President-elect Donald Trump has picked Seema Verma, a healthcare consultant who has helped shape health policy in Indiana, for a key role in the federal government. Verma will head the Centers for Medicare and Medicaid Services, the part of the Department of Health and Human Services that includes Medicare, Medicaid, and the Children’s Health Insurance Program.

Verma comes to the job with extensive Medicaid experience, having played an important part in designing Indiana's Medicaid expansion under the Affordable Care Act, known as the Healthy Indiana Plan 2.0. Her position may be important as Congress and President Trump make decisions on the status of the Affordable Care Act and Medicaid expansion.

HIP 2.0 went into effect early last year under Governor and Vice President-elect Mike Pence, and was designed to appeal to conservatives. HIP 2.0 asks participants to pay a small monthly contribution to access health insurance, and a missed payment can result in six-month lockout from coverage.

Other Republican-led states such as Iowa, Ohio and Kentucky, have contracted with Verma to submit their own Medicaid expansion proposals that include conservative provisions such as asking recipients to pay for some of their care, and requiring them to work or be looking for work.

Susan Jo Thomas, who heads the Indiana insurance advocacy group Covering Kids and Families, says Verma’s contributions to HIP 2.0 made Medicaid expansion possible in a Republican state. “She understood that in order to get expansion in this state, it’s more about what is palatable, what can get approved,” she says.

Nearly 410,000 people are members of HIP 2.0, according to the latest data from the state.

But HIP 2.0 has its critics. David Machledt, a policy analyst with the National Health Law Program, which advocates for health care for low-income individuals, argues that the lockouts and cost-sharing provisions actually reduce participation in Medicaid. “Early evaluations show that a lot of people don’t understand this plan and don’t understand the incentives in it,” he says — so they don’t get the health care they need.

Nevertheless, Machledt says if Medicaid expansion continues, Verma’s pick to head CMS could mean that proposals similar to Indiana’s may be more likely to be approved.

Joan Alker, with the Georgetown Center for Children and Families, agrees. “It is a good thing that she has experience with Medicaid and it is a positive that Governor Pence worked with Ms. Verma to advance a version of Medicaid expansion,” she says. But Trump’s pick of Congressman Tom Price to head the Department of Health and Human Services worries Alker. Price has advocated severely cutting Medicaid funding, and Alker says that could mean people will lose Medicaid. “This represents potentially a very damaging and fundamental and chaotic restructuring of the Medicaid program.”

In this context, Alker says Medicaid expansion plans similar to Indiana’s are unlikely to move forward. “Remember, the Healthy Indiana Plan has occurred in the context of generous federal funding,” she says. “And I think some of that is on deck to go away."

But Verma may be a smart pick, says Indiana state Rep. Charlie Brown, the ranking Democrat in the state’s public health committee. “She is a smooth operator, and very, very persuasive,” he says. Brown worked in opposition to Verma in crafting the Healthy Indiana Plan, but said she worked effectively across party lines.

“She’s very resourceful and intelligent,” says Brown. “But the question now becomes, ‘What will be her marching orders as they relate to Medicare and Medicaid?’”

Verma’s role in shaping Indiana’s health care policy has had some controversy. According to a 2014 report from the Indianapolis Star, she has received millions of dollars from the state through her work with the Indiana government. She was also paid by Hewlett-Packard, a Medicaid vendor that received more than $500 million in state contracts. Government ethics experts told the Star the arrangement presented a conflict of interest.

Verma did not immediately respond to requests for comment, nor did Pence’s office.

This story was produced by Side Effects Public Media.