Health and Human Services (HHS) Secretary Alex Azar revealed Thursday that his department is in talks with states about instituting block grants in Medicaid without congressional approval.

“We have discussions with states where they will come in and suggest ideas,” Azar said at a Senate hearing in response to questions from Sen. Bob CaseyJr. (D-Pa.). “There may be states that have asked about block granting, per capita, restructurings around especially expansion populations … It’s at their instigation.”