This article seeks to combine methods in the sociology of elites with those in the analysis of public policy to understand changes in the French state. To explain the role of state elites we specify a concept of "programmatic elites" that combines analyses of political and administrative careers with actors' policy frames. We present main dimensions of the concept and discuss various ways in which it overcomes some weaknesses of the positional, reputational, and decisional methods, as well as how it extends elite studies to analyses of what might be termed "the new custodians of the State." By applying our concept to health policy since the early 1980s, we demonstrate the role of these elites in bringing about major changes in important policy domains.