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Former DHS director published unauthorized report on global waiver

January 20, 2011

Ever wonder what happened to Gary Alexander, the former head of the Department of Human Services and the former secretary for the Rhode Island Executive Office of Health and Human Services?

Alexander is perhaps best known for ushering in the state’s “Global Medicaid Waiver” – a controversial move to exchange capped matching funds from the federal government for more flexibility in how that money is spent.

The waiver hasn’t saved as much money as Alexander claimed it would (Governor Carcieri estimated that the change would save the state around sixty nine million dollar in 2009. The real number was about 16 million) but it also hasn’t created as much havoc as its critics feared.

Since then,  Alexander has landed in Pennsylvania as the newly appointed Secretary of the Department of Welfare.

Around the time of his appointment, Alexander also left his mark at The Galen Institute, a free-market think tank strongly opposed to what it calls “Obamacare”.  At Galen’s website is a report by Alexander on his implementation of the global waiver.  He claims the waiver was wildly successful. In fact, Alexander says it saved the state $110 million dollars in 18 months.

The last time I had hard numbers on the waiver it was early 2010 (about a year after the waiver was approved) and the savings totaled about 16 million with an additional 15 million expected by June of 2010.  Steven Costantino, who was at the time the head of the House Finance Committee and now has Alexander’s job, chided Alexander for not saving as much as he predicted.

… we need real budgets.  This is a budget exercise and it’s a matter of knowing what the real numbers are. And not just putting in a number.  How do I know that this won’t happen again?

Elena Nicolella- the director of RI’s Medicaid program- says there’s very little in Alexander’s report that’s accurate.  In fact, it was published without the permission of the Department of Human Services, even though the state seal appears on every page of the report.  Nicolella says RI asked The Galen Institute to take that seal off, but it hasn’t and she’s considering a call to the state’s attorneys.

Nicolella says she needs to check on the actual waiver savings and she’ll get back to me on the official number.

Alexander is still listed in The Galen Institute report as the Secretary of Health and Human Services for Rhode Island, even though his writings were posted  the day after he was nominated for his new post in Pennsylvania.  Perhaps that’s why Alexander lists not a government email address for his contact information, but an address at

Update: Alexander also calls himself RI’s Secretary of Health and Human Services in this similar article for Health Reform Report published on January 10th, 2011.  He’s described as a columnist for the site, which also includes writings by Newt Gingrich and Texas Governor Rick Perry.  At the bottom of the site, in faint letters, it says that Health Reform Report is sponsored by the Center for Health Care Transformation, a consultant group/think tank founded by Gingrich.

Update: Governor Lincoln Chafee’s office declined to comment on Gary Alexander’s report.

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