UPDATED November 29, 2016 // President-elect Donald Trump today announced that Seema Verma, MPH, an architect of Medicaid expansion under the Affordable Care Act (ACA) in Indiana, is his choice to head the Centers for Medicare & Medicaid Services (CMS).

As part of Trump's team to repeal and replace the ACA and overhaul Medicaid, Verma is well versed on how to shift healthcare policy decisions from Washington, DC, to state capitals. If confirmed by the Senate, she presumably would answer to Rep. Tom Price, MD (R-Ga), Trump's nominee for secretary of the Department of Health and Human Services (HHS) and a staunch opponent of a large federal footprint in healthcare.

Verma is the founder and president of SVC, a healthcare policy consulting firm in Indianapolis. She's credited with designing the 9-year-old "consumer-directed" Medicaid program called Healthy Indiana Plan (HIP), which gives beneficiaries something similar to a health savings account — it's called a Personal Wellness and Responsibility (POWER) account — to apply toward a $2500 deductible. Verma also helped create HIP 2.0, which expanded Medicaid coverage as part of the ACA using federal dollars.

Launched in 2015 during the watch of Indiana Governor Mike Pence, Trump's vice-president-elect, HIP 2.0 points Medicaid managed care in a more conservative direction by, among other things, requiring beneficiaries to contribute an amount of money to their POWER account each month that's equal to 2% of their income. In return, they receive benefits not available with basic HIP, such as dental and visual coverage.

"Because [HIP 2.0] members' own dollars are at stake, they have 'skin in the game' and therefore an incentive to make cost-conscious healthcare decisions," Verma wrote in a blog on Health Affairs in August. If they fall behind on their payments, however, they lose their extra benefits and become subject to copays for services.

HIP 2.0 also increased Medicaid reimbursement rates for physicians to 75% of the Medicare fee schedule.

Indiana instituted HIP 2.0 by persuading CMS to waive its usual requirements for state Medicaid programs. Other states, with Verma coaching them, have tried to implement similar Medicaid changes through the waiver process. However, the Obama administration has stood in their way, Verma charged in a recent article in The Hill. That opposition looks to evaporate during the Trump administration.

The Medicaid waiver process could become a major vehicle of healthcare reform on the state level, according to Caroline Pearson, senior vice president of policy and strategy at the consulting firm Avalere Health.

"With a willing partner in CMS, Republican governors have a lot of ability to make a lot of changes to Medicaid without [federal] legislation," Pearson told Medscape Medical News. And Verma, said Pearson, is a "Medicaid waiver expert."

To be sure, federal legislation to overhaul Medicaid is likely. Trump and Congressional Republicans favor turning open-ended federal funding of state Medicaid programs into block grants, which supposedly would give states more latitude in how to spend the money. Pearson said block grants are compatible with the kind of Medicaid flexibility that states have sought through waivers.

As CMS administrator, Verma would have far more on her plate than Medicaid. There happens to be a massive Medicare program to run. Medicare hasn't been Verma's core focus, but she's up to the challenge, Pearson said. "She can bring in a leadership team that's strong on Medicare."

Good Reviews of Verma's Handiwork From Indiana Physicians

Verma will take over at CMS next year apparently enjoying goodwill with physicians, or at least with some in Indiana.

Stephen Tharp, MD, a past president of the Indiana State Medical Association (ISMA) and one of its delegates to the American Medical Association (AMA), said he isn't that familiar with Verma, but that her Medicaid handiwork — HIP and HIP 2.0 — is going over well with his colleagues.

"The experience we've had with her product has been pretty good," Dr Tharp, an internist, told Medscape Medical News. HIP 2.0, he said, has given low-income residents more benefits and boosted Medicaid reimbursement, bringing more physicians into the program.

Another indirect testimonial comes from ISMA member and AMA delegate Vidya Kora, MD, also an internist.

"I am happy that HIP 2.0 has given health access to many patients who otherwise would not have had it," Dr Kora is quoted as saying in an article on the ISMA website marking the initiative's one-year anniversary. "The enhanced reimbursement has made a big difference in our clinic and extended our ability to see additional HIP patients.

"I congratulate all the individuals both at the state and the federal level who have worked together to make this a reality."

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