Out-of-School time (OST) programs are a promising setting for reducing child obesity risk by promoting healthy eating and providing opportunities for physical activity. The Healthy Out-of-School Time Coalition developed the National AfterSchool Association Healthy Eating and Physical Activity standards in 2011 to provide comprehensive guidance on how to promote healthy eating and physical activity. To date most efforts to adopt these standards have been voluntary, but state or local laws present one option to increase awareness, uptake, and implementation of the standards. This report focuses on the potential benefits and unintended consequences of state policies specifically focused on OST programs. The report summarizes key informant interviews and case studies of California and North Carolina, two states with experience translating healthy OST guidelines into state policy. Policy recommendations and questions for future research are also presented. The report concludes that state policy approaches have the potential to result in faster, more equitable, and more thorough improvements to healthy eating and physical activity in OST settings, though experts noted that initial forays into state policy approaches should be voluntary and policy approaches should evolve as knowledge becomes available through experience.