State leaders across health, human services, and other agencies — including Medicaid, early childhood, public health, and child welfare, among others — are uniquely positioned to develop programs and services that support the health and well-being of people in their state. However, agencies often operate in siloes or in misaligned ways that create challenges for the people they serve despite the shared goal of supporting these individuals and communities.

This fact sheet outlines guidance for state leaders looking to better align systems and improve health and well-being outcomes. It describes a nine-step Framework for Collaborative Change that includes key activities to support state agencies in collaboratively engaging with and learning from the individuals and families they serve, working with partners to address misalignment and gaps, and co-creating more effective programs and services. The framework, developed through Aligning Early Childhood and Medicaid, a national initiative led by the Center for Health Care Strategies (CHCS) with support from the Robert Wood Johnson Foundation, has been tested and refined with public sector leaders working with CHCS and the National Association of Medicaid Directors.