Workforce shortages, overdoses, mental health disorders, maternal mortality—all are ongoing problems made worse over the last couple of years by the COVID-19 pandemic, and state legislatures are responding.
The nation has faced a shortage of health care professionals for years, with nursing being one of the hardest-hit professions. Nursing shortages brought on by an aging population, aging workforce, nurse burnout, long wait times for licensure approval and extended work hours not only strain health care systems but also affect patient care and overall outcomes. The shortages are particularly dire in rural and underserved areas, where lower salaries and intense workloads can impact retention.
This story is part of a State Legislatures News special report examining the hot topics and legislative trends that will dominate state lawmakers’ time in 2023.
Behavioral health conditions—including mental health and substance use disorders—are common in the United States. Nearly 1 in 5 American adults live with a mental illness, and 1 in 10 have had a drug misuse disorder. The pandemic has exacerbated the prevalence of these conditions, with reported increases in anxiety or depressive disorders, overdose deaths and suicide attempts. A shortage of behavioral health professionals, however, limits access to needed services, particularly in rural and underserved communities. About 37% of the U.S. population lives in an area with a shortage of psychologists, counselors and social workers, and nearly two-thirds of shortage areas are rural.
The demand for health care services is predicted to increase in the coming years due to an aging population and workforce as well as higher rates of chronic disease. The supply of providers, however, is not expected to keep pace with demand.
Hot Topic—Behavioral Health Needs
Data shows that the pandemic and other stresses may have triggered or exacerbated behavioral health conditions including depression, anxiety, severe mental illnesses and substance use disorders. At any time, about 1 in 5 adults and 1 in 6 young people ages 6-17 will report experiencing a mental health disorder. Mental health conditions not only can pose a significant burden to society but also can disproportionately affect specific populations, including youth and young adults, Hispanic people, Black people, essential workers, unpaid caregivers and rural communities.
In response, legislatures are strengthening and aligning health systems to support the behavioral health workforce, bolster behavioral health crisis response and increase supports for youth mental health.
A shortage of behavioral health professionals can limit access to necessary services, particularly for residents of rural and underserved communities. States’ policy options for recruiting and retaining behavioral health workers include understanding workforce needs, increasing the supply of professionals, expanding the reach of existing professionals, addressing the distribution of professionals and retaining the current workforce.
Several states have passed legislation to better understand the role of law enforcement in mental health crises and have taken steps to improve behavioral health care and treatment options for incarcerated individuals.
With the launch of the 988 Suicide & Crisis Lifeline, the 24/7 call number available to anyone in suicidal crisis or emotional distress, states are creating new options for preventing suicides and overdoses. In addition to establishing study commissions and task forces to evaluate the behavioral health care landscape in their states, policymakers are employing different funding and implementation models for the new lifeline.
Many states have enacted legislation to increase resources for youth mental health needs, address adverse childhood experiences and improve access to mental health treatment, especially in educational settings.
Hot Topic—Maternal Health
High—and rising—rates of preventable maternal mortality and pregnancy-related complications have caught the attention of state and federal policymakers, with many legislatures focusing on associated racial and geographic disparities. Recognizing the human, societal and financial costs of maternal mortality, at least 35 states and the District of Columbia have enacted more than 110 bills since 2020 to support mothers before, during and after delivery.
Lawmakers routinely pass bills or resolutions to call for action on maternal health, and many are commissioning studies to inform their policy work. All 50 states, the District of Columbia, Puerto Rico and several large municipalities have formed maternal mortality review committees to examine the underlying causes of deaths that occur during or within a year of pregnancy and to provide specific recommendations for reducing them. Responding to evolving needs, states recently have changed the membership, power and duties of their committees by, for example, including community representation or requiring recommendations to reduce racial disparities.
Some states expanded midwifery to address workforce shortages and to improve access to care for low-risk pregnancies in rural and underserved areas. Examples include licensing traditional midwives, expanding nurse-midwife scope of practice and requiring insurance coverage for midwifery care.
As the largest single payer of pregnancy-related services, Medicaid plays a significant role in maternity care. At least 10 states and Washington, D.C., approved doula Medicaid coverage; research shows that support from doulas is linked to better maternal health outcomes and decreased racial disparities. At least 24 states and Washington, D.C., have approved or are in the process of getting approval for the extension of Medicaid coverage beyond 60 days after birth, with the majority providing full coverage for a year.
For more, see these NCSL health resources: