Maryland’s Longevity Plan: How One State Could Help Redefine Aging in America

With the Trump administration slashing social services to pay for historic tax cuts, states are scrambling to anticipate and mitigate the fallout for the populations affected, including seniors who depend on Medicare, Medicaid, and Social Security. These threats to older Americans come at a time of major demographic change. The U.S. birth rate is plummeting while the population is older than ever, and that trend stands to reshape our economy, caregiving needs, and public institutions. 

As federal support recedes, the responsibility is increasingly falling on states. Maryland is trying to rise to the moment with its Longevity Ready Maryland (LRM) Plan. At the July launch of the program, Governor Wes Moore didn’t mince words: “While some in Washington threaten to pull the rug out from under our residents, placing greater strain on state resources, Maryland is stepping forward with urgency and a clear plan to put the well-being of older Marylanders front and center.”

Maryland’s approach goes beyond the usual aging-with-dignity rhetoric of programs for older Americans. Instead of confining issues around aging to a single siloed department, the LRM plan spans agencies and sectors, aiming for coordinated action. And it’s not alone. Last year, the Center for Health Care Strategies reported that 15 states have issued comparable plans, and 23 others are in the exploratory phase.

Still, Maryland faces real obstacles in executing on its ambition. As its 60-plus population swells past 1.4 million, the state has a shortage of direct care workers projected to worsen significantly, a health care system stretched thin by chronic disease management, and a housing stock not built for aging in place—challenges seen nationwide. 

To build buy-in of its plan, the state government spent two years on community engagement, including a series of listening sessions and cross-sector collaboration. Its Department of Aging “included a broad and diverse group of stakeholders in the plan development process,” said Allison Ciborowski, president and CEO of LeadingAge Maryland. She served on both the LRM Stakeholder Advisory Group and on a team focused on helping Marylanders afford longevity. Ciborowski also praised Department of Aging Secretary Carmel Roques and her team for actively seeking input beyond the work groups. 

Roques underscored this aspect in her introduction to the plan, writing that its “success depends on collective action.”

So what does it look like to turn a patchwork of services into a future-ready aging system? Maryland’s 10-year plan centers on four “epic goals” and offers a framework that could become a model for other states:

• Building a longevity ecosystem. The emphasis on systems acknowledges the need for effective collaboration between government agencies, service providers, and other public and private structures, which come together in complex, often unpredictable ways. For example, Montgomery County (the state’s largest) has its own aging plan that integrates, among other efforts, programs for welcoming immigrants, combating food insecurity and elder abuse, and senior housing.
• Promoting economic opportunity. Professionals and family members who care for older adults help to sustain the state’s economy. According to AARP’s Valuing the Invaluable report, unpaid care provided by the 760,000 caregivers in Maryland is worth $12.5 billion. Maryland’s new plan addresses the needs of family caregivers and the care workforce, offering a blueprint for engaging with employers to promote age-friendly policies and practices such as long-term care insurance. In the coming decades, skilled workers will continue to be in demand, but the types of skills necessary will likely keep fluctuating. Maryland will encourage employers to recruit, hire, and retain employees age 50 and older while creating pathways for workers to upskill, reskill, and pursue career changes to in-demand occupations.
• Making longevity affordable. The share of adults over 60 growing as the birth rate declines will further test an already strained infrastructure, especially when it comes to housing. The LRM emphasizes the role of financial literacy and planning in helping residents keep pace with the cost of living. The plan also features multigenerational living and intergenerational co-housing programs, approaches that experts recommend to keep housing affordable.  
• Optimizing health, wellness, and mobility. Demographic shifts will challenge Maryland to maintain access to resources for physical, behavioral, emotional, and cognitive health, requiring policy and technology solutions as well as a person-centered, trauma-informed approach to health and wellness. Crucial will be the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model, which builds upon a plan that saved an estimated $1 billion through coordination between health care providers and other strategies.

Of course, implementation is the real test. “The plan is just that—a plan,” said Ciborowski. “More work is yet to come on how the state will implement the initiatives, and how different parts of state government will be held accountable to timelines and goals.” New challenges will emerge; for example, she cited nutrition services as a likely flashpoint where federal cuts may force Maryland to step in and reallocate resources to prevent hunger among its seniors. 

Crucially, these sweeping plans are more than a wish-list or intellectual exercise. They are necessary to ensure that services are accessible, integrated, and flexible. And if Maryland and other states follow through on their promises, they can also revive a beleaguered idea in American life: that even in the face of staggering change, government can play its part in delivering a better, healthier future.