Commission on Medicaid [Jun 17, 2026]

I don't think we have to do anything preliminarily. So I'll just say welcome, everybody. Our mission today is to pick a technical advisor for the Medicaid Commission. And so we are going to call up. We had seven proposals, and I want to just say thank you to everybody who submitted a proposal. They're all really good. And it's going to be tough for us to figure that out. but we have invited all of the people who submitted a proposal to come today, and we're going to call people up one group at a time. And I think we'll take about, you know, you can talk about your proposal for a few minutes, and then we want to spend the bulk of the time asking questions, and so we'll spend about 15 minutes per group on questions and answers and that's the plan. I hope that sounds okay to everybody. Any questions? Seeing nobody has a question, we will start with Sarah Schmidt, President and CEO of Colorado Health Institute. Okay. Okay. Ms. Schmidt, take it away.

Yes, go ahead. Just tell us your name. Go for it.

Thank you, Madam Chair. I've shared a handout with all of you that I'm just going to walk through very briefly that gives an overview of who we are, a few examples of our experience that are also included in our proposal, and how we would propose working with all of you over the next several months. The Colorado Health Institute has been serving Colorado, providing independent, nonpartisan policy analysis and research since 2002. The work that you all are undertaking is the work that we have focused on as an organization since our founding. And we are very proud and grateful to be speaking with all of you today. We at SCHI, and in collaboration with Amy Downs, have a broad understanding of Medicaid. We have been working on it since we started, everything from home and community-based services, payment models, care delivery models, behavioral health, fiscal and program integrity. And we bring a broad lens to these specific issues, looking at them as it relates to how does this impact our rural communities? What does this mean for member experience? What are the fiscal implications of the decisions that are being made? and what does this mean for our providers, both those currently participating and those who may want to become Medicaid providers. And the examples that we have put here on our handout are just a couple of examples that demonstrate the skills and expertise that we have provided for similar activities that are the ones that you are going to be looking for from your technical advisor And we'd be happy to answer additional questions about any of those, as well as those in the proposal. Lastly, I would just want to highlight our proposed approach. We want to create a structured process for all of you to move through this work thoughtfully and intentionally and have the opportunity to ask the questions that you have and get the answers that you need. We are proposing to take this stepwise, starting to ensure that everyone has a common understanding and shared knowledge base, not duplicating what you are already getting from the departments as well as legislative council, but making sure that you have the information you need and that we have shared definitions around some of these issues. Then we want to move into a process to really create the framework for the decisions that you will need to make. And part of that includes defining your goals and your values and establishing criteria for what you mean when you say cost or access or quality. We will use that framework to then guide decision making around those issues that are most relevant and timely for you to want to dig into in a deeper level. So we'll bring that analysis for these discussions and then revisit the framework when we get to the other end of the research to then revisit where you had started, really help you think through the tradeoffs that are inherent to some of the decisions that you will have to make. Again, staying grounded in the values and the goals and the criteria that you had established at the upfront. want. We have a structured process so that you can make some structured decisions and we're flexible. We know that this is a complicated and a complex process and so we look forward to having this conversation with all of you as well as working with the chair and the vice chair to make sure that you are getting the information that you need. We will then finalize those recommendations with all of you and then we'll look forward to creating that proposal, the report that will be clear, transparent and it will be clear to both all of you as well as your colleagues in the public why you've made the decisions that you've made or not and moving forward from there I will pause and

Okay. Thank you very much for that.

Sure.

Thank you, Madam Chair. Thank you for the question, Representative Barone. As we mentioned in our proposal, part of the work that CHI does as an organization is to monitor what is happening at the legislature. in an independent, nonpartisan way, provide information and analysis to our partners and to the community broadly, and stay abreast of those issues. And so certainly over the last 12 months in particular, but for the last couple of years, we have been tracking budget issues very closely. And not only at what's happening at the state level, but then as part of the work we've been doing with communities around understanding the impacts of HR1, really looking at the relationship between some of the federal changes and what that might mean at the state level and how to put the context between the decisions that all of you made this year already and then what are we expecting to happen over the next couple of years based on the information that is available at the federal level right now. Amy?

Thank you. Yeah, I would just add to that, not only are we cognizant of the state budget situation as a whole, but really, really focused on what is happening in Medicaid. And as we put our hat in the ring for this, you know, reviewed some of the things that have been happening in Medicaid, the utilization increases that we've been seeing, you know, parsing out caseload versus utilization changes, where are the points in Medicaid where we seem to be spending a lot more, not just resources, but general fund resources in particular, and looking at what's been happening in some of our populations of folks with disabilities, elderly, who are really, while they're 15% of the population, they're driving about 75% of the general fund costs. So we have been tracking that very closely.

Thank you, Madam Chair. Quick follow-up on that question. In your opinion, what are your top two largest factors that contribute to the budget situation we're in in Medicaid right now.

Thank you, Madam Chair, and thank you for the question, Representative Brown. My preference is to talk with all of you. Well, we certainly have the understanding of what is influencing Medicaid costs. What are we paying providers? Who is eligible? What sorts of services are we providing through our benefits packages? What does the mix look like in terms of federal-state matching? What do we understand in terms of waivers, et cetera, care utilization and management? And then, of course, how we are compensating providers for value-based payment. In terms of what are the key drivers, my preference would actually be to create a process for all of you to very intentionally think through those for yourself and ask the questions and get the data and the evidence that you need to be able to make informed decisions around the recommendations that you would like to put into the report.

Thank you, Madam Chair. I'm wondering, you have done, CHI has done a lot of work. You provided it in your proposal with Colorado Medicaid policy. And I am wondering how you know if you were selected how could the commission feel confident that CHI wouldn feel attached to the things that you have worked on and put forward that now make up the thing that we are trying to really dig deep and analyze

Okay. Vice Chair Brown?

Okay. Other questions? Senator Kirkmeyer.

Ms. Schmidt.

Senator Kirkmeyer.

Ms. Schmidt.

Ms. Downs.

Okay, Senator Kirkmeyer.

Ms. Schmidt.

Okay, Rep Taggart.

Ms. Schmidt.

Thank you, Madam Chair, and thank you for the question. we would definitely be looking to the experience of other states in terms of things that they have they have done or specific communities quite frankly in colorado because we have a lot of innovation happening at the community level and we've actually just been involved in a project estimating some fiscal costs associated with treatment in place that some emergency medical services are doing in rural colorado that would generate savings if we scaled up to the state I think one of the things that I was trying to convey and that we've done in the past when we've been at pivotal moments in Medicaid is looked at what has happened in other states, what were the results, and how do we Coloradoize those? We're different than other states, but it doesn't mean that we can't learn from them. So, for example, when we were looking to potentially expand Medicaid to childless adults, CHI, as I mentioned, did an analysis of that. We looked to Oregon and said, they already have covered these people. What are they costing? Well, but we also have different provider rates. So we start with the evidence from other states, and then we make adjustments about what we know about our community, our provider rates, our eligibility categories, and try to come up with information that can inform Colorado policymakers based on empirical evidence.

I tend to agree with Senator Kirkmeyer that I'm not sure if eight sessions are enough. I think that there's going to have to be a lot of hands-on from this commission. That's my vision or what I think is going to need to be. but I also first off I want to thank you for for for submitting this because I do think you guys submitted a thoughtful proposal and appreciate it and and and being involved in in health care policy in my time at the capital I know what role you all play in that and so appreciate that but I also know things come along with that and you you have been involved and you continue to be involved in a lot of policy discussions and whatnot and data collection. And the view I have of this commission is that, that what I'm looking for is for us to have somebody that can bring us information so that we can make decisions and recommendations and, and really come up with those policy decisions. But I also know that you all have done a lot of work in this area. You continue to do a lot of work in this area. And you're, you're, the folks who work for you are heavily involved in this area. How do you come to this environment, which is a good thing, having all the experience you have, but also come to this with kind of a clear view and not being skewed, or when we do ask for information, being able to give us information that's, for lack of better words, pure and not kind of leaning one way or the other.

Thank you, Madam Chair, and thank you, Senator Mullica, for the question. It's the work that we have been doing since we were founded, helping Colorado decision makers make informed decisions about health policy. And we've been doing that as an independent and nonpartisan organization. In good times and in bad. I won't sugarcoat it. It is challenging. It is very challenging. it's partly why we talk about wanting to really start our work together in grounding in your goals and your objectives and hearing from all of you about how you define success and what a realistic outcome or outcomes from this process will look like because that gives us all then a shared understanding of what we are actually working toward and and it also creates an environment of transparency and candor where I would hope that you would look to us to be transparent and honest about what we are and aren't finding in the research and the analysis that we are doing. And then similarly, you are all being transparent with us about what you are seeing us provide you with and push us a bit and pressure test because if it's, this is the space where we can have that and continue to refine and get to the outcome that will be most effective for Coloradans.

And just one quick follow-up. I know we're running out of time. It's not a hard one. And I guess I would, I hope that everyone else who has applied or submitted these RFPs can address this as well. What does success look like in your viewpoint at the end of this, you know, if you're chosen?

Thank you, Madam Chair, and thank you for the follow-up questions there. I've turned the question back to you. I want to know from all of you what success looks like at the end of this process. What is a realistic, successful outcome for all of you? And as your technical advisor, it's our charge to make you successful.

but I will follow on to some of the line of questioning that we've been taking. I think there have been a couple of concerns about sort of your experience, which is deep and I fundamentally respect, also comes with a long history with the state. And I also wonder about how that fits in with sort of your business model and whether if there are recommendations that come out of this committee that might go counter to what some of those agencies have thought, how that sort of whether that creates a conflict with some of the work that you're currently doing. Maybe you just want to respond to that again.

Ms. Schmidt.

And thank you, Vice Chair Brown, for the question. We would not have applied for this if we did not feel that it was in the best interest of Colorado. and our work has changed a lot over the last 20 some years as our environment and the context in which we are operating has changed and there are some things about our organization though that had not changed and we have not moved away from our commitment to independent non-partisan policy analysis whether we had a way to pay for that or not because that's what we were founded to do to serve the state. And if that need no longer exists because of the work that we are doing, some might say that we've maybe done our job right. Thank you.

Thank you, Madam Chair. I would just add that CHI is a resource for legislators, regardless of political party, administrations, regardless of political party. We've had a series of Democratic governors, but CHI was founded under Governor Owens, who at the time was not interested in expanding Medicaid. So I think CHI's portfolio really reflects this movement towards greater interest and expansion of Medicaid to serve underserved Coloradans. And if policymakers are now in a position where they're looking to change course, CHI will continue to be a resource as that changes with the state budget.

No, thank you, Madam Chair. No, no, I like your question. Yeah. Go for it. I'm just really grateful that we went first. Get it out of the way. Thank you for the question, Madam Chair. You all have very hard jobs and you made the choices that you were able to make with the information that you had and I am not in a position to judge the decisions that you made You have information that I do not I believe that you and the legislature next year will need to make very hard decisions for the next several years regardless of the ones that you made this year already.

Thank you.

Thank you, Madam Chair. Yes, it's Dr. Alicia Verson.

Thank you, Madam Chair. Dr. Alicia Verson, Executive Director of the Colorado Evaluation and Action Lab at the University of Denver. And I'm here with my colleague, Dr. Courtney Everson. The Colorado Lab is the state's independent, nonpartisan, non-issue-specific research and policy lab. we work across all three branches of government, and we build evidence to inform the most pressing decisions of our state leaders. Through that process, we work with all of the agencies that are relevant to Medicaid, as well as the county's community partners and Medicaid members and other vulnerable population stakeholder groups. One of our other roles is to mobilize information so that you all can make really smart policy, programmatic resource and budget decisions on behalf of Colorado. And as we do that, we are looking at the best available research evidence both in Colorado and nationally. You'll see in our proposal that we have references to activating national experts, if that is of interest to the committee and aligned with your priorities. we have a strong network of research and policy labs across the nation. The Colorado Lab was founded in 2017. At the same time as about a handful of other policy labs in other states, we maintain close connections with them. We also work with large firms across the state and all of the research universities in Colorado. When we think about that mobilizing information for policy development and decision-making, it's the best available research evidence paired with subject matter expertise, implementation context, and the decision maker expertise, that those together is what makes smart policy. And we're here to make sure that we're packaging and distilling the information that you need, bringing you the subject matter expertise, those that are on the ground and can provide you with the implementation context to stress test your ideas and your concepts, to think about the alignment across recommendations and how that cohesively can move Colorado to a more stable fiscal state and also best serve our Colorado Medicaid members. One of the questions asked in the last interview was, what is success? So let me just start there. So for us, success is that you all leave the end of this process with a report that you can all stand behind, that it reflects each of your voices, that the report is actionable, that it is a pathway for legislative action in this coming session with clear recommendations, dependencies, timelines, and clear delineations. of what in that report, what recommendations have strong consensus and bipartisan support, and where are the areas that still need to be further unpacked, further stakeholder, because you've only got 12 sessions. This is number two. We're not going to get all the way there, but we're going to make really good progress, and we will have served you well if you all can walk away and say, this is an actionable report. It's going to move the state forward, we have confidence in the process. It was rigorous, and all of our voices are reflected in it.

Thank you, Madam Chair, and thank you for your presentation, and I really appreciate you submitting a proposal. You mentioned, obviously, that you are not issue-specific in your roles and in the organization that you represent. I mean, to what degree do you think that is a detriment to your application? Medicaid is pretty bizarre and unique and also extremely huge. And so I guess, how do you approach sort of criticism that you don't know enough about Medicaid to be helpful here?

Thank you, Madam Chair, and thank you for your question, Mr. Vice Chair. If you are looking for a technical advisor that is a Medicaid chat GPT, we're not it. Quite frankly, we have good familiarity with Medicaid policy practice. We have worked extensively with the vulnerable populations that Medicaid serves and the community providers. What we are exceptional at doing for you is listening to what are your goals, figuring out what the information that you need is, quickly distilling it, packaging it, and getting the right folks in front of you to make informed decisions.

Thank you, Madam Chair, and just one follow-up. One thing that I noticed about your application was that you've done some really great evidence-based work, and you've highlighted that. But these are very sort of narrow and specific problems. This commission has a very broad and nonspecific problem, right? Medicaid, it's big. It costs too much. People aren't getting the care that they need, right? Like these are huge problems. how do you think that your experience and your analysis either fits into that or is sort of a, is like this is too big for the kind of analyses that you traditionally do?

Thank you. Madam Chair, may I turn it over to my colleague, Dr. Everson? Sure.

Thank you, Madam Chair. Thank you, Vice Chair. When we think about this from a cross-system perspective, I think that claiming Medicaid is complex is a bit of an understatement. And I think that's actually the strength that we bring because Medicaid has tentacles that outreach to multiple of our state agencies, multiple communities. It looks different in its impacts in our rural and urban areas and our balance of state. And that is one of the strengths that we bring is the ability to have such broad cross-sector experience in our analyses to not only understand the depths of those tentacles, but then to bring it back up to the commission's charge, which is to understand how does all those parts actually equal a sum and what are those tradeoffs and dependencies. And so I think the work that we done in being cross cross and non actually is a strength that we bringing to this to be able to do complex analyses that don see it myopically but really see those trade and dependencies that we able to ultimately come up with a better solution than if we were incredibly narrow or too broad.

Senator Kirkmeyer.

I'm sorry. I thought Senator Muller had his...

He was. No, you were doing... So I noticed in your proposal that you talked about the evidence-based decision-making, and can you give me just an idea how you would evaluate our evidence-based decision-making that is done through both the OSPB and the departments and the JBC? Like, is it really good? Is it not so good? Do you have ideas for improvement? Just generally, what do you think about it?

Thank you, Madam Chair. Thank you, Senator Kirkmeyer. So Senator Kirkmeyer is referring to our support across the branches of government for House Bill 24-14-28 and our work in evidence-based decision-making, particularly with evidence-based budgeting practices. And in that work, one of the things that we are able to do for the last several years is have the great pleasure of evaluating the evidence in budget requests and asking the question of how well are we able to see evidence-based practices and programs being put forth to drive both fiscal responsibility and outcomes for Coloradans. And every year, as part of that analysis, we do what's called a congruency analysis that examines the points of agreement between the Joint Budget Committee analysts and agencies and executive branch analysts and how that evidence was applied. And I think that we have made extensive progress as a state in using more evidence-based practices and programs over the last several years. And I think there's also very much room for improvement in continuing to ask the question, how do we distill the evidence in a way that actually translates to legislation? I think one of the ways I would summarize this is the legislation often is here and the evidence is here. and there's opportunities for us to bring that together in a more synthesized way as we get at evidence-based policy and budget. And that is very much one of the strengths that we bring is that neutral facilitation to say what would it take to distill that complex information and bring it in so that it's reflective in the ultimate decision-making process as well as the outcome itself.

Thank you.

So if by chance one of the questions was at one of our facilitated commission meetings, it was brought up to you that between the years of 23 and 25, our CES population doubled. And we asked you to go back and do research to find out why that happened. How would you go about doing that?

Thank you, Madam Chair. Thank you, Senator Kirkmeyer. So this is a question that's going to come up, And I think it's illustrative of a larger question that's going to come up. So very specifically, I would go to say, where is that data held in our state administrative data systems and ensure that there's replicability in being able to pull that information out over time. Whenever possible, we will be looking to what already exists versus trying to do new analyses and new evaluations on such a short time frame. So it's coming back to where did that data come from and that data point come from and being able to find out if we can replicate that because that is part of reliability and rigor in data The other element that I believe that you are speaking to is a larger question which is also around what data is the commission going to want and going to need and to need to verify as part of this process. In reflecting on the first commission meeting, I will share this. I think one of the vulnerability points in the commission's process will be if we get stuck in a discovery process of just more and more information without the ability to eventually take that information and move it toward a decision-making goal. And so whether it's a question as specific as that for a data point or a larger piece, my recommendation is that we backward map what is the decision-making goal that you're aiming to make that that data point is relevant to, what other additional information do we need, and then how can we ensure that we concentrate and focus there to bring it forward. I would also like to pass it over to my colleague Dr. Burson for an additional response. Dr. Burson. Thank you, Madam Chair. I also wanted to share that

Rep Taggart thank you madam chair I have a couple questions one has to do

that would exist in those 17 other states? Dr. Berson.

and I appreciate the detail of the individuals, but you start off by saying this is a fixed cost proposal. what happens if the scope and the number of hours that you've estimated are very different than what's going to be necessary to really fulfill this role as our technical advisor and our facilitator? Does it remain a fixed cost?

Thank you, Madam Chair and Representative Taggart. yes, it remains a fixed cost. The Colorado Lab is here to serve the state of Colorado and the decision-making goals of state government. We presented a conservative budget. We very intentionally negotiated with the University of Denver in advance to not charge indirect costs and overhead on this proposal. And if it runs over, it runs over, and the Colorado Lab will absorb the costs because we are committed to the goals of this commission and the benefit to the

Thank you, Madam Chair. In looking back, very similar to what's about to happen in the next six months, which is a condensed timeline to make a lot of decisions where you're rapidly trying to get as much information as possible. It is believable to think that some information wasn't elevated that could be brought in at this stage in the process. So rather than a yes or a no, I think it was a maybe not yet, but now we have a new opportunity. I think most importantly is that the decisions made to date are acting as inputs into the decisions that are future forward at this point and understanding the tradeoffs and dependencies of we've set off something. So if we've made this decision, here's now the context we're working with is going to be the most important. And that might elevate new pieces of data that at the time perhaps weren't the information that was a priority but now are because it's a different angle in a different context. So rather than seeing it as a yes or a no, I think it is more around fitting time, place, and what it means for those relationships between past and present.

Sorry I didn't ask this of the first person, but I mean, I'm just going to speak for myself here, obviously. But you know what, here's the thing. The reason we had this commission is because we don't know what we don't know, and we feel like the department kept a lot of stuff from us. We didn't get accurate data. We got lack of data. We've got, you know, anytime we ask for questions about anything dealing with health care policy and finance, we got a 90-page PowerPoint that the executive director thought it was a great idea to talk the entire time that she was supposed to be presenting to us and to make sure that we couldn't ask questions. I think pretty much me and Senator Mobley. But, you know, we have stuff where the population has doubled, no explanation from the department. We have things about where we didn't get federal drawdown that we were supposed to be getting, And so Senator Mullica and I carry a bill to get down an additional $70 million over a two-year period. I want to know why the department didn't get that right and why they didn't inform us of that. So how are you going to help us get to those answers? And I'm going to ask everyone this question.

Thank you, Madam Chair, and thank you for that wonderful question. This is hard, and this is where the Colorado Lab is your best option as a technical advisor. We are built on having relationships with people at all levels of state agencies. We don't just have the relationships with your executive leaders, but the data stewards, the subject matter experts, the folks on the ground that run the programs. and we can commit to you that we will get you the information in a distilled format that is tailored to your decision-making goals and is highly scannable without losing the nuance. And when we can't get information, we will explain exactly why it doesn't exist and why it's not possible so that you understand what truly just doesn't exist because we are using the best available research and the best available data. but let us use the relationships that we have in order to support you in that so it becomes a collaborative process.

Thank you very much, Madam Chair. We are very honored to be in front of you all today and talk to you about our proposal for the Commission on Medicaid. My name is Dr. Hannah Crook. I am the Medicaid Policy Director at the Farley Health Policy Center, and I am here today with my colleague, Dr. Daniel Goldberg. Do you want to introduce yourself quickly, Daniel?

the farley health policy center was established in 2014 and is a non-partisan health policy center serving the university of colorado with an interprofessional policy team of experts across the campus our work focuses on develop and translating evidence to advance policies and integrate systems to promote whole health for all our team includes physical and behavioral health providers, public health and policy professionals, researchers, students, and educators. I just handed out a quick two-page summary of our full proposal. We propose three different work streams to accomplish the goals of this commission, evidence synthesis, analysis, and report writing, professional facilitation and process coordination, and an independent evaluation of the recommendations the commission would like to put forth or would like to consider. We have a large history of experience in and knowledge of health care policy, Medicaid, and both Colorado-specific knowledge of those topics and national knowledge of those topics. So the center has over a decade of experience analyzing health policy in Colorado. We have strong knowledge of and experience with HICPF and other state agencies, including BHA, CDHS, the Department of Regulatory Agencies, and CDPHE. And we also have experience working with multiple state Medicaid programs and understand the federal policy changes that are currently affecting Colorado And that will continue to affect Colorado over the next several years through H We also have strong experience and capability in facilitation and convening skills So in the past, the Farley Center has facilitated the three subcommittees of the Governor's Behavioral Health Task Force and helped to synthesize their recommendations into a final report. We have contracted with HICPUF to develop recommendations on creating a child and youth behavioral health delivery system that integrates funding for intervention and treatment services, and our approach to facilitation focuses on structured discussion and consensus building, helping both sides determine what commonalities exist and move towards a final cohesive goal. We are explicitly nonpartisan and neutral, and we use an evidence-driven approach. We have the ability to work across both policy and political perspectives, and we have experience in working with bipartisan groups. Additionally, we have an incredibly robust subject matter expert network. So within our team proposed in our proposal, we have expertise in a variety of Medicaid-related topics and healthcare-related topics broadly. We also have immediate access across the University of Colorado to experts in public health, nursing, behavioral health, medicine, and other topics. And we also have pre-existing connections with external subject matter in groups for areas in which we can't identify an internal subject matter expert. Our three proposed work streams are really to help you all accomplish your goals. So the first is the evidence synthesis analysis and report writing. So this team will be in charge of conducting landscape scans, literature reviews, and policy analyses, and synthesizing these materials into understandable and decision-informing insights, building on best practices identified both in Colorado and nationally. We will also create briefings and background documents for commission members to make sure that we all have a baseline understanding of the topics that we're discussing. We also will help the commission identify the priority topics and policy options and lead the drafting and revision of the final commission report. The second of our two work streams is the facilitation and process management work stream. So this team will help facilitate all commission meetings, help the commission develop a work plan, and help guide their recommendation-making process, including helping them determine what structure they want for making recommendations and putting forward potential recommendations based on your all discussion. And this team will also help develop agendas, synthesize discussions, and track progress to make sure that we are meeting the commission's deadline and ensuring that we have a robust final report completed by December 11th. And our third team will evaluate the potential recommendations that the commission is considering or thinking about putting forward to assess each recommendation for the strength of supporting evidence or opposing evidence and as well as identifying any potential unintended consequences. This group will also produce a consensus report on those recommendations to inform the final recommendations the commission would like to make. For our proposed project timeline, we have some overlapping phases that will inform each other given the abbreviated nature of this committee. So from July to October, we'll be working on priority setting and evidence synthesis. August to October, we'll be working on recommendation development and iteration. September to November, evaluation of recommendations and the consensus report. And then finally, October to December, finalizing the recommendations and drafting the final report. I just want to emphasize that all parts of our proposal are very flexible and that we are happy to accommodate the commission's needs and goals in sort of whatever way is most helpful for you all.

Thank you, Madam Chair. I will start. I think we've asked some questions about sort of conflicts of interest of previous applicants, and so I'll start there. You've identified some stakeholders and some experts in your proposal. One of the things that I notice is that they are predominantly folks who are potentially employed, not only employed by the School of Medicine, but also are sort of maybe health care providers themselves. And while those are incredibly important voices, I wonder about whether you think that you're bringing a sort of truly unbiased approach to this, or if the experts that you have identified are particularly provider-centric.

Thank you very much, Madam Chair and Vice Chair Brown. I just want to note that those experts that we have listed on page three, many of them are medical providers. but those are the experts we have identified within each school at the University of Colorado Anschutz campus to help connect us with other folks. So they are not necessarily the only folks we will be talking with, but they are the ones who can help connect us to their networks and other people they know both on and off campus. We have proactively engaged with the list of folks you see written here to ensure that this is something they are able and ready to do. So they're not necessarily going to be the ones we talk with, although they very well might be, but they are the ones who have sort of volunteered to help us reach their broader network of experts within their schools. That being said, you have brought up a very important point around perceived conflicts of interest. So we do at the University of Colorado Anschutz receive funding from Medicaid. You know, we have several providers who work there who do receive direct patient revenue for Medicaid. However, the team who will be doing this work if selected comes at this from a very neutral academic approach. So all of our team leads are actually not providers who will be receiving any funding from Medicaid. We also will establish safeguards to ensure that no conflicts make their way into final decisions or into recommendations. So, for example, we will require topic-specific reclusals. So, for example, physicians will not help make recommendations or develop evidence on physician reimbursement policy. We also will establish firewalls between this project and all of the other projects that we work on. So everything that was coming from this project will be specifically addressed in this project. And as the Farley Center, we really remain dedicated to being a trusted broker of neutral information. And at the end of the day, we are a team of academics, and we are trying to come at this with the most neutral, unbiased, evidence-based possible.

Thank you, Madam Chair. One final follow-up question. You mentioned in your proposal, sorry, in your remarks about some of your experience with other state Medicaid agencies. I wonder if you could elaborate on that a little bit. I think one of the questions that I would have is, you know, to what degree are you able to bring in I think Rep Taggart has had some questions of previous applicants about sort of the best practices from around the country and the experts that you could bring to bear on this particular project. So I'd like you to talk about that as well as your experience with other state Medicaid agencies.

Thank you, Madam Chair. Absolutely. So just to give you a few specific examples, we have worked with the Oregon Health Authority, which is the department that administers Medicaid in that state, to co-facilitate a behavioral health collaborative to align competing policy agendas and develop recommendations for the state. We also have worked with California on issues around dental health. We also have connections with the National Association of Medicaid Directors and the National Association of State Health Policy to very quickly tap into other states. Many of our team have worked in other state contexts and have familiarity with other state Medicaid agencies. Can I pass to Dr. Goldberg to see if he has any additions?

Thank you, Madam Chair. Thank you, Vice Chair. Yeah, and just to echo what Dr. Crook was saying, the Farley Center since its inception in 2015-2016 has worked extensively on the state level and in state level health policy. That's one of our strengths. And so we've, for example, held contracts with the state of Idaho. We've worked with the state of Virginia on various matters related to the delivery of health care on a variety of different matters. And so if getting the expertise of different kinds of states and state approaches to that is really what the commission needs, then Farley is really the right choice here.

Thank you, Madam Chair, and thank you for submitting this. I appreciate that, and thank you for the work that you all do. When we are looking at some of your experience, though, obviously you've done projects with HICPA, BHA, a number of different entities. My question for you is, through this process, if it's determined that maybe some of the projects that you have worked on with the state, with some of those entities, end up maybe being determined, problem's not the right word, but determined that they've played a role in the situation that we're in that we need to solve, and they weren't necessarily a good thing for the state. How are you all going to respond to that if that was some of the work that you all participated in?

Absolutely. Thank you, Madam Chair. We are incredibly open to the discovery process of this commission. And as academics, we want to make the best recommendations and promote the best findings that we can. And if that means that maybe something we worked on in the past or something that we proposed previously is no longer the best option, that is something we are very open to. We want everything to be as unbiased and, you know, evidence-driven as possible. So if there are things that no longer are serving the state of Colorado in the way that they need to be, that is something we are open to working with the commission to determine and to determine the best path forward.

Thank you, Madam Chair. And then just a baseline, you know, obviously I think the job is for this commission to come up with recommendations and reports and whatnot. But from your perspective early on in applying, what does success look like in your mind at the end of this process?

Thank you, Madam Chair. So first and foremost, I think success is producing the report that you all are mandated to create in a way that everyone is really happy with by December 11th and make sure that the recommendations in that report are actionable and are going to make an impact on the state of Colorado. Additionally, I think success throughout this process is making sure that all of you feel heard throughout your commission meetings and making sure that you're going to need a report. that all the deliberations that are being made include relevant stakeholders, include relevant evidence, and are really towards this goal of coming up with recommendations to strengthen Medicaid for the state. And that will probably include difficult decisions and difficult discussions, which I think is a challenge that we'll have to acknowledge up front. But I think at the end of the day, if the commission feels like they were able to come together to develop recommendations that will help sustain Medicaid in Colorado, that's what success would feel like for me personally but I also want to make sure that I would be working with you all to develop your idea of success and ensure we are meeting those goals as well. All right Senator Kirkmeyer I'm

chair I'll ask our question. As I stated earlier there's a lot of things we don't know what we don't know and some of us have sat through the budget discussions now for years and we still don't get accurate data we don't get complete data we still don't know about all the federal drawdowns that we aren't getting I mean we have to go find those out for ourselves and I talked earlier about the population for CES doubling from 23 to 25 and no answers from the department as to why that happens so how are you going to help us find those answers Dr. Cook

We did that. Correct. Hopefully we will be talking to additional teams to determine where the data is. If there's not the data, why isn't there the data, how that data is produced. And then once we have that data, distilling it down into actually understandable and digestible insights. So I think you asked a previous question about how we would determine why enrollment in CES doubled. So just to give you an example of maybe how I would go about that process is I would want to talk to HICPUF to see enrollment numbers, administrative data, ideally sort of hard data, not things that have already been interpreted or summarized, you know, really starting from the ground up to ensure those numbers are accurate. I would also want to look at what's going on in other states. So are other states also experiencing high levels of growth, or is this something specific to Colorado? And then I would want to look at both the policy and sort of departmental decisions made during that time period to see if anything correlates with the increase in that enrollment. So I think getting the data is the first part of it, and then there is additional work needed to contextualize and understand what that data really means. and I'd like to pass to Dr. Goldberg if he has additional feedback on that question.

Goldberg. Thank you Madam Chair. Thank you Senator Krookmeyer. So I think just to elaborate a little bit on what Dr. Krook says I mean I think one of the advantages the Farley Center would have as being a technical advisor is we can leverage existing relationships that we have with HICPF but we're also not legislators right and so I think it's possible to use that in ways as we get down to brass tacks. I mean, that's what's happening, obviously, with this report in the next six months is really trying to nail down what are the recommendations that need to come out of the changes that are coming. We are in an ideal position based on previous relationships that we have with HICPF, but we're also not too close to them to be able to serve you in this capacity to find out what's the information, Senator, that the commission needs that you haven't received in the past, and how can we go about getting it? How can we partner with HICPF to make sure that the the commission has the data that exists, that is needed to make the decisions, or of course to identify if the data doesn exist can we go get it in the time that we have to complete this report Okay Senator Kirkmeyer has a follow and then we gonna go to Rep Room Yes and thank you

The data that I talk about with regard to the Child Extensive Services, the CES, that's doubled from 23 to 25, it's in our budget documents and it was received from HICPUF and so the data's there. I already know what the data is. I don't need you to go research the data. I need you to go research why it doubled. So I think we're to step three of what you just said. Would you agree with that? Step three was you're going to go research it. I don't need to know what's going on in other states. I want to know why in Colorado that population doubled from 23 to 25. Were there rules and regulations that changed? Were there benefits that changed? Was there a statutory change that happened? Because I couldn't find it. So that's what I want to know.

Thank you, Madam Chair. Yes, if you believe that the data are accurate and already there, we would then sort of conduct the later steps of that process. So, again, let's look at other states. Did they also double or is Colorado a huge outlier here? Let's look at different legislation or policies that were passed during that time. Is that potentially a factor in what happened? Can we look at the data sort of month by month and see at any point is there sort of a large jump? That would mean we need to look more specifically into what happened around that time period. And then considering all of that, come back to you and say, here is what we think happened to cause that jump from 2023 to 2025. Not just this is the jump.

Thank you, Madam Chair. Thank you for those answers. that one of those questions was one of mine too. So Senator Kirk, my stole it from me. I don't think so. My question is, in your opinion, what are the biggest drivers of Medicaid growth in the state? Would it be enrollment, policy-driven benefit expansion, hospital billing practices, or bad actors? What, in your opinion, do you think is the biggest growth in Medicaid in the state right now?

Thank you, Madam Chair. Sure. So I think if we were to be selected, we would want to work with the commission to get sort of more solid data on this. But some things that come to me top of mind are, one, that health care growth in general is still rising. So Medicaid is particularly growing very fast, but other segments of the health care market are too. So both commercial insurance and Medicare Advantage, for example, are also rising year over year at similar rates to Medicaid or in some cases even higher than Medicaid. So for one, I think this is a national issue and it is made particularly salient in Colorado with our budget challenges and with Tabor. I think number two is actually that Colorado has been quite generous with its benefits in recent years in comparison to some other states, which I don't necessarily think that is a bad thing at all. But it means when our budget gets more constrained, it is harder to maintain that level of service. And then hopefully as part of the evidence synthesis gathering part of this commission, we would sort of get more detail on if there are specific services, you know, perhaps long-term supports and services or certain behavioral therapies that are specifically driving things. But we would really want to dig into the data to get a better idea of what are driving, I think, those two kind of components that I laid out.

and that word has been bandied about quite a bit here in our conversation today. And that's all well and good. And we've also heard a lot about data and data-driven, and more data and driven even further with data. So, and that's important. I'm kind of a data geek myself, but one of the issues that I think that we are really struggling with in the state of Colorado with Medicaid, and one of the reasons we're sitting here, is process. and so I would like to hear from you. You're not using the word data because this isn't about data. Process is not about data, and we have had some very significant breakdowns in process within the department. how do you envision going about identifying those issues and bringing them to light?

Thank you very much, Madam Chair. So first, I would want to talk with you all. I would want to hear from you what questions you want answered that you're not getting answered. I then would want to talk to different folks and leaders within the department to see their opinions on the matter and why they think these questions are getting answered or if they think they are getting answered and there's a miscommunication between what you need to make your decisions and what they're providing. This could potentially be a commission meeting sort of topic to get everybody in the same room and let you all sort of talk about what you need from each other and then develop a timeline and a process for actually getting that information and having those conversations. So we will help the commission, if selected, develop, again, a commission meeting schedule and priority topics. And if one of those priority topics is determining what the process needs to be or what process changes need to happen to get you what you need to make decisions, that certainly is something we are happy to work with. And we have experience in facilitation for really complex or contentious topics that could help us get to a final solution in a productive manner. I would like to pass to Dr. Goldberg if he has anything to add.

Thank you, Madam Chair. Thank you, Senator, for the question. Just in short, just trying to cut through some of the academic talk as well. What I'd say is, you know, the teams with which I'm involved, especially with facilitation, you know, we are pretty good at fixing things is the bottom line. Because things will break. Things will happen. Sometimes it's in our control. Sometimes it's not. But we're pretty good at finding the bugs in the gremlins. And that's really what we would do. And there's lots of processes we can talk about, like, specifically how we do that. It's not an unstructured process, but we are good at that. That's what we do is sort of error correction. And so what we would do is sort of sit down and figure out, you know, where are the gremlins? What has been breaking the things that are being broken in terms of these process? And then, you know, how can we set them right? How can we fix them?

Rep Taggart. Thank you, Madam Chair. Just a specific to follow up. to the senators, because I was one of the people that posed the question. When it comes to our CES waiver we have growth you folks know better than us in our children population somewhere below 2 more like 1 And yet we're doubling in enrollment in that area and costs. And we asked a simple question. What's happening here? How can we have such limited growth of children in our state and these costs are going through the roof and enrollment is going through the roof? Absolutely no answer. That was just as specific as a follow-up. But my questions, first off, I really like your concept of the critical review of potential recommendations. I have to tell you I'm worried about the timing because if it's a simple tweak of a recommendation, that overlap will work. if it's a major recommendation that comes at the very end that is not a simple tweak to get it to be not to have the unintended consequences that you pointed out, we've run out of time. And so I hope you're thinking about that from a standpoint, in my humble estimation, those should be almost on the exact same timeline. So we have time because if it's a number one recommendation, I know I would like the opportunity to ask you, what can we do about this? Because we've all pointed out this is one of our highest priority recommendations. And so I'm a little worried about the timing.

Thank you, Madam Chair, and thank you, Representative Taggart. The dates that we have laid out in our proposal are highly flexible and tentative. So if we would like to extend the recommendation evaluation process, that is certainly something we can do. And that process will be continuous and iterative. So as soon as you identify potential recommendations, for example, we will engage that team to start evaluating them. We don't have to wait until we have, for example, the full set of recommendations to do that. We will also make sure this team is receiving all of the commission materials and the background materials so they are briefed on what you're discussing and ready to go with that recommendation evaluation process when we do that. But again, we could certainly move that timeline up or extend it, as well as, again, the iterative process of as soon as you have something you would like them to look at, we can start engaging them. My second question is around your budget.

We have to live within a half a billion dollars. and this isn't the only cost associated with this commission, if this were to go anywhere beyond where you folks are today, we're in real trouble. And that was a half a million, not billion. Oh, did I say a half a billion? I thought you did. Oh, maybe I did. I'm sorry. I just want to point that out. We have to live with that. Gosh, for a person that's usually pretty fiscally responsible, I'm sorry for that. If we had that kind of money, we would have this commission. So I'm concerned about that. I also will needle you a little bit. One of your competitors is willing to waive the indirect costs. I would take a look at that. Hi. Dr. Crook. Thank you, Madam Chair.

Okay, that's a fair answer. Are there any other questions? And I don't see any. So thank you very much. I appreciate you being here and appreciate the proposal and all the work that's gone into that. And thank you. So next up, we are going to hear from Alnisa Washington from the Ezra Blaze Global Solutions. Okay. Oh, there you are. Good. Okay. Ms. Washington, the floor is yours. You need to turn your...

Okay. Committee members, do we have questions? Senator Kirkmeyer. I'll just go ahead and ask my question again. Yes.

Sure. Okay. Senator Perkins. Yes. Yeah. I'm just saying your name so that all of our listeners out there in the Ethernet know who's talking. Okay. Okay. Senator Kernmeier. So I would ask questions.

You're welcome.

Ms. Washington.

So for me, success at the end of the project looks like our community will be better off, where we can reach out to the rural communities, because I know a lot of the rural communities, they don't have access. Or if they have access, they have to travel. They are having to travel at least two to three hours just to get to a local office. and my solution to that is to have access even if we have to put a satellite agency or maybe have have some of our workers go to those areas at least once or twice a month in order to speak or take applications for our Medicaid recipients So to me that a success because we able to reach more people We also able to minimize the travel time and frustrations because when they get frustrated they don't apply for Medicaid and they wait too long. And then their issues, the community, their issues will become dire instead of something that could have been taken care of from the very beginning.

Okay, thank you. Any other questions? Rep Taggart.

You're welcome.

I appreciate that.

Ms. Washington.

Okay, thank you so much, Representative Taggart.

Any further questions? Seeing none, thank you so much for being here and for coming from the Western Slope. We appreciate that. And we will move on to the next person. Again, thanks for being here.

Okay, next up, we will hear from Elizabeth Baskett on the proposal from Baskett and FTI Consulting. Thank you.

Committee members.

Ms. Baskett.

Yeah, Senator Mullica. Thank you. And I guess I have two questions as follow up with that. one is FTI they're not they're not based in Colorado I take it they are I'm sorry mr. chair they are not go ahead I'll let you finish yeah and so if they are not with the number of meetings that we're looking at with I think and I don't think I'm speaking for myself on this commission but I think that you know all of us are committed to being very hands-on with this process with them not being based in Colorado, do you foresee that being, there being any issues with that, you know, and with them, you know, and I was able to do the calculation, you know, you would account for 660 hours of your firm or what you would do, and they would account for 840 hours. And so having a firm that is doing the majority of the work not being present in front of us, you don't think that there would be any issues with that?

Madam Chair and Senator Mulligot, your questions are great. I was afraid that I would see a bunch of national firms applying for this position. I was happy to see so much Colorado people who are local. FTI, I'll tell you, Ann Winter is a colleague of mine. We worked together in Arizona. She worked inside of the Arizona Medicaid Department. At that time, Medicaid had the lowest per member per month rate in the country. It was a well-run Medicaid department. than she worked in the governor's office. And since then, she's worked in UnitedHealthcare for CVS. She has a really diverse skill set, as well as Scott. He's more on the finance side and the fraud, waste, and abuse side. To answer your question, they'll happily be here. We factored in their travel into our budget. And they are the experts. If that is the direction you want to go, if there are issues that they have expertise in that you think you'd benefit from, we'll bring them here.

Would you prefer I ask it, Madam Chair, or just wait until she answers that? Whichever you would prefer. All right, go ahead and answer that if you don't mind.

Rep Sirota. Thank you, Madam Chair. I guess I will just – I ask this of another applicant as well. My concern stems around a little bit of the, I want to make sure that we are getting the very best information possible and want to ensure that our facilitator does not have an agenda and that the entity that, you know, is able to really work for us and doesn't have other financial motives. motivators and so whether that is you know being a recipient of Medicaid dollars or some someone who has you know maybe it's a separate question of somebody who has shaped a lot of the programs that we now have in Medicaid but I also have you know concerns about hiring a team where you know somebody is also lobbying us on has other clients related to Medicaid so I am curious how you might address that I know your application said there you

Thank you, Madam Chair.

Yeah, so Senator Amable Reps wrote up, Megan was very nervous about being part of the proposal. I asked her to be. And she has said that she can remove herself if it makes you uncomfortable. We just are committed. We just want you to have the expertise you need to be effective in this endeavor. If we need to remove Megan from our team, we will. Senator Kirkmeyer. Thank you. Thank you, Madam Chair. So you've heard the question about my frustration. and I think others that we don know what we don know kind of thing So specifically with regard to the CES population doubling between 23 and 25 the data good It's in our JBC documents. Eric Kurtz is sitting over there. He's the one who compiled it and got it from the Department of Healthcare Policy and Finance. I don't need you to go research the data. I don't need you to tell me if it's correct or not. I need to tell me what you would do to help us find out what the heck happened between 23 and 25 that that population doubled. That's what I want to hear specifically, please. Thank you. Ms. Baskett. Senator Mobley and Senator Kirkmeyer, I heard the hearings, and I just want to commend Eric and Tom, as you're at JBC staff, for doing their absolute best to give you the information you were asking for. It's a difficult question, but there has been policy changes at the department over the last several years. There's been the case management redesign. There's been the single entry point move. I think it's important to take a look at those policies. There's been expansion of benefits and eligibility. I think there's probably multiple factors driving the increase, looking at the impact of those policies. And then I also think it's really important to talk to the boots on the ground, our provider network, our consumers that are experiencing the program and accessing the services, the case management agencies. I'd love to hear what they think, the employers of home care workers. Now, we can't trust their information as gospel, as necessarily truth. They may have their own perspectives. But I think it's really smart to hear from everybody who's been living and breathing this system. And I think that's what was missing in the conversation. Also, I want to note that there's another data source called the All Payers Claims Database that you're familiar with. It's not perfect, but it's one of the strongest in the country, and I'm kind of proud of it, but it has Medicaid claims in it. But I'm hoping we don't have to create the situation where you have to go around the department to get your answers. And many of us are excited about the change in leadership, and we think that there is an opportunity to rebuild and to get answers and to get information. and I think part of the success of this group could be getting you in earlier in the budget process. So when I worked at HICPF, we all submitted our ideas. When it became challenging and we needed to cut, you can be included in that process earlier on so that you're not looking at a final set of recommendations that make you all very uncomfortable. Not that they're not all uncomfortable. This is an incredibly hard time, and you're going to have to make incredibly hard decisions. But I do think there's an opportunity to bring you in earlier. But it requires a deep dive, a really deep dive. And I think that's what you're all here and committed to do. But we'd have to learn more about the bizarre world of Medicaid and really dive in. And I think there's an opportunity for you to do that earlier in the process. Okay. Rep Taggart. Thank you, Madam Chair. I'd like to follow up on Senator Mullica's question, and I think I'll be even more specific. Because the budget, again, we have what we have, and you folks are already up to taking virtually 80% of that budget. and yet you have a statement in here that you don know the assumptions having to do with travel I think we need to put the assumption very clear I one that has to travel 250 miles to be here I expect all members of this team, whether it's FTI or yourself, to be here for every single meeting. No exceptions. No virtual whatsoever. If they're going to participate with us at the level that we need participation, they need to be here. And we can't afford to go beyond what you've already put down here. And unless you can make that very specific commitment, I can't support your proposal because I'm not interested in dealing with people in Arizona. They need to be here. Senator Mabley and Representative Taggart, I've heard you. We weren't sure what extent you would want our national experts here. They are excited about this opportunity. I think you'll find there are Trevor Trove of knowledge and expertise. They will be here for every single meeting. We're happy to commit to that. We don't need to change our budget. We are happy to serve you and make sure that I understand. You want us all here, and so we will be here. Okay. Are there other questions? I don't see any. So thank you very much for the proposal and for being here and appreciate all the time you put into this. Thank you for your hard work and good luck. Thank you. Okay. Next up, we are going to call up Christy, I think it's Brayton, but it could be Broughton, I guess. Broughton. Okay. I like ba with an R. Ms. Broughton.

Okay, thank you. Let's see. I think Senator Mullica, and then we'll go to Rep Gilchrist. Thank you, Madam Chair, and thank you for this presentation. I really, it's very thorough. I appreciate the questions that you have in there already laying it out. I appreciate you talking a little bit about what you think success is. One of the things I wanted to hone in on, though, that I found interesting is really kind of the outreach that you're talking about in regards to, you know, you have 10 trips to the Denver metro area, which I would assume is maybe, you know, Colorado Springs, too. But you also have 10 trips to the rural frontier area. And I just wanted to see if maybe you could describe what you think those would look like. And I guess a follow-up to that would be with that, with your vision of what those would look like, would you ever envision that maybe on one or two of those meetings that the commission actually go, attends one as well? I know there's a number of commissioners or a number of members of this committee that are not from a frontier or rural county to here. And so I guess I want to hear your vision, and a follow-up to that is with that vision, would you ever think about having the commission or the members take a field trip as well and hear from some of those folks along with you? Thank you so much for that question.

And then Senator Kirkmeyer. Thank you, Madam Chair. And thank you for the extensive proposal. I also really appreciate the focus on outside of the Denver area, even though I represent part of Denver. I think it's really important to get that feedback. But curious, we've had a handful of proposals that have come with sort of institutional backing and capacity. And so wondering if you could talk a little bit about how you envision doing this work with the two focused people, yourself included, and how you would kind of draw on national experts and how you would make sure that this, as we've talked about extensively, this is a huge undertaking, and how you envision you and your colleague being able to accomplish all of that. Ms. Broughton.

Senator Kirkmeyer. Great. Thank you, Madam Chair. So I appreciate all your comments and your thoughts so far. So, but here's the thing. This robust stakeholder process that you put in place, it's not because I don't want to hear from stakeholders. It's a little concerning to me because I'm concerned after sitting through for the last couple of years being lobbied on a pretty regular basis, almost daily, into the middle of the night sometimes it felt like. How do we reconcile a whole bunch of great ideas that we can't afford with the budget that we have? Because the reality is this. We actually did not cut our Medicaid funding in the state of Colorado. It actually got increased. We cut the potential increase, but we didn't actually cut it. We got like a 3.6% increase or something of that nature when they thought it needed to be like 11 or 12% increase. So I'm more interested in how do we make sure that we don't get a bunch of ideas, one, that we can't afford, two, that they're thinking that this is a lobbying session to tell us how bad they need their program and not come in with ideas about what we can actually cut and what we actually have to keep. And how do we reconcile that with budget cuts and administrative efficiencies and operational performance? Ms. Broughton.

Can I follow up? Senator Kirkmeyer. So when you say their voices weren't heard, are you talking by the department during rulemaking process?

Again, how are we going to reconcile that with the budget?

Rep Serona. Thank you, Madam Chair. I think I share Senator Kirkmeyer's thoughts there, just questions. And this, your proposal is very heavy on the sort of stakeholder engagement, which I do appreciate, I think, you know, to an extent, because I don't want it to become a grievance process. We receive those grievances, and I think it is, and I think buy-in is important too, but also, you know, to the senator's point, we have been lobbied by all of these entities too about what they think and what they want, And so I like this portion of your proposal. I do wonder, though, what, you know, Rep Taggart has brought up a few times being able to bring in national expertise, and I appreciate your expertise in the state of Colorado. But, you know, so we are also we are trying to understand on the ground what is happening, what is working, what is not working, but also what are other states doing? How might this work better in Colorado? What are things that we can do and change? and I wonder with the two-person team that you have put together, how do you envision being able to encapsulate not only this stakeholder process but also what is happening across the country? What are other states doing? How are they approaching these same challenges that we are facing? Ms. Broughton.

Senator Frizzell has a question. Go ahead, Senator Frizzell, sorry. Thank you, Madam Chair, and thank you so much for your presentation. It was very, very detailed. So I actually sat on the Property Tax Commission, and we did a similar, so we engaged a facilitator, but we did do kind of around-the-state world tour, listening tour, and that was very, very valuable. And ultimately, but it's a fine line to walk, right, because you have to avoid trying to create the impression that people are going to get more because they're asking for more or fill in the blank of whatever opinion that they have. I think a better way, and this is just my opinion, is to couple that listening to also educating and helping people understand the realities of our situation and perhaps even asking them for their feedback on what they think would be a better solution. So that's kind of my two cents on that. And I really, I look at this work that we are all tasked with as, I've described it as Herculean, because it is. This is a very, very heavy lift and quite daunting because I share your belief in that, you know, the ultimate goal is to make a better world for those Coloradans who are on Medicaid And we have to do it within a budget that has constraints So I appreciate that, but I worry that there isn't enough staff for you to be able to help us to the degree that I think we're going to need help. And that's kind of a question somewhere in there. Wouldn't you agree? That's the question.

Okay. Rep Taggart and then Senator Kirkmeyer. Go ahead. Thank you, Madam Chair, and thank you, Ms. Bratton. This is, in fact, a very detailed presentation, and I appreciate it. But there are components of it that make me very anxious, and I'm going to point out two or three of them. One, on page five, your last similar project, When you make the statement that you help the company, but the company is to remain confidential, that is very concerning to me, that that company has to remain confidential, especially when they're in an area where we have had significant growth, that being LTSS. So that worries me that that statement is in here. Secondly, when you go through the questions, I can't help but go through a series of questions and look at it also from a priority standpoint. And the very last set of questions has to do with sustainability and financing. And in our mission, that is one of the most important priorities that we have to address. And if we put it at the very end, I am worried what we're communicating to stakeholders and then to our final recommendation. That is an absolutely critical component and is a part of our mission, and it makes me uncomfortable its last. And then I appreciate stakeholder engagement. I truly do. I come from a business that we did a great deal of that. But a stakeholder engagement is only as good as you set it up. And one of the key components is your objective And nowhere in your objective is there anything stated about fiscal sustainability And if you don't set up those stakeholder meetings with a serious expectation that we have to live within our means, whether we like it or not, we have to live within those means, and so too does our federal government. And if that isn't in your upfront statements, if that isn't part of the objective, what you're going to get, which you said you wouldn't get, but I believe that you will get, is a series of more things that our stakeholders want us to do and we can't do them. Now, can we do them if we were to say no to some programs that are not necessarily effective today? The answer to that is obviously yes. But I don't see that in the setup of these stakeholders. And from one that has done a lot, it is worse, believe me, it is worse to do stakeholder engagement and not follow their recommendations as compared to never doing them at all. Because the people go away saying to themselves, why did I waste my time? They didn't take any of my recommendations. And so setting that up, and mind you, you already did 50 pages, so I understand that. And maybe I'm making a statement for the future, but that has to be, the fiscal responsibility has to be, if there's a 1A and a 1B, it's in one of those two. Because that's the reality of our budget. And it's the reality of our federal budget as well. Thank you. Was there a question in there, Rep Taggart? No. Okay. Rep Brown. Thank you, Madam Chair, and I want to thank you again for a really comprehensive proposal and for your engagement on this. One of the questions that I've had, and I kind of asked a similar question of another applicant, is it seems like your work is more specific to long-term services and supports, And that's a really important area of Medicaid, especially as that has been a key area of focus in terms of cost drivers. I also want to focus this, make sure that the commission is going to have questions, and I think we've already heard about it in previous meetings, about what is the structure of the way that we're administering the Medicaid benefits? do we have the right sort of contractors in place, the right people, the right MCOs or ACOs or whatever we're dealing with. And so I wonder if you could speak a little bit more to, you know, when it comes to sort of broader Medicaid policy and trends, how you can be, how your experience is either a help or a detriment potentially to your application. And then I would also just ask a little bit more about sort of the data analysis skills. Again, I think Rep. Sirota mentioned this or your focus on the stakeholder engagement process. Very important that we hear from stakeholders But I think that this is Medicaid in particular is very data heavy it claims heavy and it requires a real focus on that kind of analytical capabilities And so I wonder if you could speak a little bit more to that as well.

No, that's fine. I was just going to ask if you could speak to... Oh, Medicaid versus long-term. I'm so sorry. Yeah, sort of your specific experience and whether you can still speak to the broader sort of policy problem that we're facing, which is well beyond how we administer or design particular benefits within the long-term services and support space.

Some of your data analysis. Oh, data analysis, yes.

Okay. Senator Malika. Thank you, Madam Chair. Just a quick follow-up hearing you talk, because I do think that it was a valid question around the size of your firm and whatnot and the project that is before us. But I would love to hear kind of your vision or what you envision your relationship to be with the staff that is serving this commission as well. I know that there's a lot of research going on on that side as well. And so just wanted to give you an opportunity to kind of speak to that because that kind of came to mind when I was hearing some of your comments.

Okay. I don't see any other questions, so thank you very much. We appreciate all your time. We did go way over. And next up, we will hear from Summer Gaither-Cole, who I see has arrived from the airport. I'm not sure how long you've been here. We're asking people to sort of briefly give us an overview, and then we'll do what we were hoping to do around 15 minutes of Q&A. Go ahead.

Okay. Committee, what questions do you have? Senator Kirkmeyer, I'm going to just jump ahead. and you can, because I know you have a question.

Sure.

Thank you.

Thank you. I'm going to start with, I think, the question that you have been asking most often, which is, how do we find out more about the data? Because as you said, you have the data, correct? And I think this is where I will probably be a little bit candid, more candid than maybe I should be, in saying that this is where it comes down to relationships, right? As a former state employee, I can tell you that there are, of course, things that I was allowed to say, that that was not allowed to share. I think this is where the relationships come in of knowing others across the executive branch and state government to say, can we talk about what's going on and how do we make sure we find a way to get you the answers to some of your questions if they exist. I'm also a former CPA, so I love digging into numbers, geeking out on spreadsheets, figuring out the budgets, figuring out where there's other opportunities. I will also share that as part of the work with the Behavioral Health Task Force. We did a lot of work to uncover opportunities for additional federal funding that we could draw down across the board. It wasn't specific to Medicaid or HICPF. And what I would say is that for capacity reasons, we never got a chance to pursue those. And so I think those are other opportunities for us to say, how do we make sure that we have the capacity that once we're aware of those opportunities, that we do take advantage of them. Thank you.

I still have a question, though, if I could manage it.

I am concerned on page 13, when you point out your disclosure of relationships, that you are disclosing that you are an existing contractor with the department. And we're going to be posing questions to you that are going to put some of those people on the spot. How are you going to deal with that? Because that, to me, is a concern.

I am on the approved vendor list for HICPATH, So meaning that any time, I believe it's over the next three to five years, I have the opportunity to respond to RFPs that they submit. I'm not currently under contract with HICPF for any work. And throughout the duration of this project, should I be fortunate enough to be selected, I will not accept any work from HICPF.

Thank you, Madam Chair. I think I noted in your proposal, you're a firm of 10 people, and you would be the facilitator, though you said there are other people who could step in if you were not able. But, you know, I think the group is looking for some continuity here, somebody who's in it with us for the long haul. Do you have other contracts, or are there other things that you would anticipate might draw you away from being able to commit to this process and have to utilize other staff?

Thank you so much for the question. So just to give a little bit more background, my firm was established in 2014. So except for the leave of absence where I left to lead the behavioral health task force, my consulting firm has been around since then. The beauty of being the managing director of the firm and the founder is that I get to choose which projects I want to work on. And so if I was very fortunate enough to receive this work, I would move around some of my other projects to make sure that I could focus on this work. The reason I put that in there around if needed, we can lean into other people on the team. There is a team of 10 people that I work with. I do have a two-week vacation scheduled in October. I am planning to work during that time, but I could not be here for an in-person meeting because it is overseas. So that's really more of a, that's the backup if we need it.

Thanks. Thank you, Madam Chair. And thank you, Ms. Gathercole, for your application and for your presentation today. I guess I would ask a similar question that we've asked some of our other applicants, which is just, you know, how will you and your firm be able to connect us with the kind of data and expertise outside of Colorado that we might need? Obviously, you have deep knowledge here in Colorado, but you know we're we I think should be looking at other places and so I'd be interested to know and sort of how you your expertise and your connections will sort of benefit benefit the commission work in terms of best practices nationally Ms Gatherkall

I'm gonna add some additional context to one of my previous answers and answer that question. In terms of just questions around capacity, I know that when I stepped in to lead the behavioral health task force, I was a team of one. And I will tell you that everyone laughed at me and said, you are never going to make that happen. My response was challenge accepted and we did it. I did end up stealing an administrative assistant to help out along the way which is why you see the coordination assistants here written in the proposal but I just want you to know I do not have any concerns about taking on this work and doing it. Part of the work that I did the behavioral health task force in multiple areas along the way was actually reaching out and doing research on other states, talking to other states at times, having other states come and present either in person or virtually, depending on what the timing was, given that this was also during COVID. So I don't have any qualms about reaching out, conducting analysis, conducting best practices. Again, I feel like I have enough contacts across the system to be able to make that happen. The other thing that I have found in some of my other work that is also really useful is that If we're going to summarize that information and share it with the commission and share it publicly, we also go back to the people in the states that we talked to and share it with them so that they can take advantage of that as well. It's a great way to thank them for the time that they're spending with us when we talk to them one-on-one.

Thank you, Madam Chair. I motion to select SHG as our technical advisor with scope discussions to make sure that it meets our expectations of this commission.

I've promoted you. Thank you, Madam Chair. Just quickly wanted to, as a member of the commission, thank all those who came in. I think that it was really productive and just appreciate the presentations that we heard today and being able to read all of these And I think hopefully everyone agrees we want this to be successful But I wanted to be on the record just because it was a long day of interviews to thank the folks that did come in and spend the time to present to us And I found a lot of value in it. So thank you.

Senators and Representatives, Barone.

Bridges. Aye.

Gilchrist. Yes. Kirkmeyer. Aye.

Taggart. Yes. Brown. Yes.

Yes. That passes unanimously.

I think given the time, it might just be me today.

Thank you, Madam Chair and members of the Commission. It's a pleasure to be here with you today, and I have appreciated listening to your deliberations in your first meeting and then today. We did provide a slide deck. I am not going to go through it. And so I want to use that just as background information, really to answer the question that I believe we were asked. which is what have I been up to in the last 10 weeks since I've been at the department? I will first take a little bit of a minute to just introduce myself. There's a theory of leadership around this. There's people, there's the role they play, and then it's the systems they work within. So I am a native of the state of Colorado. I was born and raised here in Denver. I come from a long family of service. My grandfather was a doctor. My grandmother was the nurse. My father was a physician. and my mother and all of her sisters and my sister and cousins are teachers. So when I had the opportunity to think about coming back to help during this time, it's really that history of service and my commitment to service that created that opportunity. So I'm pleased to be here with you today. I wanted to just highlight one of the other things I've had the chance to do since I left the state eight years ago, and that has been to work nationally. I worked in my own firm, which I called the Public Leadership Group, where I helped with public sector leadership development for public sector leaders and consulted on health and human services programs. And then for the last 20 months prior to coming back, I was at Mathematica, which is a national policy and research and advisory services firm. So I hope to be able to share and am deeply agreeable with what you all have asked, which is what are other states doing and how might we learn from them? So when I think about what I've really been up to since being back, it's been reacquainting myself with the program. The program is quite different than when I was here eight years ago. It's been through a public health emergency. It's been through a series of growth. And it continues, though, to have some of the same cores. And that is the people that we served. I really appreciated Summer's perspective around focusing on the people. So what we included in the deck was information that you all get every month. And that's through our caseload and expenditure report. But what we tried to add was some information behind that information that some of the questions that you asked or contemplated in your first meeting like what services are people receiving What the unique delivery system or the way members connect to care? And what would be the implications of the financing as well as HR1? So those slides were really provided just to bring those members and their services and experiences to life. We also wanted to provide an update on our providers. You might see the incredible growth of the number of providers, which is something that is really something to be proud of. There are lots of opportunities for members to access needed services and supports. It has also created a challenge around program integrity and the opportunity to really understand if all of the providers enrolled in the Medicaid program are representing themselves appropriately. The federal government has asked us to do a revalidation plan. We responded to that plan and will be over the next two years revalidating a series of providers that have been identified as being concerning or high risk. The next thing I wanted to talk about was our program integrity approach. I think of program integrity in a broader framework than just fraud, waste, and abuse. It really starts with are we sure that the people who are enrolled in the program are appropriately enrolled? Are the providers appropriately enrolled and credentialed? And then are billing manuals and other areas clear enough so that providers know how to engage in providing services to members? And then lastly, are we looking at fraud as one issue, waste as another issue, and abuse as a third issue? Those often get smunched together as if they're all one thing. I would say, from my perspective and my work across the nation and in Medicaid, those are quite different and need to be thought of differently. So I will stop there because I know one of the things is, one, I can talk fast, and I would like not to repeat that, and also know that one of the things you all wanted to do was have the opportunity to be in dialogue. So I'll stop there. That's where I've been spending my time, and I'm pleased to be here with you today.

Senator Mullica. Thank you, Madam Chair, and thank you, Director Hammer, for being here today. And I would agree. I'm hoping I know that we're going to be short on time today, but would love to see you before this commission again so that we can keep this dialogue going, because I think it's really important and appreciate your willingness to do that. Just I guess I wanted to get on the record because we are starting this process. We just you just sat through this whole process that we went through to pick someone to help us through this is I would love to hear your commitment as the director of HICPF in this, because I think what we've heard as policymakers, I think what sometimes we've experienced in the past with this department is that we haven't gotten the information that that we need to be successful to make the policy decisions. And now we have this commission coupled with, you know, working with some outside folks. And so twofold. One, would love to hear your commitment on working with us to get all the information that we need to make policy decisions, big policy decisions, big reports that are coming. And then I also wanted to make this a twofold, too, and kind of hear your perspective, because I believe it was Senator Kirkmeyer brought up earlier. Really, I think our lack of sometimes working with our locals, our counties, folks who are administering these programs, and your commitment to that as well to make sure that we are bringing in all of that. So just wanted to give that opportunity for you to address and hopefully be in line with what we're hoping for as well.

Thank you, Madam Chair and Senator Mullica. So I have been very clear with all of the stakeholders I've had the chance to talk to and the staff at the department, that is our expectation that we engage and collaborate. That is the those are the two words I keep repeating because I think it is only our responsibility to do so It is incredibly important that you all understand the Medicaid program and the Child Health Plan Plus and the other programs we administer to the extent that you need to to make good decisions That is our core responsibility, I believe. And I think it's the way that we work and really make democracy happen. I actually really enjoy spending time at the legislature. I enjoyed it when I was in the Medicaid director position because it is the place where we work together to meet the needs of the people of Colorado. So you have my commitment to engage and collaborate in whatever way you all need me to. If that's me personally more, if it's staff, I also heard, I think, during my confirmation hearing that people would perhaps like to talk to other staff in the department. You have my full commitment to make that available as well. In terms of county and community engagement, that has been a hallmark of my career working here in Colorado. I spend part of my time in Route County, Colorado, so I'm also making a drive in, sir, and I spend other times here in Denver. So I am flexible and able to be wherever you need us to be. I've also asked the staff to help me with a couple of community visits around the state. I was in Weld County and in Greeley on Monday. I look forward to being in other places, trying to just connect with the breadth of the people that we are working with, from counties to our regional accountable entities, one of our major service organizers, and then other local providers, the federally qualified health centers and others.

Thank you, Madam Chair, and thank you, Director Hammer, for being here. I appreciate you, and I appreciate your renewed leadership at the department. I think you've heard a lot even today about some of the challenges, mistrust, certainly that legislators have right now. I think you hear that also probably from some of the stakeholders that you engage with on a regular basis. And so over the last 10 weeks, I'm sure you've had a chance to engage with some of those folks. I'd be really interested to know sort of how you are going about your work right now, trying to rebuild trust in the department. Obviously, at the JBC, we have felt challenged by some of the data and information that's been put forward. It is hard to feel like you're being led around with a particular set of messaging or facts, and you don't have access to the same kind of information so that you can make a shared decision, if that makes sense. So I'd be interested in sort of how you're approaching that work and how you plan to continue to engage with the community in sort of rebuilding the trust in the institution that we all believe in that you lead now.

Yes, thanks, Madam Chair. Representative Brown, thank you. I used the phrase when I came to the department that my first phase of the work of my opportunity to serve would be called respond and repair. And that that was really the framework under which we would operate, especially as I came in on April 13th, when we had, I think, five weeks left in the legislative session, that we would be responsive and we would be repairing. I shared that one of my goals was to take down the tension and temperature. some dynamic tension is natural it has to happen but as I have interpreted and been told the tension was so high it became unproductive And that's not where we need to be. And so part of the reason, again, we supported the concept of a Medicaid commission because we would genuinely like the opportunity to sit in these kinds of meetings and collaboratively understand what we're looking at and seeing in the Medicaid and CHIP program. So respond and repair. And then phase two is hold and improve. So, you know, I know that the Polis administration is in its final months and the next governor will have a point of view on who should lead the department. And so while I am here and in this role, respond and repair, hold and improve, and try and find where we can stabilize and have opportunities for improvement. So those are the two frameworks that I've been operating under. And again, also part of the reason that I've been doing and working with my staff to try and find opportunities to go out and visit communities. I'll just ask, because one of the things that we here have heard consistently is that decisions get made. and then whoever they impact gets told and they didn't see it coming and we certainly heard that on the Joint Budget Committee a lot but also now just in the last week or so we heard that the C-SNPs are getting cut by 20% with no notice

Yes. Thank you, Madam Chair. And I'll speak specifically to that issue, although Director Bates also can share deeper into that at your next meeting because I know we're short on time. We made a mistake in that process. We had some authorities that were expiring, and they were expiring soon, and we needed to act quickly. And that led to that abrupt. And so that was a mistake on the part of the department, and we will work hard to make sure that does not happen again in the future. We will hopefully continue to partner with everyone impacted by that mistake to make sure we can move forward together. But that was an authentic mistake on our part, and we'll work harder next time to not make that happen. To the larger theme of us not being engaging and responsive, one of the things when I had the chance to work nationally, the commitment to stakeholder engagement by the department is extensive. the number of standing meetings we have, the member of services advisory committees, et cetera. So we have a lot of formal ways that we engage stakeholders. I am hopeful and have participated in some of those during my respond and repair time and have found them to be productive. But we have to continue to always make those productive and meaningful for the people participating.

Thank you, Madam Chair, and thank you, Executive Director Hammer. I had a, you may have heard, I had a good discussion this morning on the exception process that we work so hard at JBC in terms of finding a way to help our IDD community, and in particular, those parents that are in situations where there just plain aren't providers available. and I appreciate the conversation but what I don appreciate is we now getting out a communication in the next week to a change that's going into effect effectively July 1st. And I don't understand for the life of me what happened between the budget sign-off on basically, what, April 7th, April 8th, in that particular situation. And now, and I was told that the medical board got together last week, but why such a delay in that group evaluating this situation? Because I'll just speak for myself. I only accepted the modifications of ours based on a robust exception process. And if you listen to constituents right now, you're not going to believe the stories that are out there, including to say the department has come out and said there will be no exception process. and that's what happens when there's a void in communication is that people fill in the blanks and you don't know what blanks they're going to fill in.

We'll let Rep Taggart have a follow-up, and then we'll go to Senator Kirkmeyer.

Ms. Hammer. Yes, thank you. I am hesitant to say 100% it is renewable. However, it would be shocking to me if it is not. So I don't want to be wrong, but it would be my expectation, given the way the policy is structured, the phasing in of the moving towards the 56-hour cap, that we would not recognize that in certain situations, individuals' needs do not change, the complexity of their needs do not change, and providers have not probably moved in So you would have my 90 commitment that it is a renewable process We can confirm that as soon as I have the chance to

Well, this would be the exact frustration and the issue that we have or that I have with the Department of Health Care Policy and Finance, because we went through this all over, I mean, from January through April. We were told there was an exception process, even though I said several times there was not and read notes from medical services board meetings and from other meetings with your department and with folks in your department. So basically, we agreed to 84 hours and then to drop down after a six-month period because there was supposed to be an exception process or an exception already in place, not a process to be developed by July 1. So there's still a lot of repairing that needs to be done, and there's a lot of frustration. So I'm going to need to know a lot of things, and I hope your department's prepared for it, because the reason we're having this Medicaid commission is because of, one, the lack of data that we receive from your department. The data that we do receive changes pretty much on a monthly basis, and we don't know if it's accurate or not. Those are three things just about the data. With regard to the air rate, I want to know where we're at specifically on a plan in place to get our air rate down and what that means. And with regard to the counties, it's not about talking at them. It's actually working with them, which actually has not really been happening that well over the last at least four or five years Well, I could probably go back 30 years quite frankly With your department, but and then this whole regionalization Centralization idea that came out of nowhere last year that counties had no idea about until we saw the governor's budget request I hope that's not happening this year There's a lot of problems with this department not getting us accurate information That we can trust Period. So there's a lot of repair that needs to happen. There's, as you can see by the questions I was asking, the reason we have this Medicaid commission, one, tried to get the department to pull down additional federal dollars with regard to the provider rate. And basically, we kept getting it pushed off to the point where we never got it. We're talking hundreds of millions of dollars. That's ridiculous. So I'd like to know what we're doing to make sure that we are pulling down all of the federal dollars that we possibly can right now.

Senator Mullica.

Ms. Hammer. Thank you, Madam Chair. Thank you. Senator Kirkmeyer. So the federal dollars issue, the state-directed payment was recently approved, and so that has been secured by the state. The non-emergency medical transportation change from administrative to a benefit is in process.

Thank you, ma'am chair. I know we're short on time. And look I think there a lot of work to do in your department I agree with a lot of what Senator Kirkmeyer has said and we had those conversations offline I do want to say something though Director Hammer because I think that in my eight years serving down here I never heard before And for you to say that you messed up, what you did was wrong, I think that speaks volumes for me. I appreciate that. I appreciate you coming to the table with that, willing to say that. And I hope that we continue to be able to be open to that rather than just kind of walking around issues. And so credit to you for being willing to do that in front of us. I think that there's a lot of work to do. I think you're well aware of that. Look forward to working with you on it. But I just wanted to make sure I was on the mic because that was the first time I've ever heard that in a public venue from your department.

I think everybody made that same comment one way or another. Senator Bridges.

Ms. Hammer. Sure. Thank you, Madam Chair. Senator Bridges, the Health Information Office is led by Parrish Steinbrecher, and he and I meet, obviously, multiple times throughout the month. And cybersecurity is his number one concern that he has lifted up to meet. He is significantly concerned about that. It is moving so quickly. So it is on our standing one-on-one agenda is his thinking about how we can continue to mitigate risks related to cybersecurity. Let's see.

Thank you, Madam Chair. Just one more specific area, and you mentioned it. We were approved for the state-directed payments. My understanding is those have to flow through a managed care environment for them to be utilized. And we have basically, I have a managed care program called Prime that has worked very effectively in western Colorado. and the resistance to expand that program, even when the data that was created by the department clearly indicated that there were better satisfaction levels, there were better outcomes, and it had significant cost savings. every time I know I rage raised it why aren't we expanding on this the answer was basically I'm not convinced that this saves money and has a better outcome and now what is it about little less than 400 million dollars that's coming our direction and it has to go that way we're not ready You need to utilize it. That's worrisome to me.

Yes.

Thank you.