There is no single list of states that “allow” telehealth across state lines, because the answer depends on what type of provider you are, what compact agreements exist, and whether the state where your patient sits has created a special registration pathway. The general rule in the United States is that a healthcare provider must be licensed in the state where the patient is physically located at the time of the visit. That said, dozens of states have joined professional compacts and created alternative pathways that make cross-state telehealth far more accessible than it was a decade ago.
Why the Patient’s Location Matters
For licensing purposes, a telehealth encounter legally takes place where the patient is, not where the provider is. The federal government and state medical boards call the patient’s location the “originating site.” If you’re a physician sitting in California seeing a patient who is in Texas, Texas law governs the encounter. You need authorization to practice in Texas, regardless of where your own license was issued. This single principle is the reason cross-state telehealth is complicated and why compacts and registration systems exist to simplify it.
Interstate Medical Licensure Compact (Physicians)
The Interstate Medical Licensure Compact, or IMLC, is the main pathway for physicians (MDs and DOs) who want to practice across state lines, including via telehealth. It doesn’t replace state licenses. Instead, it creates an expedited process so a doctor can obtain additional state licenses without repeating a full application from scratch in each one.
As of early 2026, 43 states plus the District of Columbia and Guam are IMLC members. Alaska and Massachusetts have introduced compact legislation but haven’t joined yet. Arkansas, New Mexico, and Rhode Island have passed the compact but are still implementing it. Hawaii and Vermont are members but only issue licenses to physicians already licensed elsewhere in the compact, meaning they don’t serve as a home-base state for applications. Michigan is currently working through legislation to rejoin after its participation lapsed due to a sunset provision.
The states not currently part of the IMLC are a short list: notably California, New York, and a handful of others remain outside the compact. If your patient is in a non-member state, you’ll need to pursue a traditional full license in that state.
Nurse Licensure Compact (Nurses)
The Nurse Licensure Compact, or NLC, works differently from the physician compact. Rather than speeding up the process of getting additional licenses, it grants nurses a single multistate license that is automatically valid in every member state. A registered nurse or licensed practical nurse holding a multistate license issued by their home state can provide telehealth services to patients in any other NLC state without obtaining a separate license.
The NLC currently includes over 40 jurisdictions: Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, 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, Wyoming, plus Guam and the U.S. Virgin Islands. Notable holdouts include California, New York, Illinois, Michigan, and Oregon.
PSYPACT (Psychologists)
Psychologists have their own compact called PSYPACT, which allows licensed psychologists to provide telepsychology services to clients in other member states. PSYPACT has grown rapidly and now covers a large majority of states. Current participating jurisdictions include Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the Commonwealth of the Northern Mariana Islands.
This makes PSYPACT one of the broadest professional compacts currently operating. Psychologists practicing under PSYPACT must hold an active license in their home state and meet the compact’s qualification standards, but they do not need to obtain a separate license in each state where their clients are located.
Counseling Compact (Licensed Counselors)
The Counseling Compact is the newest of the major professional compacts, and it’s still in its earliest stages. As of now, the compact is only live for licensees in Arizona, Minnesota, and Ohio, and only for specific license types in those states. Licensed professional counselors in Arizona can practice in Minnesota, licensed professional clinical counselors in Minnesota can practice in Arizona, and Ohio’s licensed professional clinical counselors can practice in both. More states have passed compact legislation, but the operational rollout is happening gradually. For counselors in most states, cross-state telehealth still requires obtaining a full license in the patient’s state.
Telehealth Registration Pathways
Some states have created an alternative to full licensure specifically for out-of-state telehealth providers. These telehealth registration systems let a provider who holds an active, unrestricted license in one state register (rather than get fully licensed) in another state to deliver telehealth services. The requirements are generally similar across states that offer this option:
- Active, unrestricted license in at least one other state
- Clean disciplinary record with no past or pending actions
- Professional liability insurance that covers telehealth in the target state
- No in-person practice in that state (you can’t open an office or see patients face-to-face)
- Annual registration and fee with the state licensing board
The specific states offering this pathway shift as legislatures update their laws. The Center for Connected Health Policy maintains a chart tracking which states have telehealth registration processes, limited licensure exceptions, and compact participation. Because these policies change frequently, checking with the specific state board where your patient is located is the most reliable way to confirm current options.
Controlled Substance Prescribing Across State Lines
Prescribing medications via telehealth across state lines adds another layer of complexity, especially for controlled substances. The DEA requires that a practitioner be authorized to prescribe by both the state where the practitioner holds their DEA registration and the state where the patient is located. The good news is that a provider doesn’t necessarily need a separate DEA registration in every state where patients are located, as long as both states authorize the prescribing. But the provider must comply with the laws of both states, which can differ significantly on what can be prescribed via telehealth and under what conditions.
Federal telemedicine prescribing flexibilities that were introduced during the pandemic have been extended in phases, but the regulatory landscape continues to evolve. Providers prescribing controlled substances across state lines should verify both federal and state-level rules for the specific states involved.
States With the Fewest Cross-State Options
A few states remain outside most or all major compacts, making cross-state telehealth significantly harder. California and New York are the most prominent examples. Neither belongs to the IMLC or the NLC. Providers who want to see patients in these states via telehealth generally need to obtain a full license through the traditional application process, which can take weeks to months and involves separate fees, background checks, and paperwork.
Oregon is another state that sits outside the NLC, though it participates in some other compacts. For providers looking to build a multistate telehealth practice, the states outside the major compacts represent the biggest logistical and financial barriers. The practical reality is that joining every relevant compact and obtaining additional licenses where needed can still require significant administrative effort, even with the streamlined processes now available in the majority of states.