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Abstract States play a crucial role in long-term services and supports. State agencies and legislatures have the power to make LTSS and family caregiver supports more (or less) accessible, affordable, and high-quality for the residents they serve. In addition, much of the policymaking during and after the peak of the COVID-19 pandemic took place at the state level. State agencies had the authority to grant providers, consumers, and family caregivers new flexibilities and options as it relates to LTSS, and states have and continue to decide where much of the federal COVID-19 funds (e.g., American Rescue Plan HCBS funding) will ultimately go. This portion of the symposium will present an overview of where states are today with LTSS and how the Scorecard can help both identify and drive system change.

Under Operation Warp Speed (OWS), the US government invested an unprecedented $10 billion to speed the development, manufacturing, and distribution of a COVID-19 vaccine, resulting in emergency use authorizations for two effective vaccine products in a record-breaking 11-month time frame. Although this is a remarkable scientific accomplishment, the United States now faces the urgent task of ensuring widespread acceptance and uptake of COVID-19 vaccines to contain the COVID-19 pandemic, and begin to resume normal economic, educational, and social activities. The operational responsibility for ensuring that COVID19 vaccines are safely and efficiently delivered in a jurisdiction falls largely on state, territorial, tribal, and local governmental public health systems that support jurisdiction-wide vaccination efforts for a variety of immunizations, including childhood diseases and seasonal influenza. Ultimately, state and territory governors are responsible for the \"last mile\" of COVID-19 vaccine distribution in their states and ensuring that vaccination is efficiently prioritized for those who need it most, as well as administered, tracked, and reported to the federal government. Although all states and territories have developed plans to increase capacity, enhance data systems, and develop partnerships to support this complex effort, the initial rollout of vaccine allocations did not match federal projections and public expectations; states reportedly distributed roughly one third of allocated doses in the first two weeks of the program.