OBJECTIVES: To study the emerging hotspot pattern of Long COVID (LC) in the U.S. population and investigate the correlation between Long COVID and state health system performance. METHODS: Using 2022 to 2024 Center for Disease Control and Prevention adult LC data, I applied the Getis-Ord Gi* statistic with the Mann-Kendall trend test to determine emerging temporal trends associated with local clustering patterns across the contiguous states. A Pearson's correlation tested LC rates and state health system performance. RESULTS: A spatiotemporal trend map described discrete patterns. In 2023, Long COVID rates were highest in Southeastern states such as Mississippi and West Virginia, but by 2024, mixed patterns were observed in some states. The LC rates showed an inverse relationship with state health outcome scores (r = -0.69, P <
0.001). Emerging hotspot analysis identified Mississippi as a persistent hotspot for Long COVID. Northeastern states showed consistently persistent cold spots. CONCLUSIONS: The states with better health outcomes showed a lower frequency of long COVID. The geographically emerging hot spots can guide focused intervention and resource allocation for these patients.