5600 Fishers Lane • Rockville, MD 20857

www.samhsa.gov • 1-877-SAMHSA-7 (1-877-726-4727)

∙

December 15, 2021

Dear State Authority for Mental and Substance Use Disorders:

As the COVID-19 pandemic continues to impact the nation, many individuals with existing or

newly developing substance use and mental disorders are facing significant stressors.

Accordingly, treatment providers are seeing increases in the demand for access to services while

the healthcare workforce is being stretched thin. Additionally, individuals who have lost their

employment, and the insurance tied to that employment, may result in the SAMHSA block grant

funding being more important than ever in assisting states with funding their substance use and

mental disorder programs.

SAMHSA recognizes that COVID-19 may have also impacted your state through an economic

downturn due to the loss of tax revenue and employment during the past almost two years.

Based on current economic data, we understand that many states are not generating normal levels

of tax revenue. Additionally, critical services in the behavioral health field may have been

impacted over the past two years, such that it is expected that states will have spent less money

overall on services this year, which may create additional maintenance of effort (MOE) shortfall

considerations. If this is the case, it may be possible that your state will be unable to fulfill your

MOE requirement this year.

Extraordinary Economic Circumstances Waiver

For both the Substance Abuse Prevention and Treatment Block Grant (SABG) and the Mental

Health Block Grant (MHBG) there is a regulatorily defined process that allows for the

consideration of a MOE waiver for any state that experiences extraordinary economic

circumstances in a state fiscal year:

Upon the request of a State, the Secretary may waive all or part of the requirement

established in subsection (a) if the Secretary determines that extraordinary economic

conditions exist in the State, or any part of the State, to justify the waiver.

1930(c)(1), Public Health Service Act (42 USC 300x-30(c)(1)) [)) [SABG MOE waiver

provision]

The Secretary may, upon the request of a State, waive the requirement established in

paragraph (1) in whole or in part if the Secretary determines that extraordinary economic

conditions in the State in the fiscal year involved or in the previous fiscal year justify the

waiver.

Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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1915(b)(3)(A), Public Health Service Act (42 USC 300x-4(b)(3)(A)) [MHBG grant MOE waiver

provision]

The Interim Final Rule implementing subparts II and III, part B, title XIX of the Public Health

Service Act defines extraordinary economic conditions as “[a] financial crisis in which the total

tax revenue declines at least 1.5 percent AND either unemployment increases by at least 1

percent, OR employment declines by at least 1.5 percent.” (45 CFR 96.134(b)).

Public Health Emergency Waiver

SAMHSA will again consider requests from states who do not meet the extraordinary economic

conditions waiver requirements under 45 CFR 96.134(b) but may qualify through a Public

Health Emergency Waiver. This process is based on SAMHSA’s public health emergency

(COVID-19) waiver authority under section 1957 of the Public Health Service Act (42 USC

300x-67), which provides in pertinent part:

In the case of a public health emergency (as determined under section 319), the Secretary,

on a State by State basis, may, as the circumstances of the emergency reasonably require

and for the period of the emergency, grant an extension, or waive application deadlines or

compliance with any other requirement, of a grant authorized under section 1911, or

1921.

Additional information will be forthcoming shortly with specific instructions on how a waiver

request will be considered under either the Extraordinary Economic Circumstances Waiver or,

for those states that do not qualify for economic circumstances, the Public Health Emergency

Waiver. As a reminder, if the waiver request is granted, you will receive formal notification. If

the waiver is denied for any reason, you will have the option to request a determination of

material compliance decision citing other factors that will be outlined in your early notification

letter.

Sincerely,

Miriam E. Delphin-Rittmon, Ph.D.

Assistant Secretary for Mental Health and Substance Use

Substance Abuse and Mental Health Services Administration

1-877-SAMHSA-7 (1-877-726-4727) • 1-800-487-4889 (TDD) • www.samhsa.gov

/Miriam E. Delphin-Rittmon/