Bipartisan Blessings for Colorado Medicaid Program
While the Trump Administration is proposing an $800 billion cut in Medicaid funding over the next decade, Colorado lawmakers are taking a different approach.
Instead of spending cuts, they are supporting a state-level program that is working to save money by providing care more efficiently and effectively.
The legislature passed House Bill 1353 in the recently ended session, endorsing the state’s plan to move forward with its Accountable Care Collaborative (ACC), which was launched six years ago to stem the growth in Medicaid spending while delivering better care to Medicaid clients.
Gov. John Hickenlooper signed the bill into law Tuesday, May 23.
The bill gives lawmakers more oversight of the ACC. They will receive annual reports from the Department of Health Care Policy and Financing (HCPF), the state’s Medicaid agency. They will also review the impact of a new payment model.
The second phase of the program is slated to begin in 2018. Phase Two will take what has been a successful roll-out of the program to the next level. It will implement a payment model that rewards providers for better performance, and it will more closely integrate physical care and behavioral health care.
HCPF is seeking proposals for organizations to oversee the ACC in each of seven regions across the state. Currently, separate physical health and behavioral health organizations share that work in each region.
Rep. Dave Young, a Democrat from Weld County, was a sponsor of the bill, which emerged from discussions in the Joint Budget Committee about the importance of the ACC. Young told members of the House Public Heath Care and Human Services Committee that he felt it was important for lawmakers to more actively weigh in on policy decisions about Medicaid.
“It’s time we got in front of this parade,” he said, noting that the annual Medicaid budget of $9 billion represents a third of the state’s $28 billion budget.
Young said that the bill was not needed to continue the ACC, but that it would set the stage for lawmakers to be more involved and have a better understanding of Medicaid, especially if a proposed shift in costs from the federal government to state governments becomes a reality.
“Currently, it’s an entitlement program, but it may not be in the future,” he said. “If not, we’ll have some hard decisions. This bill lays the foundation for those future discussions.”
Shane Mofford, payment reform section manager for HCPF, told committee members that the goal is to change how providers are paid and to reduce barriers to access to care.
“This is a huge portion of our budget, and it’s important that we get it right,” he said. “It’s important for our clients, it’s important for our providers, and it’s important for taxpayers.”
Mofford described the effort to bring together behavioral health and physical health as a “herculean task.”
The state’s behavioral health organizations, which currently oversee that portion of the ACC, support Phase Two, said Arnold Salazar, who runs a behavioral health organization covering 43 counties. He called the move a “natural evolution.” He also said he wanted to see HCPF acknowledge the work of the behavioral health organizations to date on bending the cost curve.
Despite the limited scope of the bill, and despite having Senator Kevin Lundberg – hardly known as a Medicaid fan – as a sponsor, it passed from the committee along party lines, with support from Democrats and opposition from Republicans.
Rep. Justin Everett of Littleton told fellow committee members that he came into the hearing “an easy yes.” But he became concerned that it would drive further Medicaid expansion, he said. “I went from an easy yes to a pretty solid no.”
The bill had strong bipartisan support in the Senate, which approved it by a vote of 33-2. But the House voted mostly along partisan lines, 39-26, most likely a statement by House Republicans about Medicaid in general rather than this bill in particular.