ATLANTA (AP) -- Following Gov. Nathan Deal's lead, Georgia's community health commissioner says the agency is holding off on a wholesale overhaul of the state's Medicaid program because of uncertainty at the federal level.

Commissioner David Cook cites the presidential election in November and Congress' ongoing attempts to address the law as factors that could affect how states deal with Medicaid. He says the recent Supreme Court decision upholding much of the federal health care law raises more questions about how the program will operate.

Cook says the agency is moving forward on initiatives including streamlining the administrative process and improving accountability and efficiency in the system.

The Supreme Court ruling gave states the option of accepting or rejecting the expansion of Medicaid for their low-income residents under the health care overhaul law.