Families USA produced the Public Policy Toolkit for Enrollment Assisters to give assisters and others the knowledge and tactics they need to be effective advocates.

How State Legislatures Work

Each state has a legislature that writes and passes laws that affect the residents of their state. These legislatures play the same role at the state level that Congress plays at the federal level, and the legislative process at the state level generally mirrors the process at the federal level. 

The powers, duties, size, and organization of legislative bodies differ from state to state. This guide provides an overview of state legislatures, as well as resources you can use to explore your state government further.

How State Legislatures Are Structured

Similar to Congress, 49 states have a legislature made up of an upper chamber, known as the Senate, and a lower chamber, known as an Assembly or House of Delegates. Nebraska is the only state with a single chamber. 

And as with the federal government, legislation starts in committee and then goes back and forth between chambers before it is passed. 

State Legislative Calendars

State legislatures generally meet between January and June each year, with the following exceptions: 

  • Four states meet once every two years: Montana, Nevada, North Dakota, and Texas. 
  • Five states meet year-round: Michigan, New Jersey, Ohio, Pennsylvania, and Wisconsin. 

The timeframe of sessions for the remaining states varies. Find out when your state legislature meets and other resources (such as a bill tracker and more information on the legislative process) on the website of the National Conference of State Legislatures (NCSL).  

Special sessions are when state legislatures convene outside their regular session to deal with specific issues or topics. For example, a state legislature could convene a special session to address a Medicaid expansion proposal.

Rules and procedures for special sessions vary across states: The majority of states allow the governor or the legislature to convene a special session, but there are a few states where only the governor is allowed to call a special session. 

Because most states’ legislative sessions last only a few months, many state legislators have other jobs when the legislature is not in session. This means that legislators are more likely to be working in their home communities and are more accessible than their federal counterparts, who meet year-round in Washington, D.C.

State Budgets and Fiscal Years

One key activity that all state legislatures must complete is passing a budget. Unlike the federal government, states must pass a balanced budget each year (or, in some cases, a two-year budget for the legislative session). 

While the federal fiscal year runs from October 1 through September 30, state fiscal years vary. All but four states have a fiscal year that runs from July 1 through June 30. 

  • Alabama and Michigan: October 1 through September 30
  • New York: April 1 through March 31
  • Texas: September 1 through August 31

The NCSL website has more information on state fiscal years.

If a legislature fails to pass a budget before the beginning of a new fiscal year, or if the governor vetoes the budget, lawmakers may have to extend the session or go into a special session to complete their budget work.

How to Keep Up with Legislative Activity in Your State

As noted earlier, most state legislatures follow a lawmaking process that is similar to the one Congress follows, including committee consideration, robust debate, and the need for a majority vote and the governor’s signature. State legislators value constituent input throughout this process.

The best place to find information on pending legislation is on your state legislature’s website, which can be found through the Library of Congress. Search using key words to find relevant legislation, or search for a particular bill to find when it was introduced, drafts that are available, and the status of the bill. 

Regional and Local Newspapers

News outlets based in your home city or state provide some of the most relevant information on what’s going on in your state legislature. Check your paper’s “politics” section or their website for updates on what is happening in your state capitol.


There are several state-based political blogs that update readers on the most popular activities going on inside statehouses. These blogs analyze the latest legislative developments and frequently predict the outcome of the legislation. 

Use a search engine to find a blog relevant to your state, but beware: Most blogs are either left-leaning or right-leaning, so keep this in mind when you’re reading.

Social Media 

Another way to stay up–to-date is through social media like Twitter or Facebook. Your state legislature’s chambers may have their own Facebook or Twitter accounts, or you can follow your favorite state representatives and senators. You can also look for common hashtags that pertain to your particular issue for real-time updates.


Your governor has the power to approve or veto legislation, and some governors have been very active in health care issues like Medicaid expansion. Corresponding with your governor’s office via email is another important way to influence policy at the state level. Find contact information for your governor’s office through the National Governors Association

Enlist State Agencies to Help Find Solutions to Your Issues

State agencies may be able to address many of the health care problems that consumers face by improving administrative systems, writing new rules, or better enforcing existing rules. These “administrative rules” are written by state agencies and are important because they are just as legally binding as regular laws. 

Generally, once administrative rules are proposed, the public has an opportunity to offer comments before the rules are considered final. The opportunity to provide comments on proposed rules allows you to provide insights and formal feedback on the proposed changes and solutions. 

State agencies can be an ally in your work with legislators, especially regarding problems that the agencies recognize but do not have the legal authority to solve. State agencies that may be especially relevant to your work include these:

  • The Medicaid agency, which might be part of a larger department of health or department of social services.

  • The insurance department: In some states, this department is part of a larger department that may also deal with banking or commerce. The insurance department oversees insurance companies to make sure they are following consumer protection laws, and it takes complaints about possible violations.

  • The public health department, which may be working on ways to keep people healthier and filling any gaps in the state’s health care system.

  • If your state operates its own health insurance marketplace (also called an exchange), the director and board of your state’s marketplace may also be good people to develop relationships with.

You can arrange to meet with state agencies regarding the concerns that consumers have about health coverage or health care. Many state agencies have advisory committees you may want to participate on to provide a voice for the consumers you serve. Often, these advisory committees are required to have consumer representatives. 

Use our Private Insurance Advocacy Checklist to get to know the agencies in your state.

Connect with Other Key Stakeholders in Your State

Health care advocacy attracts a wide variety of stakeholders. These stakeholders include consumer-focused organizations, legal aid organizations, medical associations, insurers, providers, and pharmaceutical manufacturers. Generally, these groups all engage in advocacy at the state level to one degree or another. 

TIP   There are ways to find ready coalition partners quickly. For instance, there are state affiliates of national organizations that are often members of advocacy coalitions.

There are also coalitions of consumer advocates whose work focuses on providing a voice for health care consumers. These advocates meet with lawmakers, testify before committees, write letters to the editor of local newspapers, and do other work to elevate consumer concerns. Working together, coalition partners are able to monitor policy changes and give voice to a variety of stakeholders, which can amplify the impact of any single organization. 

Building a coalition takes time, but there are some ways to find ready partners quickly. For instance, there are state affiliates of national organizations that are often members of advocacy coalitions. It may be useful to connect with these affiliates so that you can pool resources for advocacy campaigns during a legislative session.

Here are some examples of the types of organizations that may operate in your state:

  • AARP has offices in all 50 states with advocacy directors who work with the association’s volunteers in state capitols (see aarp.org/states/). Because AARP’s membership is so large—37 million people nationwide—it can be a valuable partner in promoting the consumer perspective during legislative debates on health care issues.

  • Other national groups with a state health care advocacy presence include the American Cancer Society Cancer Action Network (ACS CAN) and the National Alliance on Mental Illness (NAMI).

  • The Center on Budget and Policy Priorities works with partners in 42 states through its State Priorities Partnership program (see statepriorities.org/). These state budget groups provide insight into budget issues, particularly those that affect low-income consumers, including Medicaid.

    These groups are often members of broader advocacy coalitions that analyze and monitor state health care funding. The groups’ expertise on budget matters can provide a valuable perspective to health care advocates. For example, budget analyses are useful tools that can help persuade legislators that a health care program will have a positive financial impact on the state.

  • All states have Primary Care Associations, which work directly with community health centers and provide technical assistance on important policy topics. They represent health centers at the state level and do advocacy around health-related issues. To find the Primary Care Association in your state, visit the Health Resources and Services Administration (HRSA) Bureau of Primary Health Care