This paper reflects the conversations and considerations of a focus group of 18 individuals representing persons with disabilities and their advocates and State and Federal officials. Convened to review the National Academy for State Health Policy’s recent publication, A Guide to Federal Programs for People With Disabilities, the group was invited to muse about how State governments could re-engineer themeselves to improve our policies and practices affecting persons with disabilities. The result of those conversations is this paper, which sets forth a framework for re-thinking policy for persons with disabilities and strengthening State’s capacities to work closely with consumers to forge more comprehensive and coordinated care for persons with disabilities and their families. This paper is not a comprehensive analysis of models and their strengths and weaknesses; rather, it is a first step to convene consumers and policymakers to envision a new and better way of doing business together. Much more analysis and demonstration is needed, but this paper presents the range of possibilities available if Federal programs serving persons with disabilites could be better coordinated or consolidated.