For many years, government reports have said spending on entitlement programs, such as Medicaid, are unsustainable. The Centers for Medicare and Medicaid Services actuary projects that by 2023, annual Medicaid expenditures will total $850.1 billion, of which $521.8 billion will be federal expenditures and $328.3 will be covered by the states.

On Nov. 7, 2017, CMS Administrator Seema Verma spoke before the National Association of Medicaid Directors and announced steps the Trump administration was taking to modernize and improve the Medicaid program through Section 1115 Demonstration Waivers. Administrator Verma pointed out that in 1985, Medicaid only consumed 10 percent of states’ budgets; by 2016, it increased to 29 percent. She also said, “One of the things that states have told us time and time again is that they want more flexibility to engage their working-age, able-bodied citizens on Medicaid. They want to develop programs that will help them break the chains of poverty and live up to their fullest potential. We support this.”