No easy answer for states' Medicaid woes, Berwick says

"Please know that I understand fully the impacts of this rollback and it is with a heavy heart that I make this request," Brewer wrote to Health and Human Services Secretary Kathleen SebeliusKathleen SebeliusLeaked email: Podesta pushed Tom Steyer for Obama’s Cabinet Romney: Trump victory 'very possible' Fighting for assisted living facilities MORE. "However, I am left with no other viable alternative."

States that fail to maintain the coverage levels set before the reform law was enacted may lose their Medicaid reimbursement. Earlier this month, 33 governors and governors-elect, including Brewer, asked President Obama and congressional leaders to remove the so-called "maintenance of effort" requirement from the reform law.

Berwick said his agency is crafting a set of wide-ranging possibilities to help states avoid massive cuts to the Medicaid rolls.

"We will use all the leverage we have in the law to reach out to them with dollars and tech support," Berwick said. "We're here to protect beneficiaries and states."