The 2025 federal budget reconciliation act (P.L. 119-21) will likely have significant implications for older adults and people with disabilities. Reductions in funding for Medicaid, Medicare, Affordable Care Act premium tax credits, and the Supplemental Nutrition Assistance Program (SNAP) may lead to coverage losses and reduced access to services for these populations. With these potential cuts on the horizon, states face increasing pressures to identify alternative strategies to sustain coverage and services. One promising approach is the development of a multisector plan for aging (MPA), which enables states to align policies, programs, and investments across agencies to better meet the needs of aging populations and people with disabilities.
An MPA is a state-led, cross-agency, multi-year planning process that convenes a broad range of public and private stakeholders to collaboratively address the current and future needs of all people aging, including those with disabilities. More than half of the states in the U.S. are pursuing MPAs, with many having released plans in recent years. MPAs help strengthen cross-governmental relationships by elevating common goals across agencies and programs and identifying opportunities to reduce duplication and streamline efforts and resources — particularly important during periods of policy uncertainty.
This blog post outlines how states can use MPAs to prepare for or respond to changes in the policy or fiscal environment, such as state budget constraints, program eligibility changes, or shifts in federal funding. It highlights examples from states that have already implemented MPAs to better meet the needs of an aging population.
Responding to Policy Changes and Unexpected Events
The cross-agency and cross-sector partnerships established through the MPA process can help states respond more effectively to policy and funding changes that occur at the state or federal level. These partnerships enable agencies to coordinate strategies and resources across agencies. For example, during the COVID-19 pandemic, California’s MPA committees and State Cabinet Workgroup worked together to identify ways to support older adults, people with disabilities, and caregivers during the state of emergency.
Following are examples of how states are considering using — or could use — their MPAs to respond to recent and future federal changes:
- Aligning priorities: States can use their MPAs to identify which aging- and disability-related initiatives align with the priorities of state leadership and the federal government, helping them to focus limited resources during periods of fiscal constraint. The MPA process enables many states to establish strong relationships with their governors’ offices and legislatures, which can support efforts to protect or secure resources when budgets are tight. One state reported reviewing its MPA initiatives through the lens of federal policy changes and priorities to identify which initiatives can continue without disruption, which will require additional effort or resources, and which need to be deferred.
- Mapping potential impacts and needs: Data obtained through research and academic partnerships can help states identify how older adults and people with disabilities will be most impacted by policy or budget changes to inform responses accordingly. Tennessee developed its data dashboard in partnership with East Tennessee State University Center for Rural Health and Research to better understand the needs of people in rural areas and guide policy decisions. In California, relationships between the MPA Research Subcommittee helped expedite access to data during the pandemic, which helped the state design interventions for residents needing additional supports.
- Coordinating implementation of new federal work requirements: In response to P.L. 119-21, states will need to design and implement new Medicaid and SNAP work requirements that span multiple agencies, including Medicaid, tax and revenue, labor and workforce, education, SNAP and TANF, corrections, housing, and child welfare, as well as external stakeholders. Relationships established through a state’s MPA process can support coordination, data collection and sharing, and planning across these entities. These efforts may also help agencies identify populations that will be most impacted to ensure their needs are considered during implementation.
- Planning for SNAP benefit reductions: P.L. 119-21 reduces SNAP benefits and shifts additional program costs and administration to states, which will impact not only SNAP recipients but farmers, grocers, food pantries, caregivers, and health care providers. MPA relationships among food assistance programs, community-based organizations, food suppliers, and community leaders can support coordinated planning, such as assessing impacts, identifying mitigation strategies, and braiding alternative funding and resources from entities that will be less directly affected. One state is using data to evaluate the impact of SNAP cuts on older adults as part of its MPA planning efforts.
- Blending and braiding funding: Many states have successfully used their MPA relationships to braid funding from multiple agencies and partners, especially for programs experiencing federal and state budget cuts. As part of its MPA planning process, Maryland aligned grant opportunities across state agencies, which helped its Department of Aging and Department of Housing work together on a federal Housing and Services Partnership Accelerator grant. States have also partnered with philanthropy and the private sector to fund components of MPA work, such as needs assessment surveys, an approach that can be replicated to fund progress when faced with budget constraints or limited political support.
- Supporting coordinated messaging and advocacy: MPAs elevate aging and disability as a key issue across sectors, and messaging around the importance of these issues can help ensure these populations remain visible during federal policy and program changes. External MPA partners can often advocate for specific policy changes or budget decisions in ways state agencies cannot. North Carolina relied on MPA partners to successfully advocate for additional funding for its Department of Insurance’s Seniors’ Health Insurance Information Program. Another state is using its MPA stakeholder committee meetings to discuss federal changes, which is allowing the state to hear how changes are impacting community stakeholders in real-time.
Responding to New Opportunities
Having an MPA can also position states to respond more quickly to new opportunities that arise. When American Rescue Plan Act (ARPA) funding was announced in 2021, states had to quickly submit spending plans that depended on cross-sector alignment. States with MPAs were better positioned to do so. In California, many of the initiatives in its ARPA Home- and Community-Based Services Spending Plan were already established as priorities through the state’s MPA and had approval from the Governor. Many of the MPA’s initiatives ended up being funded through the spending plan, such as $150 million in funding to support direct care workforce initiatives. States with MPAs can similarly think about how their existing relationships and infrastructure can help in identifying the right teams to engage when responding to federal policy initiatives, such as the Rural Health Transformation Program.
Looking Ahead: Positioning States for the Future
States that have or are currently developing MPAs can use their relationships across agencies, state leadership, policymakers, and external partners to begin planning for policy and funding changes that are already underway or are anticipated in the near term. MPAs can help states identify which aging- and disability-related initiatives are in alignment with federal priorities and can be used to respond to new constraints, as well as opportunities. States may also benefit from strengthening their relationships with non-governmental partners, such as philanthropy, the private sector, and community-based organizations, to help build resilience against funding fluctuations and implementation challenges. These relationships can bring in alternative resources and innovative solutions during times of shifting policy priorities.
For states that do not yet have an MPA, current federal shifts may present an opportunity to pursue one. Cross-sector relationships that emerge in response to federal changes can also serve as a starting point for an MPA. Even early planning phases of an MPA can help states strengthen relationships, clarify shared priorities, and position themselves to better support older adults and people with disabilities now and into the future.
