States Respond to COVID-19 and Health Disparities

By Tammy Jo Hill | August 2021


Before the onset of the COVID-19 pandemic, increasing rates of mental illness and difficulties surrounding access to treatment for adults and youth already presented challenges for states. Legislatures were working to help strengthen and align behavioral health and public health systems to respond to these challenges. Common policy actions included improving statewide data systems, promoting cross-sector engagement and partnerships, establishing spending levels and coordinating funding sources.

However, as Americans moved into a full year of social distancing, restricted capacity in public places and limited hours for most businesses, approximately 40% of adults reported symptoms of anxiety or depressive disorders and youth assessments for anxiety increased by at least 9% from 2019. Mental Health America reported youth ages 11-17 were the most likely age group to experience moderate to severe symptoms of mental illness and suicidal ideations during this last year. The Kaiser Family Foundation also reported that adult responses to stresses from the pandemic included negative effects on sleep or eating habits, increased consumption of alcohol or substance use, and worsening chronic conditions.

These pandemic-related disruptions and changes to social determinants of health, such as employment and financial stability, elevated community concerns around healthy living and health care access. In a recent study, Social Determinants of Health-Related Needs During COVID-19 Among Low-Income Households with Children, 76.3% of families reported concerns about financial stability, 42.5% about employment, 69.4% about food availability, 31.0% about housing stability and 35.9% about health care access. Communities of color, populations with a lower socioeconomic status, rural communities, people with cognitive and physical disabilities and individuals who identify as LGBTQ are often disproportionately exposed to conditions and environments that negatively affect behavioral and physical health risks and outcomes and lead to higher rates of health disparities. A recent report by the CDC highlights racial and ethnic disparities when considering individuals stress and worry due to COVID-19.  The report found a higher percentage of Hispanic adults reported stress about not having enough food, housing stability, access to health care services and loss of job or income compared to white and Black adults.

State Action

With increased attention to social determinants of health due to COVID-19, states have taken several actions to increase, expand and sustain access to behavioral health services. NCSL previously highlighted considerations for states throughout the last year and a half which included:

  • Supporting telehealth services by expanding available services and using teleprescribing for medication-assisted treatment. For example, Arkansas passed legislation to ensure reimbursement through the state Medicaid program for certain behavioral and mental health services provided through telemedicine would remain after the public health emergency declaration has ended.
  • Continue supporting access to naloxone by ensuring funding for distribution programs. New Jersey appropriated at least $1.9 million to the state medication-assistance treatment program for training, county jail treatment initiatives and a pilot program to support individuals with reentry.

The stress of COVID-19 only increased pressure on behavioral and public health systems. This led states to further consider actions around mitigating system strain through reducing health disparities and improving overall population health. 

Since the beginning of 2020, states have introduced at least 700 bills to create task forces, advisory groups or commissions. Some also included directing money or resources for communities to address health equity through behavioral and public health systems. For example, Colorado and Vermont passed bills to improve population health data collection and create a task force or commission aimed at improving health disparities within their states. Illinois, Arizona and Tennessee continue to address maternal and infant mortality through legislation professionalizing doulas and community health workers, including reimbursement regulations, as components to mitigate behavioral health concerns and health disparities. At least five states, including Alabama and Indiana, also committed to improving chronic health conditions within their communities that can lead to increased health vulnerabilities and complications.

Federal Action

Congress has taken steps to support federal agencies with behavioral health funding through a variety of measures. The CARES Act included $425 million, and the American Rescue Plan Act of 2021 included $3.56 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA) to address mental health and substance use disorders as a result of the COVID-19 pandemic. As part of the CARES funding, certified community behavioral health clinics received $250 million to respond to the increased need for services related to depression, anxiety, substance misuse or other conditions. The American Rescue Plan provided supplements to the Community Mental Health Services Block Grant and Substance Abuse Prevention and Treatment Block Grant.

This project is supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $250,000 with 100% funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.