Policymakers often overlook people living with physical disabilities and older adults’ behavioral health (BH) needs. Older adults experience alarmingly high rates of mental illness and substance use disorders, which often intersect with neurocognitive challenges. Emerging evidence suggests the SARS-COV-2 pandemic has exacerbated these disparities. BH needs amongst older adults and people living with physical disabilities have major implications for policy and service delivery. While a multitude of local interventions to support BH exist, few state-level programs focus on this population. In 2015, Oregon established the Behavioral Health Initiative for Older Adults and People with Physical Disabilities (referred to as the Initiative) with this specific purpose. A multi-year evaluation of this Initiative suggests several important improvements have occurred. Yet, barriers remain that hinder optimal service provision and enable siloed aging and BH services between agencies. The findings indicate ways the Initiative can leverage initial successes to further support this population.