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News on practice and policy affecting internationally trained immigrants and refugees

Policy Roundup: State Efforts to Advance the Economic Inclusion of Immigrants and Refugees

Thursday September 15, 2022 | by Natalie Torres

The United States currently faces deepening labor shortages in critical sectors including health care and education. At the same time, internationally trained immigrants and refugees have education, credentials, and experience that could help meet immediate workforce needs and bolster the nation’s long-term economic vitality. An estimated two million college-educated immigrants and refugees are unemployed or underemployed in the U.S., according to the Migration Policy Institute. At least 60 percent of these individuals hold credentials from another country.

Systemic factors like insufficient contextualized English-language learning, lack of effective workforce development training, and limited recognition of credentials contribute to the underemployment of immigrants and refugees. Targeted state policy solutions can help address these barriers to economic mobility. In recent years, state policymakers have increasingly recognized the essential role of immigrant and refugee workers and made progress in advancing policies that are inclusive of all workers.

In 2022, state policy reforms across the U.S. promoted workforce inclusion, advanced recognition of credentials, and opened career pathways for internationally trained immigrants and refugees. These policies offer promising, innovative models for other states working to build equitable workforces that promote the economic inclusion of immigrants and refugees.

Expanding Access to Occupational Licensure

Fifteen states passed policies in 2022 to increase recognition of credentials and expand pathways to occupational licensure. Colorado enacted groundbreaking legislation, HB 22-1050, that creates a pathway to permanent licensure for internationally trained doctors who have not completed a U.S. residency program but meet other specified requirements. The legislation also establishes assistance and training programs to advance the inclusion of internationally trained medical graduates (IMGs) in the state’s health care workforce.

In Pennsylvania, a new law, HB 245, allows IMGs enrolled in medical residency to apply for a license without restriction after completing two years of approved graduate medical training, aligning licensure requirements with those that apply to U.S. medical graduates.

Policy reforms in five states increased internationally trained nurses’ access to the workforce. Hawaii’s state legislature enacted a law, HB 1758, that offers temporary permits to eligible internationally educated nurses while their applications for licensure by endorsement are pending. Legislation in Kentucky, SB 10, permits the issuance of a license by endorsement for internationally trained nurses who pass the National Council Licensure Examination (NCLEX), receive a satisfactory credential evaluation assessment issued by a recognized credentialing organization, and meet additional requirements.

In addition, Illinois, Maryland, and Massachusetts took steps to better align scoring standards with national best practices and to expand options for nursing license applicants seeking to demonstrate their English-language skills. Illinois and Maryland approved administrative changes to add more English-language proficiency exam choices for nursing licensure. In Massachusetts, the Foreign-Trained Medical Professionals Commission recommended expanding the English proficiency testing options, permitting the use of “superscoring,” in which a candidate’s best performance on each module out of multiple test sittings is accepted, and allowing nurses who have already passed an English proficiency test for licensure in another state to apply for licensure in Massachusetts without retesting English proficiency.

The Connecticut legislature made progress toward an inclusive mental health workforce by enacting legislation, HB 5001, that creates more accessible licensure pathways and provides support to English-language learners seeking to become licensed social workers.

Virginia enacted bipartisan legislation, SB 68 and HB 979, to promote inclusion in the teacher workforce and address the state’s teacher workforce shortage by issuing a provisional license to eligible internationally licensed educators in the state. Another law passed in Virginia this year, SB 590, creates a pathway for international dental school graduates to receive a faculty license to teach dentistry in a dental program.

New laws in Illinois and Tennessee, HB 4332 and HB 2309 respectively, reduce barriers to occupational licensure by removing certain immigration status licensure requirements. Laws enacted in Missouri, HB 2149, and Utah, SB 43, allow certain internationally educated workers to be eligible for licensure, provided their credentials are substantially equivalent to state requirements. New Mexico also enacted legislation, HB 191, to allow for one year of expedited licensure for workers who hold licenses in other countries at the discretion of licensing boards; and Maine passed a law, LD 2035, that allows the documentation requirements as well as examination and licensure fees for internationally educated licensing applicants to be waived in situations of extreme hardship.

Promoting Workforce Inclusion

Seven states passed legislation to commission studies that examine immigrant and refugee participation in the workforce and the barriers affecting immigrants and refugees who seek to enter in-demand fields. These initiatives will gather the information necessary to propel future legislation that alleviates worker shortages and advances inclusion in state workforces. A new law in Illinois, HB 5465, creates a state task force on internationally licensed health care workers to study barriers to occupational licensure and issue recommendations to address them. Maryland has enacted legislation, HB 625 and SB 440, establishing a commission to examine the state’s health care workforce shortages, including career and licensure pathways for internationally trained immigrants and refugees. Legislation in Vermont, H 661, promotes equity by calling on the state’s Office of Professional Regulation to conduct a study on mental health professional licensure that examines the barriers impeding immigrants and refugees seeking to enter the field. Additionally, Michigan invested $1 million to create a more equitable medical licensing process by establishing a task force on internationally trained medical practitioners through HB 5783.

In Colorado, a new law, SB 22-140, establishes a task force to recommend ways to improve the inclusion of internationally educated individuals in the workforce in fields such as early childhood education and care, education, and health care, with a priority given to the field of nursing. The New York state legislature passed similar legislation, S 7429, to study immigrant and refugee participation in adult education and the workforce, including barriers to licensure and language access.

The Massachusetts’ Special Commission on Foreign-Trained Medical Professionals completed a nine-month study on internationally trained health professionals in the state and released a report, SD 3237, in July with recommendations and proposed legislation to strengthen medical care in the state. The report recommends that Massachusetts create an alternative pathway to full licensure for internationally licensed physicians and dentists, as well as establish a program to facilitate IMG access to medical residencies.

Advancing the Economic Inclusion of Immigrants and Refugees

A few states passed notable policies to advance workforce and community inclusion and promote more equitable access to programs and services.

A new law in Illinois, HB 1567, amends the Governor’s Office of New Americans Act to support the social, cultural, and economic inclusion of immigrants and refugees in the state. The legislation ensures immigrants and refugees’ access to quality English language learning (ELL) programs and requires the completion of New Americans Plans at each state agency level.

Colorado’s SB 22-140 helps eliminate language barriers by investing in virtual career-aligned ELL programming to ensure that English language learners have access to work-based learning, job training, and employment opportunities.

Enacted legislation in California, SB 193, establishes the Local Government Immigrant Integration Initiative to administer grants to local governments to develop or expand initiatives that advance immigrant and refugee inclusion and economic mobility.

A Roadmap Toward an Inclusive Workforce

State policy reforms in 2022 offer a roadmap toward an inclusive workforce that promotes the economic mobility of immigrants and refugees as part of the U.S. economic recovery. The number of states enacting equitable policies provides policymakers with models to implement comprehensive welcoming and inclusion strategies in their communities. States committed to opening career pathways in the face of growing workforce shortages should focus on policy reforms that advance the recognition of credentials, examine immigrant and refugee participation in the local workforce, and develop state-level immigrant and refugee inclusion initiatives.


The IMPRINT Policy Tracker monitors state and federal policies aimed at promoting the economic mobility of immigrants and refugees who hold international credentials. Find out more.

IMPRINT’s #UntappedTalent campaign advances policies of inclusion that open pathways to opportunity to offer everyone a fair chance of reaching their educational and career goals.
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Natalie Torres is a Policy Analyst at WES Global Talent Bridge.