state.

HHS said in an email to the Washington Examiner that it had received similar inquiries from Wyden before, and that Verma had received limited authorizations for a number of states.

"Under that Limited Authorization, she must recuse from personal and substantial participation on the Medicaid ... waivers for newly eligible adults in Indiana and Kentucky as well as the managed care waiver for Iowa. This Limited Authorization was sent to the Office of Government Ethics on May 31, 2017, and made publicly available on the OGE website June 7, 2017," an HHS spokesperson said. “The administrator does not have a recusal obligation with regard to her former state clients under the Trump Ethics Pledge, so no Pledge waiver was needed. This was also explained in the July 27, 2017,involvement requirements, and Iowa had asked for flexibility on implementing Obamacare. Verma had also provided consulting in Arkansas, Indiana, Iowa, Kentucky, Ohio, South Carolina, and Virginia, according to the letter.

HHS said that it received Wyden's most recent letter and was "in the process of reviewing its concerns."

Editor's note: This story has been updated with a response from the Department of Health and Human Services.