As the country continues to recover from the effects of the COVID-19 pandemic, Governors have highlighted the need to continue to invest in and support the health and well-being of their constituents through this year’s State of the State addresses. Issues at the top of mind for Governors include investing in the healthcare workforce, developing policy to improve maternal and child health outcomes, as well as expanding behavioral health services and supports.
The highlights outlined here represent key themes that emerged from a scan of 2023 State of the State addresses as well as budget submissions delivered by state and territorial Governors.
A link to each Governors’ address is available on the NGA 2023 State of the State page located here.
Addressing behavioral health, including mental health and substance use disorder, continues to be a top priority for Governors. Over half of the Governors addressed mental health as a top priority for their administration, and over one-third of Governors committed their support to combating substance use disorder and overdose during their annual State of the State addresses. Policy priorities denoted in their statements include expanding hospital-based behavioral health treatment, providing mental health services within schools, expanding crisis services through the implementation of the 988 crisis hotline and mobile units, as well as continuing naloxone distribution.
“We need to prioritize hiring social workers and counselors for our schools to address the mental health crisis among children and teens. Currently each counselor in an Arizona school provides services for more than 700 kids on average. That’s the highest ratio in the nation and nearly three times the recommended standard. That’s unacceptable and we must do better.”Arizona Governor Katie Hobbs
“Today marks a reversal in our state’s approach to mental health care. This is a monumental shift to make sure no one falls through the cracks. The most significant change since the deinstitutionalization era of the 1970s. I’m proud to announce we will be investing more than $1 billion dollars and making critical policy changes to finally and fully meet the mental health needs of our state.”New York Governor Kathy Hochul
“We will shut the revolving door in our prisons [ … ] It’s helping those in prison overcome addiction by focusing on mental health, faith-based programs, workforce skills and doing things that challenge change from the inside out.”Arkansas Governor Sarah Huckabee Sanders
“My budget expands Mental Health Intervention Teams in our schools to have an even greater reach. It also provides funding for adult psychiatric services in the Wichita area, and funding to address the shortage of mental health workers across the state. We also need to pass legislation to guarantee mental health care for our first responders.”Kansas Governor Laura Kelly
“My budget includes an enhancement in Medicaid, to expand community behavioral health centers. This $17 million dollar expansion will add up to six clinics across the state in underserved areas including northern and rural Nevada. Ensuring more mental health services are available to anyone in need, regardless of their ability to pay.”Nevada Governor Joe Lombardo
Substance Use Disorder
“As part of this budget, I am also proposing an historic $237 million in combined State and Federal funding for substance use disorder and mental health services, to include an increase in rates paid to providers. This will allow, for example, a 48 percent increase for methadone treatment and an 8.2 percent increase for intensive outpatient services, to complement an increase in recovery residences and a 24/7 drop-in center. Second, I am directing the Department of Health and Human Services to embed a clinical expert in substance use disorder in every child welfare district in Maine to better recognize the influence of substance use, to navigate the risks to children, and to steer parents into treatment. Third, I have directed the Department of Health and Human Services to engage recovery coaches with lived experience to assist parents struggling with substance use disorder.”Maine Governor Janet Mills
“Together, we made the state’s largest-ever investment in substance abuse prevention, which is being deployed as we speak. It’s helping community partners give students meaningful things to do – like afterschool programs, clubs, sports and jobs – where they build healthy relationships, explore opportunities and feel valued.”Vermont Governor Phil Scott
“Additionally, we are putting more resources than ever before into our Recovery Friendly Workforce initiative – which has not only outpaced its growth in OUR state, but just last week our team presented to all 50 states — many who have already adopted this program. The Recovery Friendly Workplace Initiative is going national and we in New Hampshire are doubling our efforts here to help ensure everyone with this disease [substance use disorder] has a chance to work and contribute.”New Hampshire Governor Chris Sununu
“The ‘Right Help, Right Now’ plan [ … ] It’s part of a bold approach that will substantially expand system capacity – same day care, relieving the burden on law enforcement, greater pre-crisis service capacity in schools, a focus on substance use disorder, a stronger behavioral health workforce, and service innovations.”Virginia Governor Glenn Youngkin
In addition to citing behavioral health as a priority during State of the States, Governors proposed record budget commitments to address substance use and mental well-being, including expanding harm reduction services and expanding infrastructure to transform the delivery of children and youth services. For example, Oregon Governor Tina Kotek proposed $280 million for addiction treatment, overdose prevention, peer support services and other investments in substance use treatment and services, along with $40 million to support the harm reduction clearinghouse focused on reducing preventable deaths related to opioid use. Maryland Governor Wes Moore proposed $1.4 billion to support mental health and substance use programs, and California Governor Gavin Newsom proposed $8 billion to expand and transform behavioral health services, particularly for children and youth.
Ensuring people have access to health insurance coverage and reducing the number of those who are uninsured is also a top priority for Governors. Given this, Governors have proposed providing premium assistance for plans offered on the Affordable Care Act Marketplaces, expanding plans offered on State-Based Marketplaces and connecting people to commercial coverage if they are determined to be ineligible for Medicaid at the end of the public health emergency.
“I’m proud to report that the innovative solutions we’ve brought to Georgia’s healthcare challenges continue to bring great results. When I first signed the bipartisan Patients First Act in 2019, no counties had more than 2 health insurance carriers. Today, 86% of Georgia counties have three or more carriers. And while others have called for expanding one-size-fits none, massive government health programs, thanks to our policies, enrollment in the individual market has more than doubled since 2019 to over 700,000 Georgians.”Georgia Governor Brian Kemp
“Together, we should keep working to improve Mississippians’ access to quality healthcare, and together, we should keep working to ensure Mississippi’s healthcare system meets the needs of our people. Instead, seek innovative free market solutions that disrupt traditional healthcare delivery models, increase competition, and lead to better health outcomes for Mississippians.”Mississippi Governor Tate Reeves
Governors also proposed funding related to this issue in their budgets. For example, Rhode Island Governor Dan McKee proposed using $1.3 million in additional Coronavirus State and Local Fiscal Recovery Funds to help people retain health coverage once they transition off of Medicaid coverage at the end of the public health emergency. Washington Governor Jay Inslee proposed $25 million for the Health Benefit Exchange to continue healthcare premium assistance for those with incomes less than 250% of the federal poverty level.
Governors are also prioritizing advancing health equity to help all people attain their highest level of health. Through investments in communities that could most benefit from or most need resources, especially in rural areas and among people of color, Governors are committing to improving healthcare and supporting the health and wellbeing of their constituents. Governors are approaching health equity through regional, economic and social contexts.
“$700 million is on the way to improve rural hospitals and expand primary care across Oklahoma.”Oklahoma Governor Kevin Stitt
“We also created the Council on Health Equity and charged them with preparing a blueprint for reducing and eliminating health disparities across our state.”Wisconsin Governor Tony Evers
In addition to citing ways to advance health equity in State of the State addresses, Governors proposed investments to support this goal in their budgets. For example, North Dakota Governor Doug Burgum proposed funding to support four tribal health liaisons to help support tribal health needs, while New Mexico Governor Michelle Lujan Grisham added $200 million to the Rural Health Care Delivery Fund in her budget to increase and improve access to services for people who live in rural communities. New York Governor Kathy Hochul proposed adding more than $1 billion in health care capital funding, expanding Medicaid coverage for 7.8 million low-income New Yorkers and improving access to aging services and high-quality long-term care. Iowa Governor Kim Reynolds proposed increased funding for Centers of Excellence to improve access to medical specialties in rural and underserved communities, ensuring the availability of emergency medical care in rural communities and launching a rural emergency medical services pilot program.
Governors are focused on making healthcare more affordable and accessible to constituents. These efforts include a focus reducing healthcare costs while maintaining high quality care by rewarding value, considering cost reduction measures and encouraging partnerships among healthcare systems and states that will help spur innovation.
“Our growing population demands urgent action to address gaps in our current medical and health facilities. It is our responsibility as leaders to ensure our people have access to adequate health care services.”American Samoa Governor Lemanu Peleti Mauga
“Unfortunately, after housing expenses, healthcare costs are some of the highest that families face. Too many Coloradans are forced to choose between the care they desperately need, paying their rent or mortgage, or putting food on the table. Meanwhile, Coloradans still pay some of the highest costs for healthcare, particularly hospital care. Sadly, we are among the top 10 states for hospital cost, price and profit. Let’s change that.”Colorado Governor Jared Polis
“We have high healthcare costs and high energy costs and high housing costs, and the answer cannot always be more subsidies or bail outs. The taxpayers cannot afford it and too often the subsidy is an excuse for no structural reform. Deidre Gifford and her healthcare cabinet will continue to make healthcare more accessible and more affordable. And I love the recently announced partnership between UConn, Connecticut Innovations, and Hartford HealthCare to jointly identify and invest in next generation healthcare companies and life-saving treatments.”Connecticut Governor Ned Lamont
In addition to describing initiatives to reduce healthcare costs in State of the State addresses, Governors proposed ways to address this challenge in their budgets. For example, Minnesota Governor Tim Walz proposed funding to lower costs and expand access to high quality healthcare for children and families. Rhode Island Governor Dan McKee proposed $7.5 million for care reimbursement at new community behavioral health clinics. South Carolina Governor Henry McMaster proposed $5 million to develop a plan to restructure a number of health-related agencies. And Wyoming Governor Mark Gordon proposed increased payments to long-term care facilities and increased reimbursement rates for dental services for Medicaid recipients.
While nearly every Governor mentioned the workforce shortages they are facing across sectors, 32 highlighted the ongoing healthcare workforce challenges affecting their hospitals and communities. The need to support healthcare workers grew exponentially throughout the pandemic, and Governors are addressing these issues at the source. Proposals include implementing healthcare training in high schools and expanding training opportunities at the postsecondary level, increasing funding for healthcare workers, leveraging wages and other funding as tools to keep healthcare workers in the workforce, expanding loan repayment programs and scholarships for various types of healthcare workers, and streamlining licensure processes. NGA is working with 21 states and territories to advance these policy solutions through the Next Generation of the Healthcare Workforce project and will release a report this spring summarizing takeaways and state actions from the first year of the project.
“Tonight, I am proposing we establish the Alabama School of Healthcare Sciences to address the growing healthcare worker shortage we are predicted to experience in the coming years. This new healthcare high school, to be located in Demopolis, will offer an innovative curriculum for 9th through 12th graders, exposing them to a diversity of STEM and healthcare opportunities, as well as hands-on clinical training experiences.”Alabama Governor Kay Ivey
“Last year we created Care Forward Colorado, which makes it completely free for Colorado students to pursue careers in health care at any community or technical colleges, and guess what, demand and enrollment increased.”Colorado Governor Jared Polis
“We must do all that we can, within our resources and capability, to provide our healthcare workers with the means to do their important work, and to provide our people with the facilities they need to recover and heal.”Guam Governor Lou Leon Guerrero
“This year, to address the severe shortage of Certified Nursing Assistants all across our state, we are proposing nearly $4 million dollars to boost C-N-A training and programs. With this increase, we expect 4,000 additional students to gain CNA training and employment at long-term care facilities and other medical facilities, including our Missouri Veterans Homes. We owe it to Missourians to provide them with quality care, and C-N-As are critical to that mission.”Missouri Governor Mike Parson
“We have allotted $10 million each to the Juan F. Luis Hospital and the Roy L. Schneider Hospital to support the recruitment and retention of nursing and allied health professionals.”U.S. Virgin Islands Governor Albert Bryan
“I’ll propose a historic, $50 million investment to bolster Wisconsin’s healthcare workforce–to expand our long-term care providers, increase the number of mental health providers and psychiatrists, and expand the Wisconsin Nurse Educator program to provide high-quality education for our future nurses.”Wisconsin Governor Tony Evers
In addition to mentioning the healthcare workforce as a priority in State of the State addresses, Governors proposed investments in programs to strengthen this workforce in their budgets. For example, Hawai‘i Governor Josh Green, M.D. proposed increased funding for the Hawai‘i State Loan Repayment Program, which helps primary care and behavioral health providers working in designated health professional shortage areas pay of their educational loans. He also proposed funding for over 60 positions and $4.4 million for nursing and medical-related programs across University of Hawaii campuses and community colleges. Nebraska Governor Jim Pillen proposed $10 million for recruiting and retaining teachers, nurses, veterinarians, and other health care professionals, and West Virginia Jim Justice proposed $20 million for the Governor’s Nursing Workforce Expansion initiative.
Maternal and Child Health
Maternal and child health remains a priority for Governors, as maternal mortality and extending postpartum Medicaid coverage was discussed in 23 Governors’ speeches. Five Governors specifically mentioned closing the coverage gap by extending Medicaid from 60 days to 12 months postpartum. The NGA continues to support Governors in their efforts to support maternal and child populations, and the NGA is currently working with New Jersey First Lady Tammy Murphy on her initiative to reduce disparities and expand access to care for mothers and infants.
“We will further strengthen postpartum coverage, provide services to over 5,000 more mothers, close the coverage gap for parents, and reach an additional 10,000 children – in total, offering services to nearly 25,000 more women, children, and parents in need. We are going to propose covering the cost of diapers during the first two years of a baby’s life for mothers on TennCare.”Tennessee Governor Bill Lee
“The budget also proposes $1.1 million to help give pregnancy and postpartum care for moms who are Medicaid recipients. Pregnant moms who are at risk of poor birth outcomes will receive intensive care management. This will help moms have a healthy pregnancy – and this care will extend after birth. Moms who are involved in this program have babies who are less likely to be admitted to the NICU. And after birth, these moms will be able to join the Bright Start program.”South Dakota Governor Kristi Noem
“That’s why my budget sets aside $50 million for a state-level, child tax credit for families earning less than $40,000 a year to help pay for the rising costs of basic necessities for their children. We will also help lower costs for Arizona families by exempting diapers and feminine hygiene products from our state’s sales tax. These everyday items add up and we can and should help provide this relief to individuals and families who too often must choose between paying their bills or paying for the things they need to be healthy.”Arizona Governor Katie Hobbs
“By permanently eliminating sales tax on all baby supplies, diapers, wipes, closed cribs, strollers, we will be able to say that in Florida, having a child will be tax free.”Florida Governor Ron DeSantis
“We are asking for funding to expand postpartum Medicaid coverage from 60 days to 12 months to ensure that moms and their children get off to a healthy start in life.”Alaska Governor Mike Dunleavy
In addition to mentioning maternal and child health as a priority in State of the State addresses, Governors proposed investments in programs to strengthen families. This includes Michigan Governor Whitmer’s proposal for $62.1 million toward the Healthy Moms, Healthy Babies program to improve maternity supports through home visits, doula services, and services for young children, as well as NGA Vice Chair Utah Governor Spencer Cox’s $8.7 million proposal to extend Medicaid postpartum coverage from 60 days to 12 months. NGA Chair New Jersey Governor Phil Murphy proposed over $15 million for the universal nurse home visitation program, $2 million for perinatal workforce training and education and almost $2 million to enhance maternal data. And Iowa Governor Kim Reynolds proposed funding to establish a family medical obstetrical fellowship to support maternal health in rural and underserved communities.
The COVID-19 pandemic continues to have a significant impact on state Medicaid priorities. Governors are focusing on new and longstanding issues, including initiatives that expand access to improve health equity and reduce disparities. Some of these initiatives include improving behavioral health access, addressing workforce challenges, prioritizing access and health outcomes for specific populations such as rural communities, and supporting maternal and child health.
“The Georgia Pathways to Coverage program was negotiated in good faith with the federal government so that we could expand access to health insurance for those who need it the most, while also sustaining the quality of coverage. We are moving forward, and we are on target for a launch date of July 1 of this year. To meet that goal, I am allocating $52 million to stand this program up and connect those in need to its benefits. In our state, we want more people to be covered at a lower cost with more options for patients. And I’m proud to say that Georgia Pathways and Access accomplish that goal!”Georgia Governor Brian Kemp
“We cannot talk about rural Kansas without talking about Medicaid Expansion. We created the Office of Rural Prosperity. The fastest way to a healthier workforce would be to enable 150,000 Kansans to have access to affordable healthcare.”Kansas Governor Laura Kelly
“And none of these efforts are possible without the people, so we are acknowledging the countless health care workers on the front lines by proposing an across the board Medicaid rate increase to help recruit and retain these critical workers.”New Hampshire Governor Chris Sununu
“Here’s what I propose to build on that progress: We expand Medicaid Assisted Treatment [ … ] And we will create the New Mexico Health Care Authority -an innovative initiative that puts all our healthcare services under one roof and brings us a step closer to universal health care in New Mexico. Right now, New Mexico is the only state where more than half the population is on Medicaid, including 80% of children. Expanding Medicaid coverage offers us a chance to revolutionize care and become a universal healthcare state. And that’s exactly what we intend to do, building a healthier, longer living, more prosperous New Mexico where we can live for our dreams and decrease the fear and hardship of untreated chronic conditions in the process.”New Mexico Governor Michelle Lujan Grisham
“One of the ways we are seizing that moment is by expanding Medicaid. I’m grateful for our unified Democratic legislators and some Republicans who have been relentless for years in this effort to expand Medicaid. I commend the Republican leadership of this legislature for now embracing this and coming together in agreement. I also deeply appreciate the many health care professionals and advocates from all walks of life who have worked tirelessly to get this done. When we get Medicaid expansion across the finish line, it will save lives.”North Carolina Governor Roy Cooper
“Currently, children adopted through the public children services system have access to Medicaid coverage, but children adopted through private agencies do not – EVEN if these children have complex medical needs. We know there are many families who would love to open their homes to a child, including children with serious health needs, but cannot afford to do it. In our budget, we will extend that same opportunity for health care coverage to ALL children who are adopted in the State of Ohio.”Ohio Governor Mike DeWine
Older Adults and Aging
The U.S. population is aging rapidly, and Governors are proposing different ways to support older adults as they age. These proposals include increasing direct care worker wages to keep trained and trusted workers in the workforce to support older adults who require treatment at assisted living, rehab hospitals, and nursing homes. Governors are also investing in community and home-based supports for those who choose to age in place in their homes and expanding long-term care services.
“Other projects include the new UofL South Hospital in Bullitt County, the new Appalachian Valley Autism Center in Prestonsburg and the institution of the PACE program, which will keep many seniors who need extra help in their own homes, improving their health and their quality of life.”Kentucky Governor Andy Beshear
“I will be appointing a task force to study the issues surrounding quality of life and quality of care in our nursing homes. This matter is urgent. They will travel across the state and will hear directly from residents and families about their lived experiences. We will give them a voice, and we will empower them to help drive solutions.”Ohio Governor Mike DeWine
“In addition to protecting our children in schools, we must also help our seniors in nursing homes by providing a pay increase for those who care for them.”Texas Governor Greg Abbott
Governors are also including investments to support older adults in their budget proposals. For example, Louisiana Governor John Bel Edwards proposed $31.8 million to update payment rates for nursing home and hospice care, Pennsylvania Governor Josh Shapiro recommended additional investment in the state’s Area Agencies on Aging and Maine Governor Janet Mills proposed $78 million in state funds and $91 million in federal funds to expand and improve long-term care and home-and-community-based service.
Public Health Infrastructure
Governors continue to focus on public health infrastructure as it provides the foundation for all public health services; this includes prevention and treatment for chronic and infectious diseases, improving population health and emergency preparedness efforts. The NGA is working to provide support to Governors as they work to invest in public health infrastructure and craft new approaches to advance public health goals.
“We must invest $45 million in upgrading our Department of Public Health’s IT for Illinois’ National Electronic Disease Surveillance system and Long-Term Care systems — which are tools states use to monitor the spread of disease, prevent outbreaks, and protect our most vulnerable residents. And we’ll couple that with an $8.5 million investment to assist public health professionals identifying and projecting the potential impact of new and emerging diseases on the horizon.”Illinois Governor J.B. Pritzker
“Significant increase in our state’s public-health appropriation – $120 million in the first year and $227 million in the second year. So, our localized pathways to improvement must include programs to attack these issues, close to home, by building sustainable systems that prevent and respond to a crisis.”Indiana Governor Eric Holcomb
“As we invest in public health, safety, and wellness, we should also be supporting our state parks [ … ] Investing in our state parks is just the start of what we need to do on public health and wellness.”Pennsylvania Governor Josh Shapiro
Social Determinants of Health
Social determinants of health are the conditions in which people are born, grow, work, live and age that impact their health. Several Governors shared the need to create policies that improve a person’s well-being through SDOH. Common themes include improving access to care for rural populations, increasing food security, addressing homelessness and providing health care for Tribal communities. As SDOH can directly or indirectly be part of most policies and programs, NGA is working on housing, nutrition, adverse childhood experiences, rural health, broadband availability and other topics affecting the social and built environment in states and territories. NGA has built a SDOH focus into current projects and publications as they are the cornerstone of a healthy population.
“That means funding the Student Opportunity Act to make sure every student and every school gets the resources they deserve. It means doing more for mental health care and food security. Our students can’t reach their potential if they are homeless or hungry or suffering from untreated mental illness.”Massachusetts Governor Maura Healey
“The $18.3 million grant from the NIH will fund research into health disparities in minority communities. It will also attract top talent to the Dover campus, expose students to cutting-edge research, and help train our next generation of public health scientists.”Delaware Governor John Carney
“State, federal, and EVOS funds directed to mariculture initiatives and grants in just the past two years total more than $93 million. Our work to increase our food security and build independence through economic development is just getting started. By setting the right public policies around regulations, land, and infrastructure, we’ll unleash the private sector that’s ready and able to feed not just Alaskans, but people around the world.”Alaska Governor Mike Dunleavy
“Government at the state and local level has tried hard to attract big retail food chains to neighborhoods that need them with tax incentives and flashy ribbon cutting ceremonies This budget includes a first of its kind investment of $20 million to launch the Illinois Grocery Initiative, assisting municipalities and independent grocers to open or expand grocery stores in underserved rural towns and urban neighborhoods — with an additional $2 million going towards purchasing healthy, nutritious food from Illinois farmers. Home Illinois, a plan with a goal to invest $50 million this year into prevention, crisis response, housing units, and staffing.”Illinois Governor J.B. Pritzker
“Lack of access to reliable broadband limits Montanans’ access to educational opportunities, health care, and career opportunities. That’s why we made the largest-ever investment in broadband infrastructure – which will bring reliable broadband to 62,000 Montana homes that don’t have it now.”Montana Governor Greg Gianforte
Governors have also noted their focus on SDOH in their budget proposals. For example, Missouri Governor Mike Parson proposed $15 million in his budget to create hubs to address SDOH at six rural hospitals.
As demonstrated in the priorities outlined in their 2023 State of the State and budget addresses, and detailed in this publication, Governors continue to focus on ways to improve the health and well-being of their constituents. As Governors move forward with these efforts, NGA will work with them to help them achieve their goals. This will include helping Governors develop implementation plans, connecting them with state and other experts who can assist them, and supporting the staff they have tasked to carry out this work. NGA will also work with states to document what they have done and the things they have learned so other states can benefit from their experiences as well.
This article was developed by Abigail Smith with contributions form Public Health, Healthcare Delivery and Substance Use & Mental Health teams in the NGA Center for Best Practices. For more information on Governors’ efforts please contact firstname.lastname@example.org.