The Senate voted 55-43 on Monday to confirm Seema Verma as the next administrator for the CMS, an agency that spends around $1 trillion annually.
Verma is believed to have more Medicaid experience than any other administrator in the agency's history, having helped craft expansion plans in Indiana, Iowa, Kentucky and Ohio.
Verma, and Brian Neale, the newly selected director of the Center for Medicaid and CHIP Services, are expected to push Medicaid in a more conservative direction in which states could apply for and receive waivers to impose work search requirements and lifetime caps on Medicaid enrollment. The Obama administration refused to implement such proposals.
“She is a reformer with a proven record of success,” Senate Majority Leader Mitch McConnell (R-Ky.) said in floor remarks on Thursday.
From Indiana alone, Verma's Indianapolis-based firm SVC collected more than $6.6 million in consulting fees. The firm helped the state expand Medicaid in a format that requires beneficiaries to pay premium contributions, retain health savings accounts and face a benefit lockout if they don't pay premiums.
Indiana has asked the CMS to extend the program for another three years. That application has become more controversial following reports that the state made the program appear that it performed better than it did.
Democrats have opposed Verma's nomination because she was too vague on where she stood on specific policies such as drug pricing and lacked any formal Medicare experience. They also took issue with her support for requiring Medicaid enrollees to pay premiums as a condition for coverage.
“She has said that the poorest Americans need to have 'skin in the game' and pay more for their healthcare—a popular policy among Republicans,” Sen. Dianne Feinstein (D-Calif.) said on Thursday. “I can assure her that the poorest people in our society already have 'skin in the game.' ”