registrations typically include limits on patient numbers, duration of practice, or scope of services. For telehealth businesses testing new state markets without the full cost of individual licensure, these pathways can provide a compliant entry point.

What This Means for Telehealth Businesses

For healthcare entrepreneurs and clinical brands building multi-state telehealth operations, the licensing landscape in 2026 is more navigable than it was three years ago, but it still requires careful planning.

Mapping Provider Coverage to Patient Geography

The most important operational requirement is ensuring that every provider on the platform holds valid licenses in every state where they see patients. A licensing gap is a compliance gap, and it is one of the areas regulators focus on in telehealth enforcement. Telehealth platforms need credentialing workflows that track provider licenses by state, flag upcoming renewals, and prevent patient-provider matches where licensing coverage is absent.

Building for Scale Across Compacts

A telehealth business with national ambitions will typically field providers across multiple compact types. Physicians under the IMLC, nurses under the NLC, psychologists under PSYPACT, and counselors under the Counseling Compact all operate under different licensing mechanics. The platform infrastructure needs to accommodate all of these provider types cleanly.

Non-Compact States Require Individual Investment

For high-priority states outside the major compacts, particularly California and New York, the only path to legal telehealth practice is individual licensure. That takes time and money, and it should be factored into market entry planning from the start rather than discovered mid-launch.

Expert perspective: According to the American Medical Association's telehealth licensure issue brief, interstate compacts create expedited licensure pathways for physicians to deliver either in-person or telehealth services in more than one state, and licensure by endorsement provides an expedited pathway for physicians to obtain a full license based on qualifying criteria.

The AMA continues to advocate for further simplification of interstate telehealth licensing, noting that the current patchwork of state requirements creates unnecessary barriers to care access, particularly for patients in rural and underserved areas. The policy direction is toward greater interstate flexibility, but compliance with current requirements is non-negotiable in the interim.

How Bask Health Supports Multi-State Telehealth Operations

Operating a telehealth service across state lines requires more than a licensing strategy. It requires platform infrastructure that enforces licensing compliance at the point of care, documentation standards that meet each state's requirements, and security and compliance architecture that holds up under regulatory scrutiny across jurisdictions.

Bask Health's platform supports multi-state telehealth delivery with credentialing and provider management tools that track state licensing across your provider network. Our integrations and API infrastructure connect with credentialing verification services so licensing status is part of the operational workflow rather than a separate administrative process.

For businesses launching telehealth services in new states, our no-code tools allow new care pathways and intake flows to be configured quickly as geographic coverage expands. And our pharmacy fulfillment network, covering shipping to 48 states, ensures that the prescription side of care delivery keeps pace with the clinical side as your footprint grows.

Conclusion

The question of which states allow telehealth across state lines in 2026 does not have a single yes-or-no answer. The answer depends on provider type, compact membership, individual state rules, and the specific telehealth pathway being used. What is consistent is the fundamental principle: providers must be licensed where the patient is located, and the compacts exist to make that licensing more efficient, not to eliminate it.

For telehealth businesses building for national scale, understanding this landscape and building compliance into the platform from the start is what separates operations that grow confidently from those that encounter regulatory problems mid-expansion. If you are building or scaling a multi-state telehealth service, explore what Bask Health's platform can do to support compliant, scalable growth.

References

Payer Ready. (n.d.). Interstate Medical Licensure Compact guide. https://payerready.com/blog/interstate-medical-licensure-compact-guide

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