As of 25 October 2026, four compacts are fully usable for multi-state practice: the Interstate Medical Licensure Compact (44 member jurisdictions, 42 states plus Guam and DC), the Nurse Licensure Compact (43 jurisdictions), PSYPACT for psychologists (44 jurisdictions effective) and the PT Compact (38 states issuing). The Counseling Compact is live in nine states and the OT Compact in ten. The Social Work, PA and APRN compacts have not issued any privileges.
The rule that matters more than any count: a state that has passed a compact is not a state you can practise in. Check the issuing list, not the map.
Which compacts are live, and for whom?
Four compacts are mature enough to plan a practice around today, two are live but thin, and three cannot yet be used at all. The table is ordered by how usable each one is this month, with the commission's own page linked for every row.
| Compact (links to commission) | Who it covers | Enacted | Actually issuing | How it works |
|---|---|---|---|---|
| IMLC | Physicians (MD, DO) | 44 member jurisdictions (42 states, Guam, DC), 59 boards | Yes, mature. Over 170,000 licences and 90,000 Letters of Qualification issued since launch, per the Commission's own data study | One verification ($700), then full licences from each state you choose, at that state's fee |
| NLC | RNs, LPN/VNs | 43 jurisdictions | Yes, mature. | One multistate licence covers every member state, no per-state step |
| PSYPACT | Psychologists (doctoral) | 44 jurisdictions enacted (42 states, DC, Northern Mariana Islands); Alaska most recent to take effect | Yes, mature. Alaska effective 20 September 2026. Iowa and Louisiana are enacted but not yet effective (Iowa July 2027, Louisiana January 2028) | E.Passport, then an Authority to Practice Interjurisdictional Telepsychology |
| PT Compact | PTs, PTAs | 41 states | Yes: 38 issuing. Maine, Michigan, Rhode Island enacted but not yet issuing | Privilege purchased per remote state |
| Counseling Compact | LPCs, LMHCs and equivalents | 39 states + DC | Partly: 9 live. AZ, AR, GA, IN, LA, MN, OH, TN (1 Sep 2026), WY (31 Aug 2026) | Privilege purchased per remote state via CompactConnect |
| OT Compact | OTs, OTAs | About 37 states enacted; see commission map | Partly: 10 accepting. MN, OH, WV (12 Jan 2026), IN (9 Mar), VA (20 Mar), MD (15 Apr), TN (20 May), WI (29 May), AR and MS (early Oct 2026) | Privilege per remote state; each state opens at its own pace |
| Social Work Compact | LCSWs, LMSWs, bachelor's-level | 30-plus states | No. "Multistate licenses are not yet being issued" | Multistate licence, once the commission finishes 12 to 24 months of implementation |
| PA Compact | Physician assistants | 29 states | No. Commission still building its data system | Privilege per remote state, once operational |
| APRN Compact | NPs, CRNAs, CNMs, CNSs | 5 states | No. Needs 7 states to activate | One multistate licence, modelled on the NLC |
The map is not the list. Every compact publishes a map coloured by legislation. Legislation is step one. Between passing a compact and issuing the first privilege sit rulemaking, fee-setting, a data system and a commission vote, which has taken one to three years for every compact so far. The Counseling Compact map shows 39 states; you can practise in nine.
What is the difference between enacted and live?
Enacted means a state legislature passed the compact into law. Live means the state is accepting and issuing privileges through the compact's system. Only the second lets you see a patient.
Enacted
The bill is signed. The state appears on the map. Nothing is available to you yet.
Commission operational
Enough states have joined for the compact commission to form, write rules and build a data system. For Social Work and PA this is where things sit today.
State issuing
The individual state board has connected to the system and set its fee. Now a privilege can be purchased. Both your home state and the remote state have to be at this stage.
Which compact applies to me?
It depends entirely on licence type. Physicians use the IMLC, RNs and LPNs the NLC, psychologists PSYPACT, counsellors the Counseling Compact, PTs the PT Compact and OTs the OT Compact. Social workers, PAs and APRNs have no usable compact yet. A group practice with mixed disciplines is usually running three or four compacts at once.
Physicians
IMLC. The most mature route, but it issues full state licences at each state's fee, not a single multistate licence. Budget the $700 Letter of Qualification plus each state.
Nurses
RNs and LPNs use the NLC: one licence, 43 jurisdictions. NPs and other APRNs cannot use it; the separate APRN Compact is two states short of activating.
Psychologists
PSYPACT covers telepsychology in more than 40 states through an E.Passport. Master's-level clinicians are excluded; it is doctoral only.
Counsellors
Counseling Compact, nine live states. Your home state must be one of the nine and so must the client's. Everyone else still applies state by state.
Social workers
No usable compact yet. Enacted widely, issuing nowhere. Plan on individual state licences through 2027.
PTs and OTs
PT Compact is mature at 38 issuing states. OT Compact is live in eight and opening state by state through 2026.
What does a compact privilege actually cost?
The compact fee is the small part. Each remote state adds its own privilege or licence fee, and for physicians that is the full state licence fee of $35 to $895 on top of the IMLC's $700 Letter of Qualification.
| Compact | Compact-level fee | Per-state fee on top | Notes |
|---|---|---|---|
| IMLC | $700 per Letter of Qualification | $35 to $895 per state licence | LOQ valid for a fixed window; request states inside it |
| NLC | None beyond home licence | None | The multistate licence is the home licence |
| Counseling Compact | Commission fee at purchase | Set by each remote state | Some states add a jurisprudence exam |
| PT and OT | Commission fee at purchase | Set by each remote state | Expires with the home state licence; must be renewed separately |
| PSYPACT | E.Passport application and annual renewal | None per state | APIT covers all participating states |
Full state-by-state licence fees, decomposed by board, are in what licensing and credentialing actually cost.
What a compact does not do. It does not enrol you with a single payer. Medicaid is per state and requires that state's licence first; commercial contracts are state or region specific. A compact privilege gets you licensed; credentialing in the new state starts after. See the FAQ for the payer side.
Where do I check the current status before I rely on it?
The commission's own issuing list, on the day you need it. Two Counseling Compact states went live within 48 hours of each other at the end of August 2026; a list from July was already wrong.
- IMLC participating states
- NLC map
- PSYPACT map
- Counseling Compact live list (the map page lags the homepage)
- PT Compact map
- OT Compact: states accepting applications
- Social Work Compact jurisdictions
- PA Compact
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Juney Ham is the founder and CEO of Telesure, the marketplace that matches clinicians with independent licensing and credentialing specialists. Previously co-founder of Upside and CMO at Hired. Every regulatory figure on this page is taken from the issuing state board, compact commission or CMS and was verified on 25 October 2026. Fees and compact status change; confirm with the relevant board before relying on them.
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