A growing number of states are looking beyond traditional aging policy to prepare for and address the long-term needs of a rapidly aging population. One strategy gaining momentum is the multisector plan for aging (MPA), a state-led planning effort that brings together state agencies and public and private stakeholders to coordinate aging-related policies, programs, and investments. As of July 2026, 14 states are implementing MPAs, and over half of states are developing or exploring one.

MPAs, also known as master plans or strategic plans for aging, are 10-year plans designed to address the current and future needs of older adults. These plans often emerge from legislation or executive order and can help states align policy and program priorities across aging, disability, health care, housing, transportation, and other public sectors. Critically, the MPA development and implementation process is designed to incorporate the perspectives of older adults, caregivers, and other community stakeholders, which ensure that goals are grounded in the realities of people’s lives.

All state MPAs released to date include goals, initiatives, or priorities focused on supporting paid and unpaid caregivers. This attention reflects caregivers’ central role in long-term care and a growing state focus on improving caregiver supports. Unpaid caregivers provide an estimated 80 percent of long-term care. AARP reports that an estimated 59 million caregivers of adults aged 18 and older provided approximately 49.5 billion hours of care, valued at $1.01 trillion in 2024. Despite their essential role, however, many caregivers receive little support, contributing to high levels of physical, emotional, and financial strain.

Many states are drawing on the National Strategy to Support Family Caregivers — developed by two U.S. caregiving congressional advisory councils — to shape their caregiving goals, using MPAs as a vehicle to elevate and implement existing caregiving initiatives alongside new ideas.

As more states explore MPAs, they have opportunities to learn from the progress, challenges, and lessons from early implementers. This brief, developed jointly by the National Academy for State Health Policy (NASHP) and the Center for Health Care Strategies (CHCS), draws on interviews with state officials in five states with varied geographies, governance structures, and MPA maturity — California, Maryland, North Carolina, Texas, and Vermont — to understand how they are translating MPA goals into concrete actions to support caregivers.

How States Are Supporting Family Caregivers Through MPAs

Through MPA activities, interviewed states have made meaningful progress in strengthening supports for caregivers across several key domains, including:

• Providing free training and education programs for paid and unpaid caregivers;

• Expanding caregiver navigation support, including pilot programs that partner with community health workers (CHWs), and serving as trusted health partners within communities who can enhance connection with resources and supports;

• Raising awareness and use of respite care and other supports through outreach campaigns and media efforts; and

• Expanding or creating public caregiving supports, including portals, resource centers, and No Wrong Door systems.

Following are examples of how interviewed states have made progress in implementing their caregiving goals through MPA activities.

California (MPA released 2021)

Caregiver Focus in MPA

• Advance the implementation of the National Strategy to Support Family Caregivers by launching California’s Caregiver Equity Roadmap, which seeks to expand access to culturally responsive caregiver services for underserved and underrepresented populations and communities.

• Launch CalCARES (California Caregiver Awareness, Resources, Education & Support), with a focus on underserved and underrepresented populations and communities to improve the awareness of and outreach to caregivers; navigation of caregiver resources; and access to caregiver education and training opportunities.

• Launch a curated catalog of free trainings in threshold languages for public use by family caregivers and direct care workers to meet the education and training needs of California’s diverse caregivers.

Caregiving Initiatives

• Providing Caregiver Incentives and Stipends: Through the CalGROWs incentive program, California supported paid and unpaid caregivers with the creation and distribution of over 850 free courses, providing up to $7,000 in incentives to improve knowledge, enhance skills, and strengthen career opportunities for the direct care workforce. Over two years, CalGrows served over 33,000 learners, representing 10 different languages. CalGrows learners completed over 211,000 courses and received over $35.9 million in incentives and stipends.

• Partnering with Communities: To expand navigation support, California is currently piloting the CAlz Connect Program and Cal Community Connect Program in partnership with Area Agencies on Aging (AAAs) and CHWs. CAlz Connect is a CHW-led care navigation program for people living with dementia and their caregivers while Cal Community Connect provides navigation support to older adults, people with disabilities, and caregivers to access the services and supports they need.

• Strengthening Caregiver Supports: Through the CalCARES Program, California is improving awareness, navigation, and educational opportunities for caregivers from underserved and under-resourced communities, including caregivers for individuals living with intellectual/developmental disabilities.

Maryland (MPA released 2025)

Caregiver Focus in MPA

• Increase the capacity of state agencies and the Maryland Commission on Caregiving to adopt actions within the National Strategy to Support Family Caregivers.

• Improve coordination between state-led caregiver support programs, such as the National Family Caregiver Support Program, Kinship Care, and the Lifespan Respite Care Program.

• Explore recommendations from the Together in Care initiative, including to adopt a coordinated statewide training initiative for paid and unpaid caregivers.

• Expand the reach of caregiver programs to underserved populations through targeted and culturally appropriate outreach.

Caregiving Initiatives

• Building Community Networks to Improve Awareness: In 2026, Maryland launched the Respite Care Ambassador Training Program to build a statewide network of trained ambassadors dedicated to raising awareness about respite care.

• Developing Evidence-Based Support Tools: Maryland, in partnership with Johns Hopkins University School of Nursing and Maryland Information Network (211), developed a free, evidence-based memory care checklist that supports caregivers of people with dementia by identifying needs and generating a personalized report of relevant resources and services.

North Carolina (MPA released 2024)

Caregiver Focus in MPA

• Provide family caregivers with more support by enhancing and integrating programs across governmental, nonprofit, and private sectors to provide a comprehensive range of resources and services for caregivers, such as respite care and Project C.A.R.E. (Caregiver Alternative to Running on Empty).

• Expand the North Carolina Caregiver Portal to enhance its features and ensure its long-term sustainability as a free and publicly accessible educational resource, providing ongoing support and comprehensive information for caregivers.

Caregiving Initiatives

• Advancing Cross-Sector Strategies Through Partnerships: The North Carolina Caregiving Workforce Strategic Leadership Council, co-led by NC DHHS and the Department of Commerce, is advancing cross-sector strategies to address workforce shortages in nursing, behavioral health, and direct care through coordinated efforts to strengthen recruitment, training, and retention in response to rising demand from an aging population. In January 2026, the Council released its CY2026 Metrics and in April 2026 released its first update on the progress toward the metrics.

• Expanding Access to Resources: Expanded the NC Caregiver Portal to reach nearly 3,000 caregivers across 98 of the state’s 100 counties.

Texas (MPA released 2022)

Caregiver Focus in MPA

• Increase informal caregiver access to educational resources and awareness about evidence-based programs designed to address informal caregiver health and wellness. 

• Work with internal and external stakeholders through technical assistance from CHCS to develop strategies that increase awareness of informal caregiver experiences and services available to support them; also identify ways to use Medicaid managed care services to support informal caregivers.

• Enhance state and local lifespan respite care systems to provide access to respite services, increasing the number of informal caregivers and families served. Enhance the Take Time Texas website to include additional resources and training materials.

Caregiving Initiatives

• Improving Caregiver Awareness: Used American Rescue Plan Act funding to conduct the “Strengthen the Care You Give” caregiver outreach campaign, which built awareness of caregiving issues.

• Enhancing Lifespan Respite Programs: Collaborated with the Texas A&M University Public Policy Research Institute to conduct focus group interviews, a needs assessment, and evaluation of respite care needs and gaps of Texas caregivers. The state used these findings to inform its overall goal of enhancing state and local lifespan respite systems and improve access to respite care, including through the state’s Take Time Texas respite search tool.

Vermont (MPA released 2024)

Caregiver Focus in MPA

• Reduce the need for family/friends to provide full-time care/assistance to a friend/family member.

• Increase family care partner knowledge of respite options.

• Increase family partners’ knowledge of self-care, medical benefits, long-term care and estate planning resources.

• Reduce negative financial impacts on family care partners.

Caregiving Initiatives

• Supporting AAAs: Used state funds earmarked for dementia respite and services to provide enhanced funding regionally via AAAs.

• Improving Used of Respite Programs: Increased caregiver awareness of and participation in respite programs from a baseline of 24 percent of caregivers.

• Building Partnerships and Resource Centers: Supported the University of Vermont Dementia Family Caregiver Center as a gateway to specialized services for individuals living with dementia as well as evidence-based services and supports for their caregivers.

How States Have Addressed Implementation Challenges

While many states have engaged caregivers in their MPAs, the large-scale goals proposed require coordinated efforts that often face structural roadblocks. Interviews with state officials in California, Maryland, North Carolina, Texas, and Vermont surfaced three common implementation challenges, as well as examples of how states have worked to overcome these difficulties to move caregiver-focused MPA goals into action.

1. Building Alignment to Sustain Caregiver Supports

While MPAs can serve as a catalyst for improving aging-related policies and services, they may not yet have garnered dedicated implementation funding. With tightening budgets, states note that funding to support caregiving initiatives in their MPAs remains a key barrier to ensuring these plans can meaningfully address caregiver needs. Despite these challenges, states identified several strategies for making meaningful progress in a budget-constrained environment.

Through their MPAs, agencies highlight stronger relationships with partners across sectors, making it easier to deliver caregiver supports more efficiently and sustainably, collaborate on funding opportunities, and explore new financing approaches beyond traditional streams. According to a 2025 survey of AAAs, 25 percent rely exclusively on Older Americans Act funding for caregiver services.

States noted that reducing reliance on a single funding source is a key priority. Expanding access to diverse funding streams can improve sustainability, particularly for smaller rural AAAs that face resource constraints and growing demand for services such as respite care. Strategies include braiding funding through Medicaid or Medicare, leveraging nonprofit and community resources, and maintaining a pipeline of public and private grants. At the same time, states are designing caregiving initiatives with sustainability in mind so that when grant funding ends, programs can continue through reimbursement pathways, institutional partnerships, or scalable tools and resources.

State Spotlights

• California: Sustaining training and navigation initiatives. Although California’s CalGrows training incentive program ended in 2024, the state made its free trainings available on its website. California is also exploring innovative pilots using CHWs to improve care navigation and referral systems. While the CalCARES, CAlz Connect, and Cal Community Connect programs were developed using grant funding from the federal Administration for Community Living (ACL), the programs are designed with long-term sustainability in mind, primarily through Medicaid-reimbursable CHW benefits and replicable sustainability models that can be used by the aging network. California is also developing a social media toolkit and awareness campaign through CalCARES to promote the use of materials and lessons learned statewide.

• North Carolina: Aligning caregiver initiatives to support partnerships and a “No Wrong Door” framework. North Carolina has prioritized alignment across its caregiver initiatives to reduce duplication and improve program efficiency. The state is also working toward a “No Wrong Door” model, based on the ACL framework, to streamline and coordinate entry into the long-term care system for older adults and their caregivers. Through its No Wrong Door approach, the state has identified gaps in data infrastructure and regional variation and is working to build a more cohesive referral process across the state. These efforts better position North Carolina to coordinate resources more effectively and, over time, support more sustainable integrated programs.

2. Promoting Coordination and Partnership Across State Programs

MPAs are explicitly designed as collaborative endeavors. States report that cross-agency alignment is critical to maximizing resources and reducing duplication, but it requires sustained, coordinated effort.

Common barriers include difficulty securing buy-in from other agencies, coordinating across different programs and topic areas, and competing departmental priorities. States that have made progress highlight several factors driving success: identifying shared goals and convening with partner agencies, having strong support from agency and executive-level leadership, and creating both formal and informal communication channels across agencies.

State Spotlights

• California and North Carolina: Establishing advisory committees to align state efforts. California and North Carolina established advisory committees that draw on the expertise of a broad range of stakeholders, including caregivers, to align state efforts. California operates six advisory committees that meet several times a year to gather input and help guide MPA implementation. The state also convenes an Aging and Disability Lived Experience Advisory Board that provides valuable insights on issues, challenges, and opportunities impacting older adults, people with disabilities, and caregivers. Similarly, North Carolina developed a caregiver implementation workgroup, led by the state aging department, with representatives across various state sectors and agencies to coordinate implementation of MPA caregiving initiatives.

• Maryland and Texas: Building cross-agency/cross-sector partnerships for coordination. Maryland and Texas have built strong cross-agency and cross-sector partnerships through a combination of formal structures and informal relationship building. A strategy within Longevity Ready Maryland is to strengthen state agencies and the Maryland Commission on Aging’s capacity to implement caregiving initiatives in partnership with other agencies and partners. The Maryland Department on Aging, in partnership with Maryland Living Well Center of Excellence and the Alzheimer’s Association, created a 10-part caregiver webinar series. In the 2026–2027 Aging Texas Well Strategic Plan, the Office of Aging Services Coordination collaborated with the Women’s Health Commission to elevate experiences of women who are informal caregivers, including on impacts of caregiving on health and work.

• Vermont: Leveraging academic partnerships to expand state capacity to support caregivers. Vermont’s Dementia Family Caregiver Center, developed in partnership with the University of Vermont Memory Center, serves as a model for how academic partnerships can extend a state’s reach and capacity to address caregiver needs.

3. Improving Caregiver Data Collection

Caregiving-specific data is limited — at both the state and national levels — and state officials interviewed consistently identified data gaps as a barrier to understanding caregiver needs and evaluating the effectiveness of their initiatives. Challenges include inconsistent data collection practices, difficulties aligning data across AAAs, and data-sharing limitations across state departments.

To address these challenges, states are prioritizing investment in their aging-related data infrastructure, both to identify gaps in services and to build a stronger evidence base for their programs.

State Spotlights

• California: Establishing statewide caregiver metrics. California is working to partner with the University of California, Davis, to establish a core set of caregiver metrics to be used across providers of Title III-E Family Caregiver Support programs (an Older Americans Act initiative) and Caregiver Resource Centers, helping make caregiver data more comprehensive and comparable across the state.

• Texas: Using assessment data to guide goals and program design. Texas reviews caregiver assessment data collected from AAAs to measure caregiver needs and design MPA goals. Through a standardized caregiver assessment questionnaire administered by AAAs as part of the National Family Caregiver Support Program and a Caregiver Status Questionnaire administered by Medicaid and state-funded Community Care Services programs, the state collects and analyzes data on caregiver well-being. The state also used survey measures throughout the MPA development and implementation process to inform updates to the statewide caregiver goals, priorities, and programmatic changes.

• Vermont: Tracking progress using caregiver-specific data points. Vermont is tracking and measuring the progress of caregiver goals through the state’s Age Strong VT Goal Tracker. Using data collected from the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System caregiver module, as well as from its state survey on family caregivers, the state highlighted data measures specific to caregivers, including increasing knowledge of respite options, self-care, and medical benefits, as well as reducing the negative financial impacts on caregivers.

• North Carolina, California, and Maryland: Developing public-facing dashboards and progress trackers. North Carolina, California, and Maryland have developed data dashboards and MPA progress trackers that offer public transparency on goals and provide a broader picture of how the state’s aging population is faring.

Conclusion

Caregivers play a central role in making community living possible for older adults and people with disabilities. While MPAs in most states are still in early stages, examples from California, Maryland, North Carolina, Texas, and Vermont demonstrate how these plans can help states strengthen services to support caregivers, enhancing the lives of family and professional caregivers and the people for whom they provide care.

Acknowledgments

NASHP and CHCS would like to thank The John A. Hartford Foundation, the Ralph C. Wilson, Jr. Foundation, The SCAN Foundation, West Health, May & Stanley Smith Charitable Trust, and the Henry & Marilyn Taub Foundation for making this publication possible through NASHP’s RAISE Act Family Caregiver Implementation and Technical Assistance Center. The authors would also like to thank state MPA representatives from California, Maryland, North Carolina, Texas, and Vermont who participated in interviews and shared their time and expertise.