Palliative care is specialized care for people living with a serious illness. It focuses on providing relief from the symptoms and stress — whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. This care is provided by an interdisciplinary team of doctors, nurses, social workers, chaplains, and others who work alongside a patient’s other clinicians to deliver an extra layer of support. Critically, palliative care is appropriate at any age and any stage in a serious illness and can be provided in conjunction with curative or life-prolonging treatment.
Every state has taken meaningful action in some capacity to improve care for residents facing serious illness, affirms a recent publication from the Center to Advance Palliative Care (CAPC). The report documents how states are using a wide array of policy levers — such as legislation, Medicaid innovation, public education, and workforce development — to improve access to and quality of palliative care. Among the report’s findings:
- While palliative care has become the standard of care in large hospitals, gaps in access remain in for-profit and rural hospitals.
- The number of specialty-trained palliative care clinicians still lags significantly behind most other specialties.
- Innovative payment strategies and policies are emerging to help advance palliative care access and sustainability.
- Increasing numbers of clinicians are being trained in the fundamentals of palliative care outcomes, such as symptom management and serious illness communication.
- Stark inequities in access and outcomes persist, particularly for low-income communities and people of color.
The following image highlights areas in which states have concentrated their efforts (note: this is not a ranking; states are listed alphabetically):
State Strategies
There is no one-size-fits-all approach for improving palliative care. State actions vary depending on available resources, local health system infrastructure, and political will. Nonetheless, several trends have emerged, consistent with the National Academy for State Health Policy’s (NASHP) and CAPC’s observations, including:
- Defining palliative care in statute to reinforce its relevance across diagnoses, prognoses, ages, and care settings
- Expanding palliative care education and awareness, through legislatively established advisory councils and/or adult or pediatric coalitions focused on serious illness
- Growing the palliative care workforce, including increasing the capacity of all clinicians (not just palliative care specialists) to provide palliative care services
- Integrating palliative care assessments into existing state programs and care delivery models
- Exploring new Medicaid payment models, particularly to support community-based, interdisciplinary palliative care
To help illustrate how these policies and practices are implemented, NASHP hosted a webinar featuring two state leaders who shared how their agencies are driving improvements in palliative care access and delivery. Their efforts highlight replicable strategies and lessons for other states.
Kansas: Building Infrastructure and Awareness
Kansas has made significant strides in advancing palliative care through the work of its Palliative Care and Quality of Life Interdisciplinary Advisory Council, created by statute in 2018 to advise the Palliative Care Program within the Department of Health and Environment. With members from across the care continuum, the Council has developed a detailed five-year state plan (2022–2027) focused on improving access to palliative care services, especially in rural areas, through initiatives such as expanding telehealth, increasing the number of certified clinicians, advocating for better reimbursement of interdisciplinary teams, and focusing attention on emergency preparedness and disaster planning. Through no-cost Project ECHO sessions, continuing education for primary care practitioners to obtain essential palliative care skills addresses the priority of education and health care workforce training.
Public and community awareness has been boosted through media campaigns and a highly visited state website, while a statewide palliative care registry is also in development to help connect patients and providers more effectively. Looking forward, the Council will be looking to better understand the needs of its population and opportunities to address gaps through data collection efforts. In the meantime, the Council continues to build collaborative partnerships and raise awareness about the value of palliative care at all stages of serious illness, with a shared goal of equitable access for all Kansans.
Minnesota: A Comprehensive, Upstream Approach
Minnesota has taken a broad approach to palliative care by embedding it within a comprehensive system of aging and caregiver supports. Led by the Department of Human Services and the Minnesota Board on Aging, the state offers a wide array of services ranging from Older Americans Act programs to more intensive Medicaid-funded home- and community-based supports. Minnesota emphasizes caregiver support, flexible self-directed service models, and building provider capacity, especially in rural areas. Community investments such as the Live Well at Home and Dementia grants further extend the state’s infrastructure for supporting people with serious illness. The Minnesota Palliative Care Advisory Council was established in 2017 to advise the Department of Health on all palliative care initiatives in Minnesota. It has successfully helped to define palliative care in state law, developed core service recommendations, and continues to advocate for a Medicaid-covered community-based palliative care benefit. With a focus on person-centered care, aging in place, and caregiver sustainability, Minnesota continues to lead through visionary, incremental investments and cross-sector collaboration.
Looking Ahead
As states continue to confront the complex needs of people living with serious illness, promising practices from Kansas, Minnesota, and others offer valuable roadmaps. These efforts demonstrate that with clear definitions, cross-sector partnerships, and strategic investments, states are expanding access to high-quality, person-centered palliative care across settings and populations.
Resources for State Policymakers:
- Visit NASHP’s Palliative Care Hub.
- Review the Scorecard website and full report.
- Review individual state reports summarizing data, policy context, and key contacts.
- Encourage participation in CAPC’s Palliative Care Provider Directory to support accurate data collection and visibility.
Acknowledgments
This blog post is based on a recent NASHP webinar, States’ Promising Practices to Improve Care of Serious Illness. The authors thank Douglas Neal, Mary Olsen Baker, Nikki Peterson, Kate Shoemaker, Scott Bane, and Salom Teshale for their insights. This work was supported by The John A. Hartford Foundation.
