Medicaid directors also want to see improvements to ease the burden of regulations on managed care and home and community-based services, as wells as efforts to tackle drug costs within Medicaid and apply value-based purchasing principles — though those might be harder to achieve due to the powerful pharmaceutical lobby, he says.

State Medicaid programs are also pushing for Congress to streamline the Medicaid waiver approval process, Salo adds, a concept the Trump administration has backed but requires Congressional approval. 

Rep. Brett Guthrie (R-Ky.), vice chairman of the House Energy and Commerce Health Subcommittee, writes in Morning Consult that he supports streamlining the state waiver process. 

"Part of the problem is the 'Mother, may I?' mentality within CMS that forces states to repeatedly ask permission for even the most banal and routine changes to Medicaid programs," Guthrie writes. 

He contends that this mindset is likely due in large part to the fact that few of the nearly 400 staff at the Centers for Medicaid and CHIP Services have previously worked for a state Medicaid program, a health care provider — which he believes severely restricts their ability to make informed decisions.

"This is an area of Medicaid policy that holds bipartisan promise, and I look forward to working together to adopt commonsense reforms to make the waiver process more efficient, predictable, and fair for states," Guthrie writes.

More can also be done at the federal level to reform Medicaid, two former administrators of the program write in a JAMA post. Gail Wilensky, the administrator under President George Bush, and Andy Slavitt, the administrator under President Barack Obama, outline a number of ideas on how Medicaid can be improved, starting with a year-long bipartisan Congressional review process that focuses on long-term reforms to improve care and reduce costs in the non-group market.

The former administrators' other policy recommendations include making Medicaid a more outcomes-based program; improving Medicaid financing; ensuring proper access to care; investing in a data, technology, and analytics infrastructure; coordinating programs for dual-eligible beneficiaries (who qualify for both Medicaid and Medicare) and other populations; and reducing administrative burden on states and allowing for more rapid innovation.

"We believe the reforms laid out herein could receive bipartisan support," the two write. "The Medicaid review we have proposed should focus on how to modernize Medicaid in substantive ways that get at the cost drivers, capitalize on innovations in the private sector, and allow states the flexibility to innovate within safeguards that protect beneficiaries and taxpayers.

"We believe these changes will allow Medicaid to continue to meet new challenges and act as a potential vehicle to expand coverage if states choose to go that direction," they add.