Individual states are on the frontline for implementing the recently passed Patient Protection and Affordable Care Act. A few of the first pieces of that landmark legislation include the implementation of high-risk pools, cuts in Medicare provider reimbursements and new populations moving into state Medicaid programs. Against this shifting backdrop, Washington state is preparing an RFP for its Medicaid plan that could double enrollment to 1.4 million because of the reforms. The RFP may or may not pit some national MCOs against relatively entrenched local players. Oregon may have a headstart on exchanges that will be mandated by 2014 as it rolls out a five-company exchange of insurers focused on children and awaits a report in the fall examining the possibility of beginning an exchange for adults. Molina Healthcare of Washington and Compass Health are pioneering a clinic in Everett to coordinate medical care with Compass’s mental health patients, a population whose physical needs are frequently overlooked. State employees in Washington improved their health status, mostly through lifestyle changes such as exercise and diet.