Sen. Ron Wyden, the top Democrat on the Senate Finance Committee, is asking for an investigation into whether a top health official in the Trump administration has violated ethical obligations in the handling of Medicaid waivers from states.

In a letter sent to the general counsel of the Department of Health and Human Services, the Oregon Democrat wondered about possible violations by Centers for Medicare and Medicaid Services Administrator Seema Verma in how she handled waivers from states that had worked with her when she held a private consulting business, SVC Inc.

In that role, before joining the Trump administration, she advised states about how to make changes to their Medicaid programs, which cover low-income people and vulnerable populations such as children and people with disabilities. She vowed that as CMS administrator she would recuse herself from working on certain waivers or would seek written permission in cases where she would be involved.

Wyden detailed statements from governors in Arkansas, Kentucky, and Iowa in various news outlets in which they said they spoke to Verma about changes to their healthcare programs. He wrote in his letter that "governors representing multiple states indicate that Administrator Verma has personally and substantially participated in waivers submitted to CMS by states that were clients of her previous consulting business. "

In addition to opening an ethics investigation, Wyden also asked the HHS counsel, Robert Charrow, to describe the steps that his office takes to make sure Verma complies with her ethics agreements and whether she sought exemptions when she spoke to governors in each state.

HHS said in an email to the Washington Examiner that it had received similar inquiries from Wyden before, and that Verma had received limited authorizations for a number of states.

"Under that Limited Authorization, she must recuse from personal and substantial participation on the Medicaid ... waivers for newly eligible adults in Indiana and Kentucky as well as the managed care waiver for Iowa. This Limited Authorization was sent to the Office of Government Ethics on May 31, 2017, and made publicly available on the OGE website June 7, 2017," an HHS spokesperson said. “The administrator does not have a recusal obligation with regard to her former state clients under the Trump Ethics Pledge, so no Pledge waiver was needed. This was also explained in the July 27, 2017, response to Sen. Wyden."

One of the most recent waivers accepted by CMS was in Kentucky, which would allow the state to set work, education, or volunteer requirements for Medicaid enrollees. Verma helped write the initial waiver in her former job as a private consultant, but said she had recused herself from its review and from authorizing it. Democrats object to the work requirements, saying that they will result in reduced Medicaid enrollment.

"Administrator Verma's commitment to recuse herself from work with former clients appears to have fallen short of the mark thus far, which is extremely concerning given that many of her former clients have sought, or plan to seek, waivers to impose unprecedented work requirements in state Medicaid programs," Wyden wrote.

Arkansas is also seeking work and other community involvement requirements, and Iowa had asked for flexibility on implementing Obamacare. Verma had also provided consulting in Arkansas, Indiana, Iowa, Kentucky, Ohio, South Carolina, and Virginia, according to the letter.

HHS said that it received Wyden's most recent letter and was "in the process of reviewing its concerns."

Editor's note: This story has been updated with a response from the Department of Health and Human Services.