By Cory Gaines | Commentary, Colorado Accountability Project
Meet the Medicaid Commission and their newly-hired advisor.
Medicaid is a big line item in the state’s budget. It’s gotten so big, and eaten up so much of our state’s money, that our legislature has gathered up a commission.
SB26-187 (linked first below) creates a (quoting from the bill summary): “… commission on Medicaid (commission) to develop recommendations regarding implementation of new federal Medicaid policy changes that go into effect in 2026, 2027, and 2028 and to support Coloradans impacted by those policy changes.”
This commission will meet a few times and prepare a report to be used by the legislature in the 2027 session. Quoting from the bill’s fiscal note: “Between May 13, 2026, and December 11, 2026, the commission must meet between six and twelve times to engage and collaborate with representatives of state agencies, community-based Medicaid specialists, national experts, Medicaid members, health care providers, and other stakeholders.”
The commission, the ultimate decider on any work product or recommendations to be forwarded along, is made up entirely of legislators. If you’d like to see who’s on the committee, the image heading this post is them. It’s taken from the committee’s webpage linked second below.
There’s one more important group to mention. Returning again to SB26-187’s fiscal note: “The Director of Research for the Legislative Council must identify and contract with a technical advisor to facilitate the commission and write the report, with further support from the Legislative Council Staff.”
As with many things, I got curious to know about who the advisor was and what their bid/contract would look like. I reached out to Legislative Council Staff to ask. The third link below comes from them.
The first few pages are the Staff’s request for proposals (the equivalent of a call for bids in construction) listing out the qualifications and scope of the work. Page 9 and beyond is the (eventually-winning) proposal by SHG advisors. For convenience’s sake, I put a link to SHG’s page fourth below.
As mentioned above, the legislators on the commission are the deciders here, and they seemed to like what SHG was selling.** As you’ll find out if you listen to the committee audio, linked 5th below, the vote for SHG was unanimous (see at about the 4:22:48 mark) following lengthy questioning of both groups which submitted proposals.
I’ll leave it to you to paw through the materials if you would like to learn more. An overview is worth the time to discuss, however.
There are a few seemingly disparate things that, when put next to each other, give me a sense of what we can expect from this commission. It starts with noting who got picked to be an advisor and what’s expected of them. Screenshot 1 attached has an image taken from the text of the law (labeled “law”) as well as text from the Legislative Council Staff’s request for proposals (labeled “RFP”) regarding what the technical advisor needs to do and their qualifications.
It’s a broad categorization, but if you look at SHG’s site, it strikes me as one of the thousands of public policy groups I see hovering around the state government like flies hovering around cattle.
Reading through the bill, you see what the committee is to review and analyze. For the following, I lean on pictures taken from relevant bits of the bill’s language (see screenshots 2a and 2b).
Words have meanings. As I’ve noted before, look carefully at the language and note the word choices. You’ll see a “shared understanding” of the Big Beautiful Bill. You’ll see language that carefully avoids mention of the state government’s role in Medicaid’s cost, while at the same time asking for an examination of administrative structures, frictions, efficiencies, value (notably NOT cost), and efficacy.
Note also what is missing. You can search the entirety of both the bill itself and the request for proposals and not find a bare hint of the words fraud, waste, or abuse.
Note who gets the podium, whose views are sought, and whose aren’t. Repeating an excerpt from my quote above, the committee is to “…engage and collaborate with representatives of state agencies, community-based Medicaid specialists, national experts, Medicaid members, health care providers, and other stakeholders.” As with fraud, waste, and abuse, there is no explicit mention of taxpayers or groups representing them.
Lastly, note the makeup of the commission. It’s a committee made of 7 Democrats and only 3 Republicans.
This all adds to give the strong impression, informed by similar past efforts, that what we’ll get for our money (yes, we’re paying for this) is a mild exploration chock full of the usual governmentese.
I have the feeling we, the we that foot the bill, will not get a reckoning, a deep and searing look at one of the biggest line items in our budget.
It is wise to have an advisor that knows the system they’ll write about and has experience with same. It is wise to bring in the government entities and others who regularly intersect with this system.
It is also wise, if a full look is desired, to bring in people OUTSIDE the system. Their perspective has value too.
It is wise to look at federal law, it is wise to look at administration of the state system with an eye on friction and efficiency.
But politics being what they are, how much of this will be a blame game about Trump? How much of it will be shielding the Department of Health Care Policy and Financing (the state dept that administers Medicaid) from genuine accountability? You know, the kind where people lose their jobs.
Will we look at Colorado’s part to play in this little drama? Will there be any look at fraud, waste, and abuse? We know it’s there. The sixth link below is to the most recent example: the Attorney General, in a rare show of suing someone besides Trump, has charged two men out of JeffCo with $12 million in Medicaid vision fraud.
As above, I’d feel like a look at Colorado’s role along with a full accounting of, waste, and abuse would be a lot more likely if there were actual language requiring it in the law, if people from outside the government involved, and if there was a sizeable number of the opposition party on the committee.
I’ll end here.
However this process proceeds, and also whether or not you and I agree on everything about Medicaid, it struck me as important that we, the often-unrecognized, ultimate stakeholders in this, should have a voice.
Sharing this overlooked committee and what they’re up to is part of that, but it’s not the whole. I reached out to both the committee admins and SHG to ask about how regular citizens can participate.
As of this writing, I have not heard back, but when I do, I’ll update.
In the meantime, remember that the second link below is to the committee. They are the deciders about the report and the recommendations. They are all also elected. Contact any and all with your thoughts.
**SHG was one of two. If you’d like to see the other proposal that didn’t make the cut, see “Related” below.
https://leg.colorado.gov/bills/SB26-187
https://leg.colorado.gov/committees/2026A/interim/CommissiononMedicaid
https://drive.google.com/file/d/1BbhqvMdhjYvl6TjX1HUohgmyNxvYTk3d/view?usp=sharing
https://sg001-harmony.sliq.net/00327/Harmony/en/PowerBrowser/PowerBrowserV2/20260617/-1/18899
Related:
Evidence Based Policy?
The term evidence based policy is a hot one these last couple years or so. Perhaps it’s my faulty perception, but I want to say that the term has risen along with “follow the science”, at least in policy circles.**
A quintessential example of how this looks in practice can be found in the first link below. I came across this group backtracking from a press release article about them. The press release was about how this think tank was getting the name Romer (from a former Colorado governor). The first link below is to that think tank, the Romer Institute of Evidence-based Policy
To get a sense of the oft-lofty rhetoric behind such efforts, I attached the overview from their site as screenshot 1. If you are curious for more scroll down the page a little to see other common themes from this type of effort.
I want to talk about evidence-based policy more broadly, so I’ll move on from Romer.
I like the idea of evidence-based policy, but I think there are a couple things worth noting about it, a couple things that (while not necessarily negating it) bring the effort down a peg or two from how its sold.
The first is this: human beings hear what they want to hear. We can talk all day about how policymakers need to get timely, accurate, nonpartisan data. Putting aside any cynical motives on their part, politicians still need to encode that data and decide on it. And it is that very encoding that is faulty.
Our minds, unless we’re careful, weight evidence differently according to our beliefs. We don’t even have to consciously try. It’s baked in.
READ THE FULL COMMENTARY AT COLORADO ACCOUNTABILITY PROJECT
Editor’s note: Opinions expressed in commentary pieces are those of the author and do not necessarily reflect the opinions of the management of the Rocky Mountain Voice, but even so we support the constitutional right of the author to express those opinions.