Talk of forming state associations started in the 1890's. At the time, Grand Lodge banned the formation of associations. Members began to work on the formation of associations that would conform to the statutes and benefit the Order of Elks.

By 1914 there were twenty-three state associations in existence, although they were illegal. During the 1914 Grand Lodge convention in Denver, the movement to bring them into the Order gained momentum. At the Grand Lodge session the following year in Los Angeles, a comprehensive report on state associations was submitted to the delegates. The report recommended that the necessary constitutional revisions be made to allow recognition of state associations. Delegates approved the changes, and the amendment was then sent to the subordinate lodges for ratification. Upon acceptance by the subordinate lodges, state associations became legal.

Since their formation in 1915, Elk State Associations major projects have helped crippled children and visually handicapped youngsters. They have sponsored clinics; run hospitals and youth camps. They have given out scholarships and taken care of youngsters with cerebral palsy. These charitable expenditures have totaled well over $200,000,000 in seventy-five years.

Annually, these associations spend more than $26,000,000 on charitable works.

The oldest Elks State Associations are from Ohio formed in 1898, Wisconsin started in 1902 and Michigan started in 1904. Today there are forty-eight state associations, with California and Hawaii forming one association and Maryland, Delaware and the District of Columbia comprising another.