A historic amount of COVID-19 relief cash for states arrived in 2021 with the American Rescue Plan Act. States have until the end of December 2024 to dole out the funds, and many legislatures are busy allocating them to rebuild their economies and ease the pandemic’s continuing effects.
States can use ARPA funds in several ways, and many are using them for specific health-related expenditures, including for behavioral health, health care system supports and public health mitigation efforts.
The COVID-19 pandemic has challenged the overall capacity of health care systems to treat individuals and exposed significant deficiencies in public health systems across the country to address prevention on a larger scale. It’s also exacerbated behavioral and other health issues across nearly every demographic of the U.S. population.
Nearly half of adults reported at least one adverse behavioral health condition brought on by pandemic-related stressors, according to a study cited by the Centers for Disease Control and Prevention. Many states are prioritizing behavioral health—including mental health issues, substance use disorder treatment and prevention, and suicide prevention—in ARPA fund allocations.
For example, Colorado used ARPA funds to create a $550 million behavioral and mental health cash fund. The Legislature also appropriated money to various behavioral health-related programs, including addiction recovery services for people with mental health disorders.
Virginia appropriated more than $110 million to its behavioral health and developmental services department for bonuses for direct care staff, expansion of community-based crisis services, personal protective equipment and capital improvements at state facilities.
Health Care System Supports
The pandemic put some hospitals and health facilities under immense pressure and stretched others beyond their capacity. Several states are using ARPA funds to support health care facilities, safeguard health care services for high-need populations, and shore up the health care workforce.
For example, Illinois allocated over $200 million to the Department of Healthcare and Family Services for the Children’s Hospital of Chicago, safety net hospitals, general hospitals and specialized mental health rehabilitation facilities. Zooming in on rural hospitals, Kansas established a rural hospital innovation grant program and rural hospital innovation grant fund.
Washington authorized $35 million in grants to provide health care, including COVID-19-related services, primary care, preventive care and behavioral health services, to uninsured and underinsured individuals, regardless of immigration status.
States are acting to both support the current health workforce and expand the pipeline for the future. For example, Connecticut provided $7 million to its Department of Public Health for loan repayment and community health workers, and Vermont allocated $1.4 million to its State Colleges System to expand the Practical Nurse Program.
Public Health Infrastructure
Several states—California, Colorado, Connecticut, Indiana, Maine and Virginia—provided funds to their health departments to strengthen public health infrastructure. Virginia allocated $68 million to the Department of Health to modernize administrative systems and software, address broadband connectivity issues and provide building updates for local health departments. Maine allocated $1 million for strategy development and investments in public health infrastructure to reduce disparities among minority groups. Kentucky authorized funding for various critical needs related to COVID-19, including for testing capabilities in local health departments, health facilities, jails, prisons and homeless shelters.
States are addressing other public health priorities based on the unique needs of their populations. For example, Michigan and Montana are providing supplemental funding to long-term care facilities. Maine is leveraging ARPA funds to establish and maintain a program to offer free well-water testing for low-income residents. And Alaska is allocating $8 million to the Department of Public Safety to address domestic violence and sexual assault.
Policymakers face a variety of challenges in appropriating these one-time relief funds—now and for years to come.