State policymakers are responding to an unprecedented set of very complex policy changes that can shift quickly including Medicaid expansion and options, insurance standards and exchanges, public health changes and more. These policies represent a significant piece of state budgets, must engage many stakeholders, and are central to the health and quality of state residents. Policymakers must translate these opportunities and challenges in ways that fit the unique features of their state. Many of these policies require state implementation and operation; all of them require state attention. A new study for the Milbank Memorial Fund assesses how state policymakers have made decisions and implemented policies in the new environment, what resources they relied on, and what is still needed. There is a lot of important information in the report including the central role of trust among public officials, the importance of staff policy capacity, federal resources (but not necessarily federal technical assistance), and sharing lessons learned among states. States also outlined policy capacity needs including policy skill building for state staff, implementation skill capacity, and data access, analysis and management. The authors conclude with a capacity checklist of what policymakers need to succeed.
A subsequent brief dives deeper into the experience of state policymakers in creating state-based insurance exchanges.