The Centers for Medicare and Medicaid Services (CMS) has made state flexibility and reform a cornerstone of its approach to dealing with problems created or exacerbated by Obamacare. In 2017, the Department of Health and Human Services sent two letters to governors highlighting the agency's desire to work with states on innovative solutions to address access, affordability, and quality. CMS has followed through by rolling out a series of state-based reform initiatives.
