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The waiting room: Getting work done when things slow down

This article is one of a series of policy-focused briefs designed to help state health and human services leaders navigate the new era of federal uncertainty, evolving Medicaid guidance and shifting funding models. Authored by Anna Sever, Conduent’s government healthcare policy expert, each post explores the operational impact of change, and the strategic moves agencies are making to preserve and enhance services to residents.  

In early 2025, the U.S. Department of Health and Human Services (HHS) announced sweeping workforce reductions of between 8,000 and 10,000 positions across the department, with at least 300 reportedly cut from the Centers for Medicare & Medicaid Services (CMS). The reduction has quietly but profoundly altered the pace of Medicaid approvals.

For states and their residents, the consequences are immediate. Amendment requests are piling up. System transitions are stalling. And the machinery of Medicaid modernization is grinding more slowly as it needs to accelerate. 

For those of us who have worked inside or alongside the system, this is a familiar pattern. Federal agencies contract, and the oversight burden shifts downstream right onto state program directors, procurement teams and systems integrators. CMS, already managing the complexity of 50 state Medicaid programs, is now doing so with less staff and greater scrutiny. In a moment where modernization is the mandate, delay has become the default. 

From 90 days to TBD 
Just a few years ago, agencies could plan around a 60-to-90-day window for CMS to review Medicaid State Plan Amendments or contract modifications. That timeline is no longer reliable. Approval timelines for even modest amendments have stretched months.  

In late 2024, CMS confirmed it had received more than 150 applications for state-directed payment programs in just a few months, a significant jump from previous cycles. At the same time, reduced headcount means fewer analysts are available to review and provide feedback on highly technical documents that often exceed hundreds of pages. 
 
Related: In government healthcare, AI is the tool, not the point 
 
Build optionality into every plan 
For agencies navigating this slowdown, resilience is now a strategic imperative. That means thinking beyond procurement timelines and building systems that can flex. Here are three key steps to consider: 

  1. Identify vendors who are already in position 
    Agencies should take a fresh look at their current vendors, especially those operating adjacent to mission-critical systems. If your eligibility vendor has capacity in claims processing, or your data analytics partner supports another program module, they may be your best option in a moment of disruption.
  2. Pre-negotiate fallback scopes and extensions 
    Build optionality into your contracts now, before disruption hits. Include language for emergency scope expansion, phased transitions, or six-month bridge arrangements. These tools can buy time while CMS works through its backlog.
  3. Treat CMS like a partner, not just an approver 
    The earlier you involve CMS, the better. Submit pre-briefs, request technical assistance, and provide clear documentation on cost neutrality and risk mitigation. Transparency helps reduce delays, and builds trust that pays off later. 

What this means for modernization 
This moment should not be interpreted as a reason to pause modernization. Quite the opposite. It is a reminder that systems must be built to endure uncertainty, not just technical debt. Federal slowdowns come and go. The best programs are those that have built-in adaptability, and partners who can deliver under pressure. 

All governments are facing real constraints. State programs are facing real consequences. The contractors that will thrive in this period are those that plan for disruption and act with agility. Whether that means relying on a trusted vendor for a short-term takeover or structuring contracts with resilience in mind, the time to prepare is now. 

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About the Author

Anna Sever serves as President of Government Solutions at Conduent, helping government agencies modernize operations, improve service delivery and lower costs. She brings more than 30 years of leadership experience across federal and state programs, including prior roles as President and CEO of Magellan Federal and executive leadership positions at Maximus. Her expertise spans Medicaid, Medicare, health and human services including mental health and disability services. Anna holds a bachelor’s degree from Davidson College and a master’s degree in social work with a certification in gerontology from the University of South Carolina.

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