Medicaid is in need of reforms to strengthen the way it’s administered between the federal and state governments, Centers for Medicare & Medicaid Services Administrator Seema Verma said on Tuesday.

Speaking during an interview with USA Today Verma said Medicaid is in need of updates, including reforms to better account for short-term, low-income beneficiaries and improve the way state governments work with federal officials to makes changes to the program.

“One of the major problems is the relationship between the federal government and the state government,” Verma said. “It’s supposed to be a jointly funded program, and yet all of the decision-making is in Washington.”

Verma also said President Trump’s recent proposed budget cuts to the program tie in with per-capita caps, since states would be paid according to “a trend rate that is more comparable to what we see in the private market.”

“I think that’s something that folks aren’t talking about right now. There is such an opportunity here,” Verma said. “If we move to a system where the budget is set, then we can actually move away to talking about improving health outcomes.”

Verma also dismissed the Congressional Budget Office’s cost estimate for the House’s healthcare proposal, noting “CBO numbers have historically been problematic” and that her focus has turned to the Senate’s version of the legislation. The CBO report estimated the bill could cut Medicaid funding by $834 billion over ten years, and leave 23 million people without health coverage by 2026.

“I’ve been working with a lot of the senators. We want to make sure that the president’s core principles are incorporated into the final version,” Verma said. “I think what’s more important is what the Senate comes up with. Really, the House version is something that’s outdated at this point.”