Alexander OK'd as head of R.I. health, human services
4:44 PM Tue, Jun 09, 2009 | Permalink
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PROVIDENCE, R.I. - Amid unanswered questions about how much he relied on Medicaid reforms conceived and sold to federal officials by a failed GOP congressional candidate in New Hampshire who is also a friend, Rhode Island's acting chief of health and human services Gary Alexander won Senate confirmation Tuesday to the $135,661 job he has held on an interim basis since February. The Senate's vote on Tuesday afternoon was unanimous. As chief of the Executive Office of Health and Human Services, Alexander oversees a network of state agencies that provide cash benefits and services to over 300,000 Rhode Islanders, including the Departments of Human Services; Mental Health, Retardation and Hospitals; Elderly Affairs and Children, Youth and Families. An ordained deacon in the Saints Sahag and Mesrob, Armenian Orthodox Church of Providence, with a 2002 law degree from Suffolk University, Alexander, 40, will continue in his dual role as DHS director, in what a spokeswoman for Governor Carcieri described as a cost-saving measure. In leaving Alexander in charge of the day-to-day operations of the massive, $1.8-billion human service agency, spokeswoman Amy Kempe said the governor also hopes "streamline operations across agencies'' and "provide citizens with seamless services across populations.'' Alexander began his state government career in 1997 as a $39,240 project manager in the office of former Republican Lt. Gov. Bernard Jackvony. A year later, he began his rise up the ranks of the Department of Human Services. When the Republican Carcieri nominated Alexander in February to replace Adelita Orefice as health and human services secretary, he cited his role in helping Rhode Island win a Global Medicaid Waiver that gives the state unprecedented freedom in how it spends its federal Medicaid dollars, in exchange for agreeing to a five-year, $12.1 billion spending cap. The waiver is aimed at saving the state $67 million this year alone by steering the elderly away from nursing homes to "community-based'' settings, redefining who is sick enough for certain services and creating "selected" treatment networks for the people enrolled in this state- and federal-financed medical coverage program for the elderly and poor. Carcieri has hailed the waiver, granted during the final days of the Bush administration, as a major win for Rhode Island and given Alexander credit for it. "With the establishment of the Rhode Island Global Consumer Choice Waiver Compact, Gary Alexander has distinguished himself as both an architect of and proponent for lasting reforms that make government more responsive, accountable and cost-effective," he said the day he nominated him to head the EOHHS. But Alexander's nomination was put on hold by the Democrat-controlled state Senate in late May in the wake of recently disclosed information about the state's reliance on one and then another company affiliated with John Stephen, a former health and human services commissioner in New Hampshire who mounted an unsuccessful Republican primary campaign for a congressional seat in 2008, with Alexander campaigning with him at one point, and hosting a fundraiser for him. A Manchester Union Leader editorial said: "John Stephen offers Republicans the chance to send a true fiscal conservative to Washington.'' When Stephen's name first surfaced, along with that of The Lucas Group, a Boston-based consulting company, Kempe said the company was working on the state's Global Medicaid Waiver negotiations with federal officials on a "voluntary basis. ... We are not engaged with Lucas. There's no contract. ... It's strictly voluntarily offering advice and guidance." Stephen is a partner in the company. On its own Web site, however, The Lucas Group takes credit for having "originated" and "constructed" and then "led" the negotiations with federal officials that resulted in Rhode Island's winning the far-reaching Medicaid waiver. While his confirmation was postponed once, it went ahead on Tuesday despite statements of concern by some senators, including Sen. Joshua Miller, D-Cranston, who said Monday that "it is troubling that Lucas Group seems to be taking credit for something that the administration [in response] to all inquiries stated that Lucas Group hasn't been paid for doing." "I am less troubled by a consulting firm trying to sell its wares than I am ... an administration not being forthcoming ... about how much work was outsourced," said Miller, adding that he believes Alexander "has been honest" about the extent of his knowledge. Alexander did not respond to queries about the company's description of its role in winning the waiver and then crafting a public-relations plan for selling it to "differing audiences," including state lawmakers. The Lucas Group has not been paid, according to the state controller's office. But Alexander for weeks has declined to answer whether the Lucas Group or John Stephen requested payment for their roles in winning the Medicaid waiver. Alexander referred the question to Carcieri spokeswoman Kempe, who also did not provide an answer. While billed as a major cost-saving measure, the waiver is also being watched with concern by advocates for the poor and elderly nationwide for reasons Rhode Island's congressional delegation stated in a letter to the governor last winter. Warning of the potential for massive budget deficits and "unprecedented cuts" to health-care programs for elderly, poor and disabled Rhode Islanders, they wrote: "There are no protections to ensure that essential benefits are available to those for whom they are medically necessary, and the specific changes that the state will seek remain unknown." 
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