- Seema Verma's Plan to Upend the Medicaid Expansion, Without Congress Stat by Casey Ross — With a broad overhaul of Obamacare stalled in Washington, one of President Trump's top health care leaders is drawing the outlines of sweeping changes to Medicaid that could pare enrollments and cut costs without congressional approval. Seema Verma, director of the federal Centers for Medicare and Medicaid Services, is promising to give states an "unprecedented level of flexibility" to design their Medicaid programs as they see fit. In an appearance in Cleveland this week, she pledged to reduce scrutiny of state requests for waivers from federal rules meant to preserve access and quality standards. "We want to get to the point where we are making the whole waiver process easier," Verma said during a discussion at the Cleveland Clinic's annual medical innovation summit. "We're not going to tell the states what their priorities are. They are going to come and tell us what their priorities are."