For years, working as an occupational therapist in more than one state meant starting a separate full license application for each one. The forms, the fees, the waiting. In 2026, that finally started to change.
The Occupational Therapy Licensure Compact began issuing compact privileges in January 2026. A compact privilege works like a license in another member state. If you are an OT or OTA who is licensed and in good standing in a member state, you can practice in other member states without building a second license from the ground up.
This is one of the bigger shifts in OT mobility in a long time, and it is worth understanding before you make your next move.
What a compact privilege actually is
A compact privilege is not a watered-down version of a license. It is treated as the equivalent of a license in the state where you want to practice. You hold one home state license, then apply for privileges in other member states that are up and running.
Two things have to be true for it to work:
- Your home state has to be operational, meaning it has finished connecting its licensing system to the compact.
- The state where you want to practice also has to be operational.
You still follow the practice rules of the state where your client receives care. The compact lowers the barrier to entry. It does not erase each state's own regulations.
Which states are issuing privileges
Minnesota, Ohio, and West Virginia were the first to begin issuing privileges in January 2026. Indiana came online on March 9, 2026. Virginia, Maryland, Tennessee, and Wisconsin have also completed the integration that lets them issue and accept privileges.
Thirty-four states have signed the compact into law. The rest are working through integration on their own timelines, so the list of live states will keep growing through 2026 and beyond.
If you are weighing a move, a new caseload, or a second state, the first step is simple. Check otcompact.gov to see whether your home state and the state you have your eye on are both issuing privileges yet.
What it costs and how you apply
You apply through CompactConnect, the system the member states use to verify licensure and issue privileges. The fee is $75 to the compact, plus whatever fee your state sets. Privileges are issued state by state, so if you want to practice in two new states, you apply for each.
The clinician who lives near a state line
This is where the compact gets practical, and it matters most in the Northeast, where state lines sit close together and a short drive lands you in a different licensing system.
We see this every day at Coral Care. An occupational therapist in Foxboro or Attleboro, Massachusetts who lives twenty minutes from Rhode Island. An OT north of Boston, around Lawrence or Haverhill, who is a quick drive from New Hampshire. A clinician outside Philadelphia who crosses into New Jersey to see a child in Cherry Hill or Camden. The family is right there across the line. The thing standing in the way has been a second full license in the neighboring state.
The compact is built for exactly this clinician. Once both states are issuing privileges, that neighboring state becomes a privilege application instead of a license from scratch.
Here is the honest status. The first states to go live have been Minnesota, Ohio, West Virginia, and Indiana, with Virginia, Maryland, Tennessee, and Wisconsin also integrated. Several Northeast states are still working toward issuing privileges. So if you practice in Massachusetts, Rhode Island, New Hampshire, Pennsylvania, or New Jersey, the move right now is to check otcompact.gov for both your home state and your border state, and to be ready to apply the moment the two are live.
Where Coral Care fits in
Coral Care connects occupational therapists with families for in-person sessions in the family's living room, across nine states: Massachusetts, Connecticut, New Hampshire, Rhode Island, Pennsylvania, Virginia, Texas, Illinois, and New Jersey. Virginia, one of our markets, is already among the integrated compact states.
That nine-state footprint is the point. As the compact opens up the Northeast and our other markets, a single home state license plus a privilege next door can mean a fuller, steadier caseload without a stack of separate applications. Whether you are relocating, living near a state line, or simply want more children to work with, the compact and a marketplace that already spans your region fit together well.
To be clear about our model: Coral Care is in-person care, not telehealth. The compact is often talked about in a telehealth context, but the value for our clinicians is mobility. You bring the license and the clinical skill. We bring the families, the scheduling, and the back-office support, so your hours go to the work you trained for instead of the logistics around it.
If the compact opens a new state for you, we would love to be the reason you have families to see there.
What to do this week
- Check otcompact.gov and confirm whether your home state is operational.
- Look up the states you want to practice in and see if they are issuing privileges.
- If both are live and you are in good standing, you can apply through CompactConnect.
- If your state is not live yet, keep an eye on the map. New states are coming online throughout the year.
Stay in the loop
We track licensure changes, new markets, and the things that actually affect your day as a clinician. If you want updates as more states come online and as Coral Care grows across our footprint, sign up for our newsletter.
