Broadcast Retirement Network’s Jeffrey Snyder discusses the development of states master aging plans with Sheppard Mullin’s Adam Herbst.

Jeffrey Snyder, Broadcast Retirement Network

Adam, welcome back to the program. So great to see you again this morning.

Adam Herbst, Sheppard Mullin

Jeffrey, thanks for having me again. It’s great to be with you.

Jeffrey Snyder, Broadcast Retirement Network

And I love that you’ve got a new role, but what I love about your perspective is that you actually served in a major state’s Department of Aging, and I think that provides great context to our audience. Let’s talk about master aging plans, because when you and I first met about a year, year and a half ago, you were part of New York’s process to establish a master aging plan. And I guess my first question is, how are the states doing in preparing for all of us that are gonna turn age 65 at some point?

Adam Herbst, Sheppard Mullin

Well, thank you. Great question. First of all, I appreciate coming back now that I’m in the private sector again.

I was the former deputy commissioner in New York State’s Department of Health overseeing the Office of Aging and Long-Term Care. And I was the chair of the governor’s master plan for aging in New York. And it was a wonderful opportunity to talk about aging policy, because often, Jeffrey, it’s easy to drift into abstractions, right?

Program names, acronyms, certainly in government, we see a lot of acronyms. We see a lot of different funding streams. But for me, this work has always been very concrete.

It’s about whether an older adult can stay in their home safely, whether a family caregiver can keep their job, or whether a system actually shows up when people need it most. That’s why I think this is a particularly important moment when we look at the different states’ master plans for aging and different aging initiatives across the federal level as well. Because while a lot of the rules and dollars come from Washington, like you said, the real decisions that shape people’s daily lives are being made at the state level, often quietly, but under enormous pressure.

And that’s usually why trying to balance a budget never quite balances. What we’re seeing right now is a real shift in where aging policy sits and lives. The federal government still sets the outer boundaries, with Medicaid rules and Medicare payment and waiver authority.

But the states are the ones that are designing the systems, including the state’s various master plans for aging. The states decide what services are available, how integrated care works, and how much providers are being paid. And ultimately, it’s whether the policies feel human or bureaucratic to the people that live inside those various states.

So in many ways, Jeffrey, aging policy today sits at the state-led, federally constrained and locally delivered. That’s how I like to describe how the various master plans and aging initiatives are happening across the different states. And that tension defines almost every challenge that we’re dealing with now.

In New York specifically, because it’s a useful case study and it’s where I came from, it operates at scale, right? You’re talking about millions of older adults, one of the largest Medicaid programs in the country, and an extraordinarily complex network of providers, which include home care agencies and nursing homes and managed care plans and PACE programs and housing organizations. You name it, we have it in New York.

When I was in state government, working on aging and long-term care policy, the challenge was never a lack of ideas. The challenge really was aligning policy ambition with the operational reality. It’s one thing to say that we want to rebalance towards home and community-based care.

It’s another thing to make sure that a workforce is there to deliver it and housing is there to support it. And the payment systems that don’t quietly undermine it are working appropriately and functioning appropriately. New York’s master plan for aging was an important initiative, not just because of what was in it, but because of what it acknowledged.

And this is what other states are doing right now as well. The acknowledgement is that aging is not a healthcare issue at all. It’s not even a healthcare issue alone, right?

It’s a housing challenge. It’s a transportation challenge. It’s a workforce challenge.

It’s a caregiver challenge. And unless those systems are pulling in the same direction, no single program, no single policy idea, no matter how well-designed is going to succeed. And the whole kind of whole of government approach is very difficult.

It requires a lot of trade-offs and patience and a willingness to admit when the system itself and not the individual is what needs fixing. And that’s where the states are finding the challenges with their respective aging initiatives.

Jeffrey Snyder, Broadcast Retirement Network

Yeah. Adam, if I could just jump in real quick, I think what makes New York very unique and I think a microcosm for the US, and I wonder if you agree, is that New York is not just New York City. New York is not just upstate New York.

I mean, it has rural parts of the state. It has the major city. New York is the biggest city, I think, in the United States.

So that creates challenges. You talk about demography, you talk about targeting and getting people health and help and support, and be doing it uniformly because you’re not supposed to put anyone else over somebody else, right? I mean, I don’t know what the right legal term is for that, but that is really the challenge, I think, that New York and other states have, one of the challenges.

Adam Herbst, Sheppard Mullin

That’s exactly right, Jeffrey, and you’re right. It’s one of the reasons that New York is such a useful microcosm for the country at all, because New York isn’t one place. It’s New York City, like you’re saying, it’s dense suburbs, it’s small towns, it’s deeply rural communities upstate and across the Western part of the state.

You’ve got enormous wealth and deep poverty, and you also have world-class medical centers in New York and places where access to care is genuinely fragile. A lot of deserts in New York currently exist as well. All of that exists under one policy and financial framework in the state.

That diversity creates real challenges when you talk about aging policy. The needs of an older adult living in Manhattan are very different from someone aging in rural county upstate New York. Transportation is different, housing stock, workforce availability, even social isolation look completely different.

A single one-size-fits-all, like you’re saying, solution doesn’t just really work in any state, but New York is a microcosm. What New York’s experience shows, I think, Jeffrey, and this is the true, I think, nationally, is that good aging policy has to operate at multiple levels and at the same time. You need a common vision and shared goals, and that’s challenging at a state level, but you also need flexibility to tailor solutions locally based on demographics and geography and community need, and that’s where real targeting matters, and the complexity is actually the point, right?

If you can design aging policy that works in a state as diverse as New York across urban, suburban, and rural communities, I think you start to see what’s possible nationally, but it does require moving beyond the blunt tools, what I was talking about before in describing and really designing systems that can adapt to very different realities on the ground.

Jeffrey Snyder, Broadcast Retirement Network

So how do you, as somebody who was a chair, was in state government, help put this together for New York? I mean, clearly it was a team. I mean, just like it’s complex, one person can’t do it, but you were part of a team.

How do you align the private sector, which may be the health insurers, the care providers, with the not-for-profit arms, the NGOs and other entities to swim, or row, maybe that’s a better analogy, in one direction? Because as you said, there are different motivations. I think everyone wants to do the right thing.

So I think, and people come into this with, hey, I want to do the right thing, but I have shareholders, or I have voters, or I have patients, right? So how do you get everybody to row? How do you deploy diplomacy, it sounds like, or negotiation to get people to row in the same direction?

Adam Herbst, Sheppard Mullin

It’s a great question, and I have four thoughts to that, because alignment doesn’t happen by accident, and it definitely doesn’t happen by decree. I can tell you that firsthand. You’re absolutely right that this was a team effort.

In state government, especially on something as complex as aging, no single person, no single state agency can do it alone. The real work is about creating the conditions where very different actors can move in the same direction. From my experience, alignment starts with a shared problem statement, right?

That’s what we did in New York, and that’s what many states are doing with their master plans for aging. Insurers, providers, nonprofits, and state agencies may have very different incentives, but they’re all facing the same realities. We’re all seeing an aging population, workforce shortages, rising costs, and families who are struggling to navigate the fragmented systems.

If you can get everyone to agree on what the problem you’re trying to solve is, not just what the program you’re funding is, you’re halfway there, I think. So that’s number one. Number two, you need clarity of roles, right?

The state’s job isn’t to run everything. It’s to set a lot of the guardrails and align those incentives to create the accountability. But health plans need to manage risk and coordination.

Providers need to deliver care. Nonprofits need to bring the trust and community connection, and often the innovation. And when those roles are muddled, I think systems break down.

So when they’re respected, that’s where the collaboration becomes possible. That’s second. And third, and this one’s critical as well, is payment and incentives, right?

When you can’t ask the private sector or nonprofits to behave differently if the financing model rewards are the old behaviors, right? You need alignment, and that really starts when payment structures support integration and prevention and long-term outcomes, not just volume or short-term fixes. So if you take those three ideas and then you put the human factor in, right?

You take the human side, which doesn’t get talked about enough, Jeffrey, I think. Alignment requires a lot of trust and continuity. You need regular, honest engagement, right?

Not just crisis or procurement cycles. You need people to believe that the state is listening and that policy changes won’t shift overnight, and participation won’t put them at risk. And I did town halls in nearly every community across the state, and that’s the biggest takeaway I had when I spoke to communities across New York churches and YMCAs and different centers and communities.

It really is that trust and continuity that we are listening at the state level. That’s where the dialogue needs to happen and people need to engage with the state, and that’s where policy shift will start to happen. One of the lessons from New York that I took is when you bring the plans and the providers and the nonprofits into the process early and not after decisions are made, you’re gonna get better policy and better buy-in.

It doesn’t eliminate that tension, and there’s certainly tension that’s gonna be there, but it turns tension, I think, into something productive. So that’s the alignment that you’re saying is critical, and I agree. It’s not about everyone agreeing on everything.

It’s about creating a shared direction and aligning the incentives with that direction and building enough trust so very different actors are willing to move forward together even when it’s very, very hard.

Jeffrey Snyder, Broadcast Retirement Network

Certainly, it’s not an easy problem to solve. It’s one that I think we’ll be talking about for a long period of time. There’ll be advancements, there’ll be questions, and I think over time, these issues will get solved.

Adam, it’s always great to see you. Thanks for joining us, and we look forward to having you back on the program again very soon.

Adam Herbst, Sheppard Mullin

Thank you so much, Jeffrey. It was a lot of fun. Look forward to it.