In her first act as CMS Administrator, Seema Verma joined HHS Secretary Tom Price in writing to the nation’s Governors to urge collaboration on improving the Medicaid program, with an emphasis on services for “truly vulnerable” populations. Price and Verma contend that the “expansion of Medicaid through the Affordable Care Act (ACA) to non-disabled, working-age adults without dependent children was a clear departure from the core, historical mission of the program.” Thus, they announced their intention to use existing Section 1115 authority to approve state innovations that “build on the human dignity that comes with training, employment and independence.” They also encouraged states to align their Medicaid benefit designs for non-disabled adults with various commercial health insurance policy features (e.g., health savings accounts and premium/contribution requirements) “to help working age, nonpregnant, non-disabled adults prepare for private coverage.” Furthermore, CMS committed to working with states to make the state plan amendment and waiver review processes more transparent and efficient. On the regulatory front, CMS intends “to conduct a full review of managed care regulations in order to prioritize beneficiary outcomes and state priorities” and to give states additional time to comply with a 2014 Home and Community-Based Services (HCBS) rule. Finally, the letter outlines ways HHS is seeking to give states more tools to address the opioid epidemic.