Colorado is one of many states that will have a new governor and administration in January 2011. The current administration considered how to prioritize the tasks related to national reform, and how to leave behind a good transition plan and roadmap for the incoming team. Governor Bill Ritter signed an executive order in April 2010 to establish an Interagency Health Reform Implementing Board and appoint a director of health reform implementation.
The Board functions as an inter-agency task force comprised of representatives of the state agencies that are most affected by health reform, including those overseeing Medicaid, insurance, behavioral health, public health, information technology, taxes, employee benefits, economic development, and medical schools. It also includes members of the governor's office: a policy advisor, budget advisor, and legal counsel.
Governor Ritter appointed his health policy analyst, Lorez Meinhold, to be the director of health reform implementation and named Joan Henneberry, executive director of Colorado's Department of Health Care Policy and Financing, to chair the Board. "If we don't coordinate all of the reform implementation work," says Henneberry, "we'll have great little projects but not a well-sewn together quilt." The Board's goal, according to Henneberry, is "to point to the data in 2020 and say that Colorado's people are healthier." The official duties of the Board, as described in the governor's executive order, are summarized in Figure 3.
Colorado's Interagency Health Reform Implementing Board Duties
Developing a strategic plan for implementation;
Coordinating agency efforts to implement and monitor health reform;
Providing leadership and being accountable for implementation of state and federal health reform;
Engaging stakeholders to advise and assist in implementation;
Collaborating with appropriate federal agencies, state agencies, and stakeholders when necessary regarding the establishment of new rules, regulations, or mechanisms for implementation;
Providing transparent access to information;
Launching and regularly updating a new website that will provide residents with information about health reform, the phases of implementation, and how changes may benefit them;
Identifying opportunities for collaboration within the State, as well as regionally and nationally;
Analyzing the impact of health reform on state departments and agencies;
Recommending executive action or legislation to effectively implement health reform; and
Pursuing federal and state grants to assist in implementing health reform
Source: Executive Order B 2010-006 April 20, 2010
The Board will present a strategic plan for health reform implementation to the governor by November 1, 2010. Its meetings are open to the public and reserve time for public comment; meeting notes and decisions are posted on the governor's Web site. In its remaining months under the current administration, the Board has three priorities related to health reform implementation:
- Fulfilling the law's short-term requirements, such as creation of a new high-risk pool that will function alongside Colorado's existing high-risk pool. The state contracted with the non-profit Rocky Mountain Health Plan to administer the new pool, which began accepting applications in early July for a September start date.
- Reaching out to state residents to inform them how national reform complements Colorado-specific health initiatives, and to counter misinformation about health reform. Board members currently are traveling around the state to attend town hall meetings and make presentations to chambers of commerce, provider organizations, and other groups.
- Planning for the insurance exchange, which Colorado's leaders view as critical to the success of health reform but also a significant challenge, given the state's lack of experience with exchanges. In July, the Board will begin a series of eight to 10 public forums in conjunction with two large consumer advocacy organizations to elicit input from consumers and health industry stakeholders about the exchange's governance model, plan benefits, and other features. The Board will then prepare a short consensus paper for the next governor and legislature.
Compared with many other states, Colorado may be in a stronger position to implement certain aspects of reform, including the Medicaid expansion. Last year, Governor Ritter signed legislation to phase in a Medicaid eligibility expansion up to 100 percent of the federal poverty level (FPL), using hospital fees to draw federal matching funds. From this starting point, the new federal reform that expands Medicaid to 133 percent of FPL in 2014 "doesn't' feel overwhelming," says Henneberry. "We're doing the administrative, systems, outreach, and other preparation work now."
Colorado's leaders suggest that states need to assess which elements of federal health reform require state intervention, then map out the necessary tasks and determine what resources are needed for implementation. Colorado, like other states, has been hit hard by the recession and state budget crisis. They are managing reform planning and implementation by redeploying and expecting more out of staff and consultants. Also, says Henneberry, Colorado is fortunate to have several health foundations that support the administration in implementing reform. But she also says, "The resource deficit is incredibly real, and could jeopardize early success if states don't receive planning funds through the federal government or foundations."
For more information, contact: Joan Henneberry, executive director of Colorado's Department of Health Care Policy and Financing, email@example.com.