After getting the ball rolling on moving Medicaid in a more conservative direction Brian Neale, director of the Center for Medicaid and CHIP Services at the CMS said he feels now is the time to step down.
"I have accomplished everything that I've set out to accomplish in this role," Neale said in call with Modern Healthcare. "I have spent 10 years in the public sector and now is the time to step away and determine my next steps."
The departure comes as the CMS is beginning to make strides in incorporating such conservative principles as work requirements into Medicaid.
Neale just signed off on allowing Kentucky to become the first state in the country to make employment, or the search for it, a condition of Medicaid coverage.
Also under Neale's leadership, Mississippi received the first-ever 10-year extension of a Medicaid Section 1115 demonstration waiver, allowing the state to continue providing family planning services for people with income of up to 194% of the federal poverty level.
In a staff memo sent to Modern Healthcare Tuesday, Verma announced that Neale would be leaving the agency in February to pursue other endeavors.
Neale's "leadership from the start has made all of our accomplishments possible," Verma said in an email. "We could never have advanced our Medicaid reforms without his leadership and dedication."
Industry insiders who work with both the CMS and states said the sudden departure surprised agency staffers. At issue was some sort of disagreement between Verma and Neale that erupted in the past few days.
One source said workload may have also played a factor in Neale's decision to exit.
Neale denied both of these assertions, as well as the sentiment that his exit was sudden. However, he did not reveal how long he had been planning to leave and he declined to comment as to whether his next steps would consist of another government post.
Over 25 waivers received approval actions over the past year, and Neale has already completed a lot of the legwork necessary to ensure that CMS exceeds that total in 2018, Verma said in the staff email.
Sources say Calder Lynch, who quit his job last year as Nebraska's Medicaid director to become a senior counselor to Verma, is a likely Neale replacement.
In addition to his role in Nebraska, Lynch served as chief of staff to Louisiana's health secretary from 2015 to 2017.
Prior to joining the CMS, Neale was executive director at the United States Congress Joint Economic Committee and served as healthcare policy director for Vice President Mike Pence when he was Indiana governor. He worked with both Verma and Pence to create the Healthy Indiana Plan, the state's Medicaid expansion plan also known as known as HIP 2.0.